Summary: Mrs X complained the Council did not carry out a financial assessment or provide her with sufficient financial advice when her late husband, Mr X, moved into a residential care home in July 2018. This meant she used his life insurance money to pay for his care fees. There was no fault by the Council.

The complaint

1. Mrs X complained the Council did not carry out a financial assessment or provide her with sufficient financial advice when her late husband, Mr X, moved into a residential care home in July 2018. As a result, Mrs X used her husband’s life insurance money to pay for his care fees. She later discovered life insurance bonds are exempt from being used towards care fees. Mrs X is upset with the matter and believes the life insurance money should be paid to her.

Back to top

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)

Back to top

How I considered this complaint

4. I considered the information Mrs X provided and I considered the information the Council provided.
5. I considered the relevant law and guidance.
6. Mrs X and the Council had the opportunity to comment on the draft version of this decision. I considered their comments before making a final decision.

Back to top

What I found

Legal and administrative background

7. 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.
8. 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.
9. 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.
10. In some circumstances, a local authority may choose to treat a person as if a financial assessment had been carried out.
11. The regulations state a local authority is to be treated as having carried out a financial assessment in an adult’s case and being satisfied on that basis that the adult’s financial resources exceed the financial limit where:

• with the consent of the adult, the authority has not carried out a financial assessment in accordance with these Regulations; but
• the authority is satisfied from the evidence available to it that the adult’s financial resources do exceed the financial limit.

What happened

12. Mr X had dementia. He lived at home with Mrs X. In July 2018, Mrs X sought support from the Council in finding a care home placement for her husband. Mrs X had Lasting Power of Attorney for Mr X’s finances. From the Council’s social care case records, a social worker met with Mrs X on 3 July 2018. At the meeting they noted, Mrs X ‘thinks that he would have enough funds to fund himself for one year before needing NCC to assist’. The social worker noted they explained, ‘how things work in relation to funding in relation to residential care, top up fees etc’.
13. The records note that on 5 July 2018, the social worker gave Mrs X two information leaflets about care charges. The leaflets were, "Thinking about residential and nursing care” and “Thinking about non-residential services”. The leaflets contained helpful information about charges and funding of care. In the “Thinking about residential and nursing care” leaflet, it stated, ‘If you have more than £23,250, you will have to pay all the care fees. Some types of capital are disregarded – for example, Japanese Prisoner of War payments and certain types of investment bonds that include life insurance’.
14. Mrs X arranged a respite stay for her husband at a care home in late July 2018 for two weeks. At the end of the two weeks, the social worker met with Mrs X and Mr X at the care home. Following the meeting, it was agreed Mr X would remain there as a permanent resident. In the case records the social worker noted Mrs X had a number of questions regarding finances. They noted they advised her to contact the Citizens Advice Bureau and the Department for Work and Pensions.
15. In September 2018, the Council records show that a conversation took place with Mrs X and the Council where Mrs X confirmed her husband was self-funding and they were paying the bills directly to the care home. It detailed that Mrs X ‘did not reveal the amount of her husband’s capital’, and she said, ‘she was in the process of separating their joint accounts’. The records note the Council ‘asked when she thought the monies would be below the threshold’ and in response Mrs X said, ‘maybe in a year’. In March 2019, the Council’s records show a further conversation took place with Mrs X and the Council. The records state Mr X was self-funding his care for another year and Mrs X was advised by the Council to let it know two to three months before Mr X’s capital decreased towards the threshold.
16. In January 2020, Mrs X informed the Council her husband’s capital was reducing and almost near the threshold. As a result, the Council arranged a visit with Mrs X and completed a financial assessment in February 2020. Mr X’s capital was provisionally assessed to fall below the threshold in May 2020. Mr X died in June 2020.

The complaint

17. In August 2020, Mrs X informed the Council that she had cashed in her husband’s life insurance bond to help pay his care fees. She continued that she recently discovered life insurance bonds should be disregarded as capital to use towards care fees. Mrs X said the Council did not inform her of this or carry out a financial assessment whilst it helped her look for a care home for her husband. She said she had spoken with the Council on several occasions during that time and not once had the Council mentioned a financial assessment. Mrs X asked the Council to refund her the money she used from the life insurance bond.
18. The Council investigated Mrs X’s case and responded to her. It said in July 2018, a social worker gave Mrs X leaflets about charges and funding of care to help answer any questions that she may have had. The leaflets had necessary information about life insurance bonds being disregarded as capital to pay for care fees. The leaflets also stated that the Council suggests the reader seek advice from a financial advisor or a solicitor if they are unsure about charges or funding of care. The Council continued that the social worker also advised Mrs X to seek advice from Citizens Advice Bureau and the Department for Work and Pensions when she had questions about finances.
19. Mrs X said she cannot say for certain what leaflets the social worker gave her. She said at the time, she was focused on getting her husband settled.
20. The Council continued with its response. It referred to discussions she had with the Council’s Financial Assessment Team in September 2018. It said, ‘at no point, did you disclose how much capital [Mr X] had or inform us of the source of that capital’. The Council said it was looking to complete a financial assessment but as Mrs X did not disclose the necessary information, it was not in a position to advise her of the implications of cashing in any bond.
21. Mrs X said she cannot recall a conversation with the Council where she did not disclose financial details to it. Furthermore, she cannot recall the Council referring to a financial assessment verbally or in writing around the time her husband moved into the care home. She said the Council only asked her if Mr X had capital over £23,250 and told her to get back in contact with the Council once his capital decreased towards the threshold. Mrs X said it was a difficult and emotional time for her when she was arranging residential care for her husband.
22. The Council concluded its investigation and said it was unable to refund any money to Mrs X. It said it gave Mrs X the charging guides which had relevant information about life insurance bonds and its social worker advised Mrs X to seek financial advice. In addition, Mrs X did not at any point disclose information about the amount or source of Mr X’s capital. It said it was satisfied from the evidence it had that Mr X’s capital exceeded the financial threshold. The Council added that it has an obligation to offer proportionate advice and in Mrs X’s case, it believed it met its obligation and provided her with proportionate advice based on the information it had at the time.
23. Mrs X remained unhappy and complained to us.

Back to top

Findings

24. The Council said it gave Mrs X proportionate advice. It gave Mrs X information leaflets about charges and funding of care. Although Mrs X cannot say for certain the Council gave her the leaflets, the Council’s records indicate it did.
25. Furthermore, the Council’s records indicate a social worker spoke with Mrs X about residential care funding and top up fees when the Council was helping her look for a care home for her husband. The Council advised Mrs X to seek advice from the Citizens Advice Bureau and the Department for Work and Pensions in response to Mrs X’s questions about finances. It asked Mrs X to contact it when her husband’s capital decreased towards the threshold. I find no fault with the advice and information the Council gave to Mrs X.
26. The Council said it carried out a light touch financial assessment of Mrs X’s husband’s capital. It was satisfied her husband’s capital exceeded the threshold of £23,250. Although Mrs X cannot recall what conversations took place, the Council’s records indicate she told the Council Mr X had over £23,250 and that he had sufficient funds to fund his care for around a year. The records show conversations took place between Mrs X and the Council where Mrs X confirmed her husband was self-funding his care. In the circumstances, the Council carried out a light touch assessment in line with guidance and this is what we would expect it to do. The Council was not at fault.
27. In addition to the above, the Council could only act on the information it had from Mrs X and Mrs X did not provide the Council with specific information about her husband’s capital. The Council carried out a complete financial assessment when Mrs X informed it that her husband’s capital was decreasing towards the threshold. I find no fault with the Council’s actions.

Back to top

Final decision

28. I have now completed my investigation. There was no fault by the Council.

Back to top

Investigator's decision on behalf of the Ombudsman