Summary: Mr X complained about errors in the way the Council calculated his contribution to his residential care costs. The Council was not at fault.

The complaint

1. Mr X complained about errors in the way the Council calculated his contribution to his residential care costs. He says, as a consequence, he has been asked to pay more than he should towards the costs of his residential care.

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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 Mr X and the Council; and
• Relevant law and guidance, as set out below.
4. Mr X and the Council had an opportunity to comment on my draft decision. I considered their comments and the additional documents provided before making a final decision.

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What I found

Relevant law and guidance

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 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. The assessed contribution should leave the person with not less than the personal expenses allowance (PEA).
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. This process is known as financial assessment. The council will take into account net income (except from earnings) and most state benefits. Where a person has capital between £14,250 and £23,250 the council will include a figure called tariff income, which is calculated as £1 for every £250 (or part thereof) of capital between those limits. The council can make adjustments to reflect costs a person has towards maintaining their family home.

What happened

8. Mr X lives permanently in a residential care home. Mr X had capital above the upper threshold (£23,250) and was paying the full costs of his care. In February 2020 Mr X told the Council his capital would soon fall below the upper threshold and asked it to carry out a financial assessment.

Assessment of capital

9. Mr X said at the end of February he had capital of £31,294 and that he had written a cheque for care home fees for £5,068, which left £26,226. This meant that when he paid the care home fees for March his capital would fall below the upper threshold. Therefore, he considered his contribution to his care costs in March should be £2,976, which is the difference between his capital and the upper threshold.
10. The information Mr X provided shows the Council carried out financial assessments in February, March and early April. I have seen these assessments and the bank statements on which they were based and can confirm the capital was properly recorded. The Council was entitled to use the bank accounts as evidence of the amount of capital Mr X had and was not required to take into account cheques written but not yet paid. It therefore assessed the capital as being over the upper threshold until it had bank statements to show otherwise.
11. Mr X provided a copy of his letter to the Council dated December 2019, enclosing evidence of the sale of some shares. There Council said it had no record of receiving it and I have seen no evidence to suggest it did receive it. It therefore asked Mr X to send the evidence again, which he was not able to do immediately for reasons connected with the COVID-19 pandemic. Mr X resent the evidence in early October 2020, and also provided bank statements for the period June to September 2020.
12. After receiving the additional evidence, the Council carried out a financial reassessment for each month from late February 2020. In mid October, it sent letters to Mr X setting out the contribution he should make towards his care from February 2020 onwards. I have seen these assessments and most of the bank statements on which they were based. These show Mr X’s capital was fluctuating so for some months he had to pay his care costs in full because his capital was above the upper threshold and in other months he had to pay an assessed contribution towards the costs of his care.
13. From July onwards, Mr X’s capital remained below the upper threshold, although the assessed contribution changed slightly each month due to the calculation of tariff income (see below).

Assessment of income

14. Mr X said the Council used incorrect figures for his state pension. For the tax year 2020-21, the Council used £306.07 per week, which it verified with the Pension Service.
15. Mr X said the Council used an incorrect figure for his occupational pension. This was because insufficient tax was being deducted from this pension and he would be liable for further tax. The Council correctly took the net income figure for his occupational pension from Mr X’s bank accounts. It said it would adjust his assessed contribution if Mr X provided evidence he had paid a further tax demand.

Tariff income

16. Mr X said the Council was incorrectly calculating his tariff income on the basis his capital remained at £23,250 throughout although in fact his capital was reducing each month. I have checked the financial assessments for the period May to September 2020. Each assessment correctly calculated the amount of capital between £14,250 and the upper threshold (the assessable capital) and correctly calculated the tariff income based on the assessable capital.

Allowances

17. Mr X’s wife, Mrs X, was still living in the family home and Mr X wanted to ensure she had sufficient income.
18. The Council agreed not to include half of Mr X’s occupational pension as a contribution to her maintenance.
19. The Council also took into account some of his costs relating to maintaining the family home, including building insurance, water rates and utilities. This increased Mr X’s personal expenses allowance (PEA) from the standard £24.90 per week to £48.05 per week from February 2020, and £47.01 per week from September 2020.
20. Mr X said the Council should also take into account the fact he pays the Council Tax for the family home on behalf of his wife. The Council declined to do so because Mr X is permanently living in the residential care home, therefore he is not liable for the Council Tax on the family home. Mrs X is solely responsible for this, although she may be able to claim a discount if she is living alone. I note the Council has offered to check whether she is receiving all the financial assistance she is entitled to.

Appeals

21. Mr X appealed a number of the financial assessments carried out. The Council responded to the questions he raised and carried out reassessments when he provided further evidence. It also provided a comprehensive leaflet explaining how care costs for residential care work.

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My findings

22. I have found no fault in the way the Council carried out the financial assessments. The assessments were based on the evidence Mr X provided and, when he provided further evidence in early October 2020, the Council carried out reassessments for each month from February 2020. The Council followed relevant guidance in deciding what expenses to take into account when calculating Mr X’s income and in calculating the tariff income. It provided general information about care costs and responded to the specific questions Mr X raised in appeals.

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Final decision

23. I have completed my investigation. I have not found fault.

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Investigator's decision on behalf of the Ombudsman