Summary: The Council did not provide the proper information to the late Mr X’s family about the cost of his residential care. It delayed in assessing his finances. The Council agrees to apologise to Ms X and waive the outstanding debt.

The complaint

1. Ms X (as I shall call the complainant) says the Council failed to inform her family of the likely costs for her late father’s stay in residential care. She says the family paid the costs for which they were invoiced but the Council then told them they were only provisional and issued a large invoice.

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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. 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

3. I considered the information provided by Ms X and the Council. I spoke to Ms X. Both Ms X and the Council had the opportunity to comment on an earlier draft of this statement and I took their comments into consideration before I reached a final decision.

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What I found

Relevant law and guidance

4. The charging rules for residential care are set out in the “Care and Support (Charging and Assessment of Resources) Regulations 2014”, and the “Care and Support Statutory Guidance 2014”. 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.

What happened

5. Mr X lived in sheltered accommodation. He had dementia. In June 2016 he was admitted to hospital after being found wandering in the street: he was diagnosed with cancer as well.
6. Ms X says she talked regularly to the social worker who managed her father’s care. She says she visited several care homes as the social worker said the family would have to agree to his admission when he was discharged from hospital. The Council’s records contain an assessment of Mr X’s needs in September 2016 and a recommendation for a placement in ‘residential dementia step-down care’, prior to discharge to extra-care housing. The Council says the social worker advised the family verbally of the need for a financial assessment when discussing the placement but it has no written record.
7. The social work case recording shows that the social worker discussed the step-down care placement with Ms X on 7 November and Ms X said she was happy with the location. Mr X was discharged to the care home on 17 November. The Council says it sent a copy of the placement agreement to the care provider. The agreement says a copy should be sent to the care manager at the Council, the care provider, and the client. The placement agreement refers to a sum of £130.70 a week as the service user contribution to the cost of care. The Council says it does not have a copy of the agreement signed by Mr X or his family. Ms X says she never received a copy.
8. As extra-care housing was not available and Mr X settled in the home, the family agreed to a permanent placement in the care home.
9. Ms X said they started to receive bills (usually for about £578 a month) for Mr X’s care from the care provider which they paid monthly.
10. In April 2017 an officer from the Council’s finance department telephoned Ms X and said the Council had to assess Mr X’s finances. He said he would send a form to her to complete. Ms X says she was unsure why the Council was assessing her father’s finances as she thought it was no longer involved in his care.
11. The Council sent a form for the family to complete in June 2017. Ms X completed the form and returned it on 13 June. The Council then notified her there were significant arrears. Ms X met the financial assessment officer in January 2018 to discuss the arrears.
12. On 29 June 2018 the Council wrote to her and said there were arrears of £8,987 for her father’s care. This was for the “client contribution to the local authority” which was assessed at £180 a week

The complaint

13. Ms X complained to the Council. She said “We strongly believe it should have been the Council’s responsibility to fully communicate the financial aspects of the care plan, including undertaking any assessments and explaining the charges before they moved my father and he was first billed”.
14. The Council responded to Ms X in August 2018. It apologised for the delay in completing the financial assessment. It said the officer who had been responsible had since left the Council and it could not ascertain the cause of the delay.
15. Ms X complained again to the Council. She said at no time had the social worker responsible for her father’s care told the family about any financial contribution. She said her father had been in care for seven months before the assessment form was issued.
16. The Council says “It is standard practise for client contributions to be collected by care providers through billing the clients. All clients in residential care are charged a minimum of a provisional contribution whilst we carry out the financial assessment on their actual income. (Ms X) was aware of this arrangement as she made payments from November 2016 to August 2017.”
17. The Council also says, “when a client is placed with a residential care provider, at the point of placement, the family are informed of the provisional contribution and are charged by the provider while a full assessment is undertaken. (Ms X) was aware of this arrangement as she made payments to cover a provisional contribution”. Ms X says she never received a copy of the placement agreement which showed the provisional contribution.
18. The Council says it has suggested a payment plan to Ms X to repay the outstanding debt.
19. Mr X died in December 2019.

Analysis

20. There is no evidence the Council ever explained to Mr X’s family the financial implications of the care home placement. The family paid the bills which they were sent by the care provider. It is disingenuous of the Council to say that because they paid the ‘provisional’ bills, they therefore must have been aware of the arrangement. In the absence of a copy of the placement agreement, or any discussion about financial assessment, it is not surprising Ms X was shocked when she received a letter saying they were nearly £9000 in arrears. The poor communication was fault on the part of the Council which caused significant injustice.
21. A consequence of the communication failure was the lost opportunity to act differently. When Mr X was discharged from hospital he was recommended for step-down care followed by extra care housing. As no extra care housing was available at the time, and he was happy in the placement, his family agreed for it to be permanent, but that decision might have been different had they known the full financial consequences. At the least they should have had the full information on which to base their decision.
22. There was also a delay (which the Council acknowledges but cannot explain) in the financial assessment. That was fault too.
23. For the reasons given in paragraphs 20 – 22, there was injustice as a consequence of fault on the part of the Council.

Agreed action

24. Within one month of my final decision the Council will write off the debt it says Mr X’s family owes;
25. Within one month of my final decision, the Council will review the timescales for completion of financial assessments;
26. Within one month of my final decision, the Council will consider the information it gives to families at the point of discussion about residential care and review what written information should be given as a matter of course.

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Final decision

27. There was fault on the part of the Council which caused injustice.

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Investigator's decision on behalf of the Ombudsman