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London Borough of Hillingdon (20 002 979)

Category : Adult care services > Charging

Decision : Upheld

Decision date : 31 Mar 2021

The Ombudsman's final decision:

Summary: Mr X complains about how the Council handled Mrs Y’s care costs resulting in him receiving a larger than expected bill. We find the Council was at fault for not specifying how much Mrs X’s care charges would be. The Council has agreed to apologise to Mr X and review its procedures to ensure it tells people the costs they must pay for care.

The complaint

  1. The complainant, whom I refer to as Mr X, complains about how the Council handled Mrs Y’s care costs. Mr X says:
    • He nor his sister, who have power of attorney, were involved in the negotiations with the care home about costs.
    • The Council did not provide him with information about the cost of Mrs Y’s placement and he only found out the cost after receiving a bill.
    • There are two different rates for care the local authority rate and the rate for self-funders.
  2. Mr X says the above caused him to receive a larger then expected bill for Mrs Y’s care costs.

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The Ombudsman’s role and powers

  1. 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)
  2. 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

  1. As part of this investigation I considered the complaint made by Mr X and the responses from the Council. I discussed the complaint with Mr X over the telephone and considered the information he sent. I made enquiries to the Council and considered the information I received in response. I sent a draft of this decision to Mr X and the Council and considered comments received in response.

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What I found

Law and guidance

  1. The Care and Support Statutory Guidance 2014 says:
    • Councils must provide information to help people understand what charges they must pay, when they have to pay them and how much the charges are.
    • Where someone lacks the mental capacity to make decisions about their care councils should where possible work with someone who has the legal authority to make financial decisions on behalf of the person.
    • Where a council decides to charge for care it must carry out a financial assessment of what the person can afford. A council should explain how it carried out the assessment, what the charge will be and how often it will be made.
    • If a person has capital above £23,250 they must pay the full cost for their care and will not receive means tested support from the council.
    • In supporting self-funders to arrange care, the local authority may choose to enter into a contract with the preferred provider, or may broker the contract on behalf of the person. Where the local authority is arranging and managing the contract with the provider, it should ensure that there are clear arrangements in place as to how the costs will be met.

What happened

  1. Mrs Y suffered with dementia. She lived with her daughter, Ms X, who was her main carer.
  2. Mrs Y was admitted to hospital in October 2019 after suffering a fall. The Council assigned Mrs Y a social worker who carried out a care assessment in November 2019. The social worker recommended a placement for Mrs Y in a 24 hour care setting with the intention of reviewing her. The Council classed this placement as short-term.
  3. On 31 December 2019 Mrs Y moved into a care home. The Council started assessing Mrs Y’s needs and finances so it could decide how much Mrs Y would need to contribute towards her care costs. On 15 January 2020 the Council wrote to Ms X, saying Mrs Y’s care contribution would be £142.35 per week. The Council explained this was a provisional amount as it had not completed the full financial assessment.
  4. The Council completed Mrs Y’s social care assessment in February 2020. The Council decided Mrs Y needed long term care. The Council also received evidence from Ms X, showing Mrs Y’s capital had increased to over £23,250.
  5. On 24 February 2020 the Council wrote to Ms X confirming Mrs Y’s contribution to her care costs were £345.57 per week from 02 January 2020. The Council also sent another letter to Ms X on 24 February 2020 saying from 30 January 2020 Mrs Y would have to pay the full cost of her care. The letter did not specify how much the full cost of Mrs Y’s care was.
  6. In April 2020 Mrs Y passed away. Mr X received an amended invoice for Mrs Y’s care costs in May 2020 which show from 9 February 2020 the weekly cost of care was £1,200. He had received a previous invoice showing the costs from 9 February 2020 were £626 per week.

Mr X’s complaint

  1. In May 2020 Mr X complained to the Council after receiving confirmation of the care costs for Mrs Y. Mr X said:
    • He was unhappy the Council did not provide a list of prospective costs for each care home.
    • The costs increased from £626 to £1,200 per week and he nor Ms X were informed of the increase in costs.
    • Why was Mrs Y being charged a different rate to other residents?
  2. The Council responded to Mr X’s complaint at stage one:
    • The Council provided Mr X with a list of the range of costs on each category of care need. The Council said it was not usual for it to do this and it negotiates with the care home dependent on the person’s needs. The Council explained Mrs Y’s needs were for dementia nursing care which was the highest category at £626 per week.
    • The Council said the £626 per week was valid when it assessed Mrs Y as needing a short term placement. Once the Council assessed Mrs Y as needing a long term placement and the self-funded rate applied (as she had capital over £23,250) her costs increased to £1,200 per week.
    • The Council said as financial assessments are completed retrospectively it must wait for evidence and may have to revise the assessment.
    • The Council said residents are charged according to they type of care they need, so some residents will pay less than others in the care home.
  3. Mr X responded to the Council’s stage one complaint response. He said:
    • The Council should publish the scale of care costs it mentioned in its complaint response.
    • Does every patient pay the same costs at the care home or does the Council have the ability to negotiate cheaper rates.
    • The contract between the Council and care home was inappropriate as he should have been able to negotiate with the care home.
    • Why has Mrs Y’s care costs increased from £626 to £1,200 per week when she was receiving the same care.
  4. The Council provided its final complaint response in July 2020. The Council said:
    • It will discuss internally whether to publish the prospective costs for each care home.
    • When a care home placement is classed as short term the value of a persons property is not considered as part of the financial assessment, so the care home cannot levy their self-funded rates onto the Council. When a placement becomes long term a persons property value can be considered in the financial assessment and the care home will charge the Council the same self-funding rate as it would charge a client who approached the care home directly.
    • When a persons assets are over £23,250 they will pay the full cost of their care either at the short or long term rate. The Council said when Mrs Y’s placement was deemed short term her capital was under £23,250. The Council reviewed her care needs and decided she needed a long term placement. At this time the Council also received evidence Mrs Y’s capital had increased above £23,250 so she was liable to pay the long term self-funding rate of £1,200 per week.
    • The care home initially agreed to accept her at a reduced rate when she first moved in. However when it was known Mrs Y had capital over £23,250 the local authority rate no longer applied.

Analysis

  1. The Council was not at fault for commissioning Mrs Y’s care. When it carried out an assessment of her needs and started the financial assessment, Mrs Y’s assets were not over £23,250. Therefore at this time Mrs Y would have been entitled to support with her care costs from the Council.
  2. As per the Care and Support Statutory Guidance 2014 the Council is required to tell Mr X and Ms X what charge Mrs Y had to pay towards her care. The Council did initially tell them of the provisional charge while it finished Mrs Y’s financial assessment. The Council also told them what the charge would be from 1 January 2020.
  3. When it became apparent Mrs Y’s capital was over £23,250 the Council only told Mr X and Ms X she had to pay the full cost of her care. The Council did not specify what this cost was in the letter it sent to Ms X nor can I see evidence that it told them her cost would further increase once she became a long term resident. This is fault.
  4. As a result Mr X was not aware of the costs Mrs Y needed to pay for her care, nor was he aware of the increase in costs following Mrs Y being assessed as needing a long term placement. Had the Council made Mr X aware of the costs Mrs Y would need to pay he could have considered other options, given Mrs Y was a self-funder.
  5. I do not consider Mrs Y lost out financially as once the Council satisfied itself Mrs Y was a self-funder, the Council no longer had a statutory duty to contribute towards her care costs. Therefore she would have had to pay the private care home rate of £1,200 per week.

Agreed action

  1. Within one month of my final decision the Council agreed to carry out the following and provide evidence to the Ombudsman it has done so:
    • Apologise to Mr X for not telling him how much Mrs Y would have to pay for her care following the completion of the financial assessment and decision her placement was long term.
    • Review its procedures to ensure it tells people the actual costs they must pay for their care.

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Final decision

  1. I have completed my investigation on the basis there was fault by the Council which caused injustice. The Council has agreed to the above actions to remedy the injustice caused.

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Investigator's decision on behalf of the Ombudsman

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