Summary: There is no evidence of fault in how the Council made the decision that Mrs C’s mother was ineligible for a deferred payment arrangement.

The complaint

1. Mrs C complains on behalf of her mother, whom I shall refer to as Mrs D. Mrs C says the Council unfairly considered that her mother was ineligible for a deferred payment arrangement. Mrs C says this will lead to her mother facing avoidable debts to pay for her care.

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The Ombudsman’s role and powers

2. We investigate complaints of injustice caused by ‘maladministration’ and ‘service failure’. I have used the word ‘fault’ to refer to these. We cannot question whether a council’s decision is right or wrong simply because the complainant disagrees with it. We must consider whether there was fault in the way the decision was reached. (Local Government Act 1974, section 34(3), 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. As part of the investigation, I have:
• considered the complaint and information provided by Mrs C; and
• considered information provided by the Council; and
• considered the relevant policies
• communicated with Mrs C about her complaint.
5. I also sent a draft version of this decision to both parties and invited their comments.

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What I found

Legal and administrative background

Assessment and provision of care and support

6. The Care Act 2014 provides the legal framework for the assessment and provision of care and support for adults assessed by councils as having eligible needs. The Act is supported by several statutory regulations and the Care and Support Statutory Guidance (the Guidance).
7. Councils have a duty to assess if a person has care and support needs, and if so, what they are.
8. After assessing the total extent of a person’s needs, the council should consider which are eligible needs under the Care Act 2014. The guidance says councils must consider whether:
1. The adult’s needs are due to a physical or mental impairment or illness.
2. The adult’s needs mean they cannot achieve two or more specified outcomes.
3. Because of being unable to achieve those outcomes there is, or is likely to be, a significant impact on the adult’s wellbeing.

Eligible needs are those that meet all these conditions (a-c).

9. The outcomes referred to in b) above include:
• maintaining personal hygiene,
• managing food preparation,
• maintaining a habitable home,
• maintaining significant relationships and
• accessing the community.
10. The guidance says: “being unable to achieve these outcomes” includes being able to achieve them with assistance or achieving them without assistance but where “it takes significantly longer than would normally be expected”.

Deferred payment arrangements

11. Deferred payment arrangements are designed to prevent people from being forced to sell their home in their lifetime to meet the cost of their care. Councils must offer them to people who meet the criteria.
12. Councils must offer a deferred payment arrangement to people who meet all the criteria set out below:
• Have eligible needs that the Council decides should be met in a care home.
• Have less than (or equal to) £23,250 in assets, excluding the value of their home.
• Have a home that is not occupied by a spouse or dependent relative.

Background

13. Mrs D is in her early 90’s, and previously lived alone in her home.
14. The Council carried out a review of Mrs D’s care needs in August 2018, which concluded that she should have a package of care consisting of 45-minute care visit daily, to support Mrs D with her personal care.

What happened

15. In July 2019, Mrs C contacted the Council and said that she wished her mother to move to a residential care home. The Council arranged for a social worker to visit Mrs D at home to carry out an assessment of her needs.
16. The Council says it told Mrs C that, if the assessment concluded that Mrs D could be supported at home, the Council would not fund a placement in a care home and Mrs D would not have access to a deferred payment arrangement.
17. The case was allocated to a qualified assessor who contacted Mrs C and her brother to arrange an assessment. The Assessment was subsequently arranged to take place at Mrs D’s home, with Mrs C and her brother present.
18. The Council has provided a copy of the assessment, which shows it considered whether Mrs D had eligible needs across the range of outcomes set out in the Care Act.
19. The assessor recorded that Mrs D was suffering from an increased fear of falling. She recorded that Mrs D uses a walking stick, a stairlift, a toilet frame and handrails. The assessor also recorded that she viewed Mrs D standing independently, but she would benefit from an additional toilet frame.
20. Because of Mrs D’s anxiety of falling, the assessor referred Mrs D to a physiotherapist.
21. The assessor concluded that Mrs D’s care needs could still be met at home, but at an increased level.
22. The assessment shows that Mrs D told the assessor she was going to a care home for a funded break. The assessor recorded that she told the family that if Mrs D decided to make this stay permanent, the Council would not fund the placement as Mrs D’s needs could be met at home.
23. Mrs D subsequently made the decision to stay at the care home. The Council wrote to Mrs D’s son and said because the assessment concluded Mrs D did not meet the criteria for residential care, her stay would need to be funded privately.
24. As Mrs D was no longer at home, the Council cancelled Mrs D’s appointment with the physiotherapist.

Analysis

25. Mrs C complains that the Council failed to properly assess her mother, and that it subsequently concluded her mother was ineligible for the deferred payment scheme.
26. It is not the Ombudsman’s role to say what a person’s needs are, or what services they should receive. The Ombudsman’s role is to consider if the Council has followed the correct processes to assess a person’s needs. The Ombudsman cannot question the right or wrongs of a decision where the council has reached it properly.
27. I have considered the documents provided by the Council which included Mrs D’s assessment. I find no fault in the completion of the assessment. The assessor considered all relevant factors, including Mrs D’s concerns about her mobility when making the decision that her needs could be met at home.
28. The Ombudsman cannot question the merits of the decision itself without evidence of fault in the way it was made. I find no fault in the way the decision was made.
29. Records show that the Council informed the family that it would not fund a residential placement, if the assessment found that Mrs D’s needs could be met at home. I am therefore satisfied that the family were aware of the financial implications surrounding Mrs D’s decision to continue her stay in the care home.
30. Council’s only have a duty to offer a deferred payment arrangement when it has assessed that an individual’s needs should be met in a care home. As it did not come to this conclusion in Mrs D’s case, I am unable to find fault with its decision not to offer such an arrangement.
31. To summarise, I have seen no evidence of fault to support the claim that the Council failed to properly assess Mrs Y’s needs, I am satisfied that the Council properly communicated with the family about the financial implications and the Council acted without fault when it declined the family’s request for a deferred payment arrangement. The Council therefore acted in accordance with the Mental Capacity Act 2005.

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Final decision

32. I have concluded my investigation on the basis that there is no evidence of fault in how the Council dealt with the matters raised in Mrs C’s complaint.

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Investigator's decision on behalf of the Ombudsman