Summary: Mrs X complains the Council did not provide her family with information that she would potentially have to pay for the full cost of her care fees. The Ombudsman does not find fault with the Council. This is because it did provide Mrs X’s family with information she would have to pay for the full cost of her care fees if her capital was over the limit of £23,250.

The complaint

1. Mrs X complains the Council did not provide her husband and her family with information that she would potentially have to pay for the full cost of her care fees. Mrs X says the Council only told them they might have to pay a top up fee but did not tell them in what circumstances the top up fee would apply. Mrs X said if they had been given information that she could potentially be a self-funder, they were likely to have chosen a different care home nearer to her husband’s home.
2. Mrs X is represented by her granddaughter, Mrs Y.

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The Ombudsman’s role and powers

3. 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)
4. 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)
5. 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

6. I spoke with Mrs Y and considered the information she provided.
7. I made enquiries with the Council and considered the information it provided.
8. I sent a draft decision to Mrs Y and the Council and considered their comments.

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What I found

Legislation and guidance

9. 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 a council arranges a care home placement, it must follow these rules when undertaking a financial assessment to decide how much a person has to pay towards the costs of their residential care.
10. The rules state that people who have over the upper capital (e.g. savings, property) limit of £23,250 are expected to pay for the full cost of their residential care home fees. Once their capital has reduced to less than the upper capital limit, they only have to pay an assessed contribution towards their fees.
11. The statutory guidance also states a lack of financial assessment should not be a barrier to a council arranging care and that it is not necessary to complete financial assessments before, or whilst, taking action.
12. Councils should also ensure there is sufficient information and advice available to ensure the person needing care, or their representative, can understand any contributions they are asked to make.

What happened

13. In April 2019, the Council received a referral from Mrs X’s hospital. The Council met with Mrs X’s family at the end of April 2019. Mrs X family included:
• her husband, Mr X;
• her son, Mr P; and
• her granddaughter, Mrs Y.

It was agreed Mrs X would be discharged home with a care package.

14. The Council’s records show the social worker explained to the family the Council would send out a financial assessment to the family to complete. This was because Mr X, told the social worker they had savings of around £7000.
15. The records noted the social worker provided Mr X with a financial assessment factsheet. This factsheet outlined the following:

“You will not be eligible for financial support for your social care if you have savings or capital assets that exceed the capital limits. These are

• £23,250 for single people.
• £23,250 if you are a member of a couple and chose to be assessed as a single person.
• £46,500 if you choose to be assessed as a couple and are willing to disclose all savings and income held by yourself and your partner.

If you declare that your savings are over the capital limit you will not have to complete a financial assessment. You will have to pay the full cost of any Social Care arranged on your behalf by the Council.”

16. On the same day, Mr X returned a signed form to the Council which confirmed he had received the financial assessment factsheet.
17. The records also highlighted the family asked the Council to send all correspondence to Mr P’s address.
18. Mrs X was discharged from hospital at the end of April 2019 with a care package.
19. The Council wrote to Mr P in May 2019, asking him to complete the financial assessment form. The Council’s letter included information about the upper capital limit for a single person and for a couple. The Council asked Mr P to return the completed form by the end of May 2019.
20. Mrs X was admitted to hospital three times in May 2019. At the end of May, the Council completed a mental capacity assessment which determined Mrs X did not have capacity to make decisions about her care and support. The Council met with Mrs X’s family and agreed that it was in Mrs X best interest to go to a care home that was registered to provide nursing care.
21. As the family had not yet returned the financial information to allow the Council to complete Mrs X’s financial assessment, the Council agreed the placement contract with the care home. The Council explained that where a resident, or their representative, declares they are not a self-funder, it will sign the contract with the care home and then invoice the resident for their assessed contribution.
22. Mrs X moved into her care home in June 2019.
23. The Council wrote to Mr P at the beginning of June 2019 asking him to complete the financial assessment form. The Council also sent an information booklet titled ‘Choosing and Paying for Care in a Care Home’. This booklet set out that financial help towards the cost of care in a care home was only available to people who have less than £23,350 in capital, savings and investments.
24. The Council wrote to Mr P again at the end of June chasing him for the completed financial assessment form and supporting evidence. The Council asked him to provide the information by July 2019. The Council advised if they did not receive the information, the Council will assess Mrs X to be a self-funder.
25. Mrs X’s family returned the financial assessment and supporting evidence at the end of July 2019. The information provided noted Mr and Mrs X had joint savings of just over £84,000.
26. The Council wrote to Mr X at the end of July 2019 and told him it considered Mrs X a self-funder as she had savings above £23,250. The Council did not write to Mr P.

Analysis

27. The law is clear that people who have over the capital limit of £23,250 are expected to pay for the full cost of their residential care home fees.
28. The evidence shows Mr X told the social worker in April 2019 that Mrs X only had savings of £7000. Therefore, it was appropriate for the Council to ask Mrs X’s family to complete a financial assessment form.
29. Mrs X says the Council did not provide Mr X or her family with information she would potentially have to pay for the full cost of her care fees. However, the evidence shows the Council provided Mr X with a financial assessment factsheet which contained information about when someone would have to pay for the full cost of their care. The Council gave Mr X the factsheet during the family meeting, which Mr P was also present for.
30. Further, the evidence shows the Council provided a booklet to Mr P in June 2019. This booklet outlined that financial help towards the cost of care in a care home was only available to people who had less than £23,350 in capital.
31. Therefore, I do not find fault with the Council. This is because the evidence shows the Council provided Mrs X’s family with information that highlighted she would have to pay for the full cost of her care if her capital was over £23,350.
32. There is also no fault in the way the Council completed its financial assessment. This is because the evidence provided by Mrs X’s family clearly shows she has capital over the £23,350 limit. This is because she has joint savings with Mr X of over £84,000.

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Final decision

33. I find no fault with the Council as it provided Mrs X’s family with appropriate information about when someone has to pay for the full cost of their care fees. I have therefore completed my investigation.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman