Summary: The Council is at fault at it did not provide sufficient information for Mrs Z and her family to know she had to pay a contribution towards her care home fees. The Council also delayed in sending an invoice to Mrs Z’s family for the client contribution. The faults caused distress to Mrs Z’s family and Mr Y was put to avoidable time and trouble in pursuing the complaint. The Council will remedy this injustice by apologising to Mrs Z’s family and making a payment of £250 to the family and a payment of £100 to Mr Y.

The complaint

1. Mrs X and Mr Y complain that the Council did not clearly explain that Mrs Z would be responsible for paying a client contribution towards the cost of her residential care home place and delayed in sending invoices for the contribution. As a result, the family were not aware of the client contribution until the Council issued an invoice for £6390.23 in November 2019, some nine months after Mrs Z was placed in the care home. Mrs X and Mr Y consider the Council should waive the client contribution for Mrs Z.

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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 we considered this complaint

4. We have:
• Considered the complaint and the information provided by Mrs X;
• Discussed the issues with Mr Y;
• Made enquiries of the Council and considered the information provided;
• Invited Mrs X and the Council to comment on the draft decision.

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What I found

Charging rules

5. 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.
6. The rules state that people who have over the upper capital limit of £23,250 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.
7. 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.
8. Most people will have to pay something towards the cost of a care home even if they have capital of less than the lower capital limit of £14,250. Usually a person is expected to pay all of their regular income towards their placement after deducting an amount for their personal spending which is known as their personal expenses allowance.

What happened

9. In late 2018 Mrs Z and her family decided she should move into a residential care home. A member of Mrs Z’s family held power of attorney for her. Mrs Z had capital of less than £14,250 so the Council would contribute to her.
10. The Council’s records show a social worker met with Mrs Z and her family to explain the financial implications. The record of the meeting records the social worker provided the Council’s leaflet on paying to live in a care home. The Council’s records show it had a number of discussions with Mrs Z’s family about available care home places and the financing of their preferred place including top up fees.
11. Mrs Z moved into a residential care home in early March 2019. A member of Mrs Z’s family who was her power of attorney signed the placement agreement and individual service contract. This indicated the provider would charge the Council a weekly fee of £463.05 for Mrs Z’s place and a third party contribution of £100 would be paid. Mrs X and Mr Y have said they understood the Council would pay the fee of £463.05 and they would pay the top up fee of £100. They understood Mrs Z would not pay anything.
12. The individual service contract also set out the conditions of the agreement. This included:

“The service user shall receive the service and pay the client contribution in accordance with the terms of the agreement, individual service contract and support plan.”

The contract also refers to the service user’s responsibility to pay an assessed charge subject to the financial assessment.

13. In November 2019, the Council carried out a financial assessment to determine how much Mrs Z needed to contribute towards her care home place. The Council wrote to Mrs Z’s family to advise they would receive an invoice for £6390.23 for her client contribution between 4 March and 17 November 2019. The Council said that there had been a delay in issuing the notification and invoice due to resource issues and system changes and apologised for the inconvenience caused.
14. Mr Y contacted the Council to question the invoice as the family were not aware Mrs Z had to contribute towards her care. He then made a complaint. Mr Y said the Council told the family it would pay £463 per week and the family would pay the fee of £100 per week. The Council apologised for the delay in sending the invoice for Mrs Z’s client contributions. It said its records show the social worker provided the family with the Council’s paying for care leaflet in December 2018. A family member also signed to confirm they had received this document when singing the placement document. The Council also referred the placement document referring to the service user’s responsibility to pay an assessed charge subject to financial assessment. It therefore did not uphold Mr Y’s complaint that the family had not been informed Mrs Z would have to pay a client contribution.
15. I understand Mrs Z sadly passed away in early 2020.
16. In response to my enquiries the Council has said the delay in sending the invoice to Mrs Z for her client contribution were caused by staff resources and a system change which led to a backlog of financial assessments. The Council has said the system problems have been rectified and resources put in place to clear the backlog.

My assessment

17. The Council is not at fault for requiring Mrs Z to pay a contribution to her care costs. Even if a person has less than £14,250 in capital they are required by law to contribute their regular income towards their care home costs. I understand Mrs Z would have been willing to pay her client contribution.
18. The Council should provide clear, written and timely information about care costs to enable people to make an informed decision about their care. On balance, I do not consider the Council provided sufficiently clear information to Mrs Z and her family for them to understand she was required to contribute to her care home fees. I set out my reasons below.
19. There is no evidence to show the Council clearly explained to Mrs Z and her family that she would be expected to contribute towards her care home fees. There is no reference in the Council’s records of any discussion about the client contribution. The discussions focussed on top up fees but the Council should have ensured the family were fully aware of and understood all the costs of placing Mrs Z in a care home.
20. The Council’s records and the individual service contract show a social worker provided a copy of the Council’s leaflet ‘paying to live in a care home. But I do not consider the leaflet provides clear and sufficient information about the client contribution. The leaflet says the majority of individuals must contribute something towards the cost of their care. But it does not clearly explain that a service user will have to pay the client contribution even if they have capital of less than £14,250. The individual service contract refers to a client contribution and assessed charge but does not explain what these are. On balance, I do not consider the leaflet and individual service charge provided sufficiently clear information about the client contribution. This lack of clarity, together with the lack of any evidence to show officers explained the client contribution, leads me to conclude the Council did not provide sufficient information for Mrs Z and her family to be fully aware she had to contribute to her care home fees.
21. The Council has acknowledged it delayed in notifying and sending an invoice for Mrs Z’s client contribution. I note this was due to resource and systems issues but the delay of nine months is fault. I welcome the action taken by the Council to address the problems which led to the delays.

Injustice

22. In the event we find fault by the Council we have to consider the injustice caused by the fault. Mrs Z would have always had to pay the client contribution even if the Council had clearly informed her and her family of the requirement before she moved into the care home and had not delayed in sending the invoice. So, it is not appropriate or proportionate to recommend the Council waives the client contribution. As Mrs Z has sadly passed away, I understand any recovery of the client contribution by the Council would be from Mrs Z’s estate.
23. Mrs Z and her family would have been aware sooner of the true costs of her care if the Council had clearly informed her and her family of the client contribution. Mrs X and Mr Y and their family were caused distress by the unexpected and delayed invoice. Mr Y was also put to avoidable time and trouble in pursuing the complaint. The Council should remedy this injustice.

Agreed action

24. That the Council will:
1. Send a written apology to Mrs X and Mr Y and their family for the distress caused by the Council’s failure to provide sufficiently clear information for them to understand Mrs Z needed to pay a client contribution and delay in sending an invoice for the contribution.
2. Make a payment of £250 to Mrs X or Mr Y to acknowledge the distress caused to their family.
3. Make a payment of £100 to Mr Y to acknowledge the avoidable time and trouble caused to him in pursing the complaint. The payments at b) and c) are in accordance with our guidance on remedies.
4. Review its leaflet on paying to live in a care home and other information given to service users about care home charges to ensure they are fully aware they will be charged a client contribution even if their capital is less than £14,250.
5. Ensure, by training or other means, that officers also explain the client contribution when providing or discussing information to service users on care home charges and record an explanation has been provided.
25. The Council should take the action at a) b) and c) within one month of my final decision. It should take the action at d) and e) within three months of my final decision and provide evidence to the Ombudsman of the action taken.

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Final decision

26. The Council is at fault at it did not provide sufficient information for Mrs Z and her family to know she had to pay a contribution towards her care home fees. The Council also delayed in sending an invoice to Mrs Z’s family for the client contribution. The faults caused distress to Mrs Z’s family and Mr Y was put to avoidable time and trouble in pursuing the complaint which the Council has agreed to remedy. I have therefore completed my investigation.

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Investigator's decision on behalf of the Ombudsman