The Ombudsman's final decision:
Summary: The Ombudsman finds fault with the Council for not adequately explaining an assessed contribution towards the costs of a care home placement and for giving wrong calculations of the outstanding amount. This caused the complainant significant distress and confusion. The Ombudsman also finds fault with the Council for poor complaint handling. The Council has agreed to set up a payment plan for the amount agreed in its final decision and pay a financial remedy to the complainant in recognition of the distress caused.
- Ms B complains the Council wrongly calculated an outstanding debt for her father’s care.
- Ms B complains the Council delayed calculating and setting up a payment plan.
- Ms B also complains that once the payment plan was agreed, the Council then changed the amount to a higher cost. Ms B says it is not clear why the Council increased the amount it needed to recover, and this has caused her and her mother significant distress.
- Ms B also complains about the Council’s poor handling of her complaint.
The Ombudsman’s role and powers
- 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)
- 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)
How I considered this complaint
- I considered Ms B’s complaint and her correspondence with the Council. I also considered information from the Council. I considered comments on my draft decision from Mrs B and the Council.
What I found
Charging for social care services: the power to charge
- Councils can make charges for care and support services they provide or arrange. Charges may only cover the cost the council incurs. (Care Act 2014, section 14)
- Councils must assess a person’s finances to decide what contribution he or she should make to a personal budget for care. (Care Act 2014 Department for Health, ‘Fairer Charging Guidance’ 2013, and ‘Fairer Contributions Guidance’ 2010)
- The care and support planning process will identify how best to meet a person’s needs. As part of that, the council must provide the person with a personal budget. The personal budget is the cost to the council of meeting the person’s needs which the council chooses or is required to meet. The council must ensure that at least one choice is available that is affordable within a person’s personal budget and should ensure there is more than one choice.
- If no suitable accommodation is available at the amount identified, the council must arrange care in a more expensive setting and adjust the budget to meet the person’s needs. In such circumstances, the council must not ask anyone to pay a ‘top-up’ fee. A top up fee is the difference between the personal budget and the cost of a home.
- Mr A lived with his wife, Mrs A, at home. Mr A entered a care home in May 2018. In August 2018 Ms B’s husband spoke to the Council which advised that Ms B could apply on her father’s behalf for financial assistance.
- Ms B liaised with the Council on behalf of her father and family.
- The Council financially assessed Mr A. Following this assessment a contract was issued for £227.79. Ms B understood that this was the only contribution required in addition to the Council’s payment.
- There was no mention in the contract of any assessed contributions Mr A needed to pay. Ms B followed up with the Council about the third-party costs and was told the third party costs totalled £227.79 and that the Council had negotiated a reduction in fees with the care provider. The Council’s communication with Ms B was worded in a way that suggested the Council’s payment and Mr A’s £227.79 would cover the care fees. On this basis Ms B signed the contract on behalf of the family.
- In Sept 2019, Ms B received a bill for her father’s care fees. The amount on the bill was higher than had previous agreed.
- The Council advised Ms B there had been an assessed contribution to be paid towards Mr A’s care. The Council said Mr A’s his financial assessment had shown he should be paying this in addition to the third party top up.
- Ms B told the Council that it had not told them of any assessed contributions that needed to be paid by Mr A. Ms B felt that it was unfair of the Council to tell her this information a year after the financial assessment had been completed and she had signed the contract.
- Ms B said to the Council that she and her father would not have agreed to the contract for the care home. Ms B said if they had known there were additional costs and would have explored alternative care choices.
- The Council said that Mr A would need to pay the assessed contributions for the care he had received so far.
- Mr A died in May 2020. Ms B contacted the Council to arrange to settle the outstanding amounts and make a complaint about how the first amount was communicated.
- During its complaint process, the Council said its records showed the assessed contributions were discussed by telephone call but accepted that no letters or written confirmation were sent about the assessed contributions. Ms B said no telephone calls took place about any assessed contributions cost.
- In light of the Council not giving the suitable information about the care costs at first, the Council calculated the outstanding debt to be £19,013.77. This removed the assessed contributions between 2018 and 2019 and applied them from when Ms B was made aware of the assessed contributions cost. The decision was made by a service manager and the Council described this as “the final decision”.
- Ms B agreed to this calculation and terms of repayment. She contacted the Council multiple times to try and arrange a payment plan to settle the debt.
- The Council wrote to Ms B and advised the calculation in the “final decision” was wrong and asked her to settle a higher amount of £25,425.34. The Council offered Ms B £200 for her time and trouble.
- Ms B did not agree that she was being asked to pay a different amount and felt the Council had not handled the calculations appropriately. Ms B bought her complaint to the Ombudsman.
- I have reviewed documents and records from the Council, as well as information and correspondence from Ms B.
- The first contract between the Council and Ms B, on behalf of her father, made no mention of any assessed contributions to be paid by Mr A.
- The follow up messages between Ms B and the Council also did not mention any assessed contributions to be paid.
- It is my view that Mr A and his family did not know he needed to pay contributions towards his care. I accept Ms B’s argument that if they had known about the additional amounts, they would not have agreed to the first contract.
- I also accept Ms B’s complaint that they were not made aware of the additional amounts owed until 2019.
- It was therefore fault by the Council to ask Ms B to settle an amount the family had not agreed to or been told about.
- During the complaints process, the Council agreed to wipe the part of the debt from before the family were told about the assessed contributions. In June 2020, the Council wrote to Ms B advising of a final amount. This was described to Ms B as the final decision by the Council.
- Ms B agreed with the rational that had been applied in the final decision and agreed to pay the amount asked by the Council in its final decision. She accepted the terms of the amount and asked to enter into a payment plan.
- It is significant maladministration for the Council to have wrongly calculated an amount for the second time, and unreasonably expect Ms B to settle a higher debt to the one she has already agreed to.
- The Council gave Ms B multiple different costs and totals between 2018 and 2020. Two of these calculations were wrong, but this was only told to Ms B after she had agreed to pay them. This was significant fault by the Council. It was also unreasonable for the Council to expect Ms B to pay higher amounts than it has agreed with her or informed her about.
- It is my view the amount to be paid by Ms B is the amount communicated to her in the final decision. This was the decision dated June 2020 and totalling £19,013.77. The Council should not expect Ms B to settle the higher amount it calculated in August 2020 of £25,425.34.
- Ms B initially raised her concerns to the Council about the payment amounts in 2019, she then complained to the Council about the handling of the issue.
- I have reviewed the communication with Ms B and the Council about the amounts to be settled.
- On multiple occasions, the Council delayed responding to Ms B and her requests to clarify the situation. The Council also delayed providing her with clear explanations of how the amounts were calculated. When the breakdowns were provided, the Council then told Ms B the amounts were wrong but only after she had entered into an agreement with the Council.
- The Council also delayed agreeing a payment plan with Ms B.
- This was fault by the Council. Ms B had to navigate this very confusing situation with little help from the Council, while mourning her father, and supporting Mrs A through the loss of her husband and managing his estate.
- It is my view the Council’s actions regarding complaint handling has caused Ms B and Mrs A significant distress and confusion.
- Within 4 weeks of my final decision the Council has agreed it will
- Write to Ms B and Mrs A and apologise for how it has handled the issue of payment amounts and complaint handling. The Council will also pay £200 to Ms B in recognition of the distress it has caused her.
- The Council will discuss and set up a payment plan with Ms B for the amount agreed in the decision dated June 2020 for £19,013.77.
- Within 12 weeks of my final decision the Council has agreed it will
- Review how it communicates about assessed contributions for care costs, and ensure that decisions are communicated in writing.
- The Council will also review how it quality checks calculations for care costs, and how this is communicated to service users. This should include how decisions are communicated in writing rather than via telephone, and how records are maintained in this area.
- The Council will also review how it responds to complaints about care fees, and how it quality checks information being given to complainants about amounts outstanding.
- I have now completed my investigation. I find fault with the Council for not adequately explaining an assessed contribution towards the costs of a care home placement and for giving wrong calculations of the outstanding amount, and for poor complaint handling. This caused Ms B and Mrs A significant distress and confusion.
Investigator’s decision on behalf of the Ombudsman
Investigator's decision on behalf of the Ombudsman