Summary: Mrs B complains the Council did not properly explain the financial implications of her husband, Mr B, moving into a care home. Mrs B says the Council suggested it would provide financial help but then wrongly said she had decided to self-fund. The Ombudsman finds the Council at fault for not completing a full needs assessment and financial assessment. We also find fault in how the Council communicated its position for temporary care home placements.

The complaint

1. The complainant, who I refer to as Mrs B, complains the Council did not provide adequate information about her husband’s care choices and the financial consequences on discharge from hospital. Mrs B says the Council suggested it would provide financial support. However, it then said she told the Council she was self-funding. Mrs B says she did not ever say she was self-funding and always expected to receive support from the Council.

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The Ombudsman’s role and powers

2. We investigate complaints about ‘maladministration’ and ‘service failure’. In this statement, I have used the word fault to refer to these. We must also consider whether any fault has had an adverse impact on the person making the complaint. I refer to this as ‘injustice’. If there has been fault which has caused an injustice, we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
3. If we are satisfied with a council’s actions or proposed actions, we can complete our investigation and issue a decision statement. (Local Government Act 1974, section 30(1B) and 34H(i), as amended)

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How I considered this complaint

4. I considered the information provided and spoke to Mrs B about her complaint. I then made enquiries of the Council. I sent a copy of my draft decision to Mrs B and the Council for their comments.

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What I found

Legislation and Guidance

5. Sections 9 and 10 of the Care Act 2014 require local authorities to carry out an assessment for any adult with an appearance of need for care and support. They must provide an assessment to all people regardless of their finances or whether the local authority thinks an individual has eligible needs.
6. The charging rules for residential and non-residential care are set out in the Care and Support (Charging and Assessment of Resources) Regulations 2014 (“the Regulations”), and the Care and Support Statutory Guidance 2014 (“the Guidance”). When the Council arranges a care home placement, it has to follow these rules when undertaking a financial assessment to decide how much a person has to pay towards the costs of their residential care.
7. The rules state that people who have over the upper capital limit are expected to pay for the full cost of their residential care home fees. However, once their capital has reduced to less than the upper capital limit, they only have to pay an assessed contribution towards their fees.
8. The council must assess the means of people who have less than the upper capital limit, to decide how much they can contribute towards the cost of the care home fees.
9. The Guidance says councils should ensure they provide enough information and advice to ensure the individual or their representatives understand any contributions they are asked to make. Our Focus Report “Counting the cost of care: the council’s role in informing public choices about care homes” (September 2015) says councils need to provide information in writing at the earliest opportunity so that people can make informed choices about the choice of care home, including the costs and how to meet them.
10. A temporary resident is someone admitted to a care or nursing home where the agreed plan is for it to last for a limited period, such as respite care, or there is doubt that permanent admission is required. The Council can either charge the person under the rules for temporary residential charging or treat the person as if they are still living in the community (i.e. the non-residential rules for charging).
11. If the person is treated as a temporary resident of a care home, the Council must disregard any housing associated costs, such as mortgage, ground rent service charges, water rates or insurance premiums. It must leave the person with a personal allowance of at least £24.90 per week. If it treats the person as living at home, it will need to leave that person a minimum income guarantee. In the case someone in a couple, who has attained pension credit age, the minimum income guarantee is £141.55.

Background

12. In October 2018 Mr B had a fall. He was admitted to hospital with a broken hip. The Hospital discharged Mr B in November 2018 and referred him to the Council for a needs assessment. A social worker from the Council visited Mr B in hospital. Mrs B was present at the assessment.
13. The social worker’s case notes record that she told Mrs B ‘all social care is chargeable from day one’. She explained the financial criteria and gave financial forms to Mrs B, including a leaflet on charging and a financial assessment form.
14. The case note shows the social worker recorded Mr B’s difficulties with mobility, personal care, nutrition and other care needs. It records Mrs B’s views in each of these areas. It says Mrs B said she would like Mr B to return home and this had always been his past wish. However, she did not feel able to meet his needs currently. She asked the social worker to consider an interim placement.
15. The social worker recorded that she explained the options for an interim placement and for contracting a care home. Mrs B then said she could not make the decision alone and would like to talk it over with her family.
16. The social worker recorded that she would visit again the following day to confirm Mrs B’s wishes. However, later that day Mr and Mrs B’s daughter, Mrs Y, telephoned to say she had asked for a case conference with various professionals. Mrs Y wanted Mr B to be considered for residential rehabilitation.
17. The case notes contain a brief record of the case conference. The social worker has also given a written account. The notes say the rehabilitation team told the family that Mr B was not suitable for residential rehabilitation. The social worker therefore discussed the social care options with the family again. The family said they wished to think over the matter.
18. The social worker says that around an hour later, Mrs Y telephoned her and said the family did not want to pursue a social care placement and would instead find a ‘self-funding’ placement. She made a record of this in the case notes. The Council says both Mrs B and Mrs Y have power of attorney for financial affairs.
19. The social worker’s case note records that Mrs Y said their preferred homes did not have any vacancies. She asked which homes the Council contracted with, as they would not wish to move Mr B when his private funds ran out. The social worker emailed a list of homes to Mrs Y. The family privately arranged a placement with one of the care homes and the hospital discharged Mr B to the Home within two days.
20. Two days later, the social worker recorded another entry on the case notes. It said someone from finance telephoned her to say Mrs B had asked questions about submitting the financial assessment form. The social worker told the officer the family had indicated they were arranging the care privately. The finance officer said the initial information suggested the family were below the capital threshold. The officer said she would wait for the financial form from Mrs B to make a decision.
21. Mrs B sent her financial assessment form into the Council. There is no evidence the finance team followed up on this. It did not complete a financial assessment or contact Mrs B about the form.
22. Mr B stayed in the care home for six weeks before returning home. Mrs B paid the full cost of the placement. She says that, during the six weeks, she was expecting to hear back from the Council with their contribution to the care home fees. Mrs B says she did not at any point say Mr B was self-funding and always expected the Council to contribute. She says the Council did not give her enough information at the outset about the financial implications of Mr B going into a care home.
23. The Council says it did provide information about financial matters. It says it has now reviewed the financial assessment form Mrs B submitted and the figures show it would not have contributed to Mr B’s care home fees in any case. This is because, having calculated Mr B’s income, his assessed contribution would have been higher than the Council’s standard contract rate for care homes.

Findings

24. I find the Council at fault for not completing a full needs assessment and financial assessment.
25. The initial assessment of Mr B was person centred in that it involved both Mr B and Mrs B as his main carer. It is clear the social worker recorded Mrs B’s views and provided her with information about the financial implications of Mr B going into a care home. However, the assessment does not record the social worker’s views. It does not say whether the social worker believes Mr B has eligible needs, whether he needs an interim placement at a care home or whether his needs could be met at home. It therefore cannot be said to constitute a full assessment in line with the Care Act 2014.
26. I understand why the social worker may not have completed a full assessment at that point in time. Mrs B wanted to speak to her family and the social worker planned to confirm her wishes at a later time. The social worker needed to clarify Mrs B’s wishes in order to properly complete the needs assessment. Mrs Y then told the social worker the family wished to self-fund and indicated they were over the financial limit. This effectively ended the social worker’s involvement.
27. However, Mrs B then submitted a financial assessment form, which indicated she was below the capital threshold. She telephoned the finance department to ask questions about the form, making it clear she wanted the Council to provide financial assistance. The Council should have responded to this request for a financial assessment and there is no evidence it did.
28. I recognise that councils will normally only financially assess a person when they have decided to charge for a placement. Yet, even if a person has arranged their own placement, they can at any time tell the Council that their capital has dropped below the threshold and ask it to complete a financial assessment. The starting point then is for the Council to complete a needs assessment and decide how it thinks the person’s needs should be met. If the person has eligible needs and requires care the Council will charge for, it should do a financial assessment.
29. In this case the Council did neither. Its initial assessment had not recorded what care the Council considered Mr B needed. It did not then complete a full needs assessment after Mrs B submitted the financial assessment form and it did not complete a financial assessment. It just relied on the fact Mrs Y previously said they were self-funding.
30. I accept that Mrs B and Mrs Y appear to have given conflicting messages to the Council and this may have caused confusion. However, the Council should have followed up on Mrs B’s financial assessment form. If only to clarify why she had submitted the form, when Mrs Y previously indicated they would self-fund. If Mrs B said she did want to self-fund, it could have left it there. If, as would have happened, she said she wanted the Council to contribute, it should then have completed the assessments. There is no evidence it did so, and that is fault.
31. It is also relevant that Mr B’s placement was always meant to be temporary. The Council knew this was the case from the outset.
32. The rules for calculating income are different for temporary residential care. As set out at Paragraphs 10 to 11, the Council can choose between treating the person under the rules for a permanent placement or as if they were living at home. It must also disregard certain housing related costs.
33. The Council’s information leaflet does not say anything about how it will calculate income in the case of a temporary placement. There is no record the Council explained this to Mrs B. It is therefore my view the Council is at fault for not providing full information to Mrs B about the charging options, although I accept this only relates to small differences in how the Council treats income. This alone would not likely have made much difference to Mrs B’s decisions about her husband’s care.
34. I have gone through the different calculations the Council might have reached using either choice. If it had treated him as living at home, it would likely have assessed Mr B’s contribution as over its contracted rate. If it treated him as a permanent care home resident and properly disregarded his housing related costs, his contribution might have been under the contracted rate. Either way it might depend on factors such as whether he continued to receive attendance allowance and whether the Council decided he had other assets or notional capital.
35. The Council could not make this decision until it completed a full financial assessment. Therefore, I do not agree that any fault would have made no difference to whether the Council contributed to his care home fees. If the Council had completed a full needs assessment and a financial assessment, it could have made a difference. However, I acknowledge that, based on the financial information available, even if the Council did contribute something to the fees, it would have been a very low amount. Mr B’s income is such that he would have paid at least the majority.

Consideration of Remedy

36. I have found fault on the following issues:
• The Council did not complete a full needs assessment and financial assessment for Mr B
• The Council did not give Mr B’s family full information about how it would calculate income for a temporary residential placement
37. I cannot say for certain whether the Council would have needed to contribute anything to Mr B’s care fees had it done a full needs assessment and financial assessment. I therefore cannot say the Council should pay Mrs B a specific contribution to the fees.
38. I also cannot recommend the Council do a retrospective financial assessment. This is because I do not know what decision of the Council would have reached in its needs assessment. It might not have decided that Mr B needed a temporary placement, in which case Mr B would have had to self-fund anyway.
39. The uncertainty about what would have happened causes an injustice to Mrs B in terms of distress. The level of injustice is low as, even if the Council did contribute something, it would have been a very low amount. I therefore recommend the Council apologise to Mrs B and pay her £100 to recognise the fault.
40. I also recommend the Council update its information leaflet, to give details of how it will approach the calculation of income for a temporary stay in a care home.

Agreed action

41. The Council has agreed to, within a month of this decision:
• Apologise to Mrs B for not completing a full needs assessment and financial assessment, and for not giving full information about how it calculates income for temporary residential care
• Pay Mrs B £100 to acknowledge the distress this cased
42. It will also, within three months of this decision:
• Provide evidence it has updated its information leaflet to give details of how it will approach the calculation of income for a temporary residential placement

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Final decision

43. I find the Council at fault for not completing a full needs assessment and financial assessment. I also find fault in how the Council communicated its position for temporary care home placements.

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Investigator's decision on behalf of the Ombudsman