Summary: Mr X complained he was not told about the standard charge for care services at the extra care housing accommodation where he lives. The Council was at fault as it failed to explain the standard care charges associated with extra care housing when Mr X moved in. The Council has agreed to waive the charges and assist Mr X to move should he wish to do so. It has agreed to ensure prospective tenants are provided with information about the service charges associated with extra care housing.

The complaint

1. Mr X complains he is being charged for care services at the extra care housing accommodation where he lives but does not receive the services and did not agree to them when he moved to the property. He says he cannot afford to pay the charge and would not have moved in if he had known about it.

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. We cannot question whether a council’s decision is right or wrong simply because the complainant disagrees with it. We must consider whether there was fault in the way the decision was reached. (Local Government Act 1974, section 34(3), as amended)
4. 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

5. I have considered the information provided by Mr X and have discussed the complaint with him on the telephone. I have considered the Council’s response to my enquiries and the relevant law and guidance.
6. I gave Mr X and the Council the opportunity to comment on a draft of this decision and considered any comments I received in reaching a final decision.

Back to top

What I found

7. Extra care housing is purpose built housing with care primarily aimed at older people to promote independent living. The occupiers live in self-contained properties and have access to care and support 24 hours a day either on site or on call.

Charging for adult social care

8. The Care Act 2014 sets out the legal framework for charging. Councils can make charges for care and support services they provide or arrange. They must do so in line with the Care and Support (Charging and Assessment of Resources) Regulations 2014. Charges may only cover the cost the council incurs.
9. Councils must assess a person’s finances to decide what contribution he or she should make to a personal budget for care. The assessment must comply with the principles in law and guidance, including that charges should not reduce a person’s income below Income Support plus 25% (also known as the minimum income guarantee). The Council can take a person’s capital and savings into account subject to certain conditions. If a person incurs expenses directly related to any disability he or she has, the Council should take that into account when assessing his or her finances. Those with capital assets of over £23,250 have to pay the actual cost of the care they receive. (Care Act 2014 Department for Health, ‘Fairer Charging Guidance’ 2013, and ‘Fairer Contributions Guidance’ 2010)
10. The Care and Support Statutory Guidance sets out some key principles councils should take into account when making decisions on charging. This includes that the approach to charging for care and support needs should:
• ensure that people are not charged more than it is reasonably practicable for them to pay
• be clear and transparent so people know what they will be charged and
• apply the charging rules equally so those with similar needs or services are treated the same and minimise anomalies between different care settings.

The Minimum Income Guarantee

11. The Social care – charging for care and support Local Authority Circular DHSC (2019)1 sets out the level of the minimum income guarantee. For those age 25 up to the qualifying age for pension credit the rate is £151.45 per week. This increases to £189.00 for those over the qualifying age for pension credit.

The Council’s Charging Policy

12. The Council’s Non-Residential Care Charging Policy sets out how the Council will financially assess individuals to determine the contribution they should pay towards the cost of their care. It calculates the financial contribution by calculating:
• Income and capital
• Less housing costs and disability related expenditure (DRE) such as extra costs of cleaning or domestic help, private chiropody, special clothing or footwear
• Less the minimum income guarantee.
13. The Council’s policy sets out that if a person disagrees with the amount or the figures used in the assessment, they should contact the financial Assessment Team in the first instance. It says bills will be sent every four to five weeks.

What happened

14. Mr X lived in a council owned property. He has physical health conditions. At the time he received one 30-minute visit each day to assist with getting dressed and applying cream to his legs. The Council assessed that Mr X did not need to pay any financial contribution towards the cost of his care.
15. In July 2019 the Council carried out a reassessment of Mr X’s needs. In the review it noted at the previous review they had discussed extra care housing which Mr X had declined to pursue. The assessment records do not refer to any advice given by the Council about charges for around the clock support. Mr X now felt extra care would be a better option of him. It suggested Mr X visit a scheme to have a look and ‘also to discuss with on-site support staff about the rental charges and what benefits could apply’.
16. In October 2019 Mr X signed a tenancy for extra care housing. Due to issues at the property the move was delayed until March 2020. The tenancy agreement set out the weekly rental charge plus a £30 charge for food. It made no reference to any standard care charges - which are a standard charge normally made for residents in extra care housing (ECH) covering their access, whether they use it or not, to round the clock support.
17. Mr X moved into the ECH in March 2020. At the time he received one 30 minute care each day. In April 2020 the Council carried out a six week review of Mr X’s care package. Mr X said he did not need the care anymore as he had the equipment in the shower to assist him to be independent. He asked the Council to suspend his care package.
18. In late April 2020 Mr X rang the Council. He said he had heard from other residents that they had to pay £79.51 a week (the standard care charge) for living at the ECH. The Council officer told him not to compare himself with other residents but he should look at the letter from finance which should provide him information about the financial contribution he needed to make towards his care costs. Mr X asked the Council to end his care package.
19. In September 2020 a Council officer visited Mr X. He said he did not understand the standard care charge for living at the ECH which had increased to £108.87. The officer advised Mr X he did not have to pay it as per his financial assessment.
20. The council officer spoke with the manager of the ECH. They said they had met with residents and had explained the standard care charge element was to cover the cost of on site staff at the ECH.. They said they explained residents were financially assessed to calculate what they could afford to pay. The manager said the provider had told residents about the charge before they were considered for a move to ECH.
21. In late September 2020 the Council reassessed Mr X’s financial contribution and concluded Mr X needed to pay £40.75 per week care contribution. Mr X appealed the charges. The Council responded in January. It said Mr X’s financial contribution was properly assessed and he was left with enough each week as per government guidance. It did not uphold the appeal. Mr X contacted the Council in February 2021 to say he refused to pay the weekly charge as he was not informed about it when he moved in, and he received no support. He formally complained to the Council in April 2021.
22. The Council reviewed Mr X’s needs in May 2021. Mr X said he was managing without care and was looking to move out of the ECH once the problem with what the Council said he owed was resolved. Mr X’s support plan following the review set out ‘supported living- block – cost £108.87 starting 26 May 2020’.
23. In May 2021 the Council responded to Mr X’s complaint. It explained the contribution to care charges was financially assessed in terms of affordability and Mr X was currently being charged £41.75 per week as his assessed contribution towards his care costs. It said the service ‘is a key aspect of extra care living and when service users are offered the chance to move into extra care, it is explained that this is a standard charge which is financially assessed., alongside any additional service costs specific to the needs of the individual tenant’. It said the assessor at the time conveyed this to Mr X.
24. In June 2021 the Council reviewed Mr X’’s financial contribution. It assessed he needed to pay £78.60 per week from July 2021. A community care worker visited Mr X who was unhappy about the contribution. Mr X said he would not have moved in had he known the cost but he did not want to move out until the debt was resolved.

Findings

25. Extra care housing works on the premise that residents pay a standard charge for care and support whether or not they use it. This is to cover the cost of a round-the-clock staff presence. It is not fault for this charge to be made for care available to residents at an ECH scheme.
26. The Council’s approach to charging for this support is to carry out a financial assessment in line with the Care and Support Statutory Guidance. The financial assessment is used to calculate the individual’s contribution to the cost of their care; that is to calculate their contribution to the ‘block charge’ for round the clock support in extra care housing plus any care package they receive to meet their individual assessed needs.
27. The Council properly assessed Mr X’ s financial contribution. It took into account his income and disability related expenditure and left him an amount in line with the minimum income guarantee level set by government. There was no fault in the way it carried out the financial assessment and calculated his financial contribution.
28. However, the Care and Support Statutory Guidance 2014 makes it clear that councils must be clear and transparent about charging for care and support needs so people know what they will be charged. There is no evidence the Council explained to Mr X there was a standard charge for care services when he first moved into ECH. There was no reference to the charge in his tenancy agreement or in his needs assessment and no evidence he was provided with any clear information about the charge before he agreed to move to ECH. The support plan sets out the charge but does not explain what it is. There was no letter, leaflet or other information provided to Mr X to explain there was a standard weekly charge for living in ECH. I cannot say what discussion Mr X had about charges with ECH staff. But even if they had mentioned charges, the responsibility for clear and transparent information lay with the Council. Its lack of information provided to Mr X is fault. This fault meant Mr X could not make a properly informed decision about whether the cost of moving into the ECH was justified by his needs.
29. Mr X needed minimal support and shortly after his move into ECH ended his individual package of care. Mr X has been left with a significant bill for a charge he was not made aware of and did not need. Had the Council acted without fault, Mr X could have decided whether or not to move into the ECH in the knowledge of what this would cost him. Subsequent assessments and decisions to end care mean he probably would not have decided on the move had the Council acted without fault.

Back to top

Agreed action

30. Within one month of the final decision, the Council has agreed to:
• apologise to Mr X and cancel his debt:
• discuss with Mr X whether he wishes to remain living at the ECH. If Mr X no longer wishes to live there it should support him with applying for social housing and not charge him his financial contribution for a period of up to three months while he seeks alternative accommodation. If Mr X decides to stay he will need to sign a new tenancy agreement which clearly outlines the service charges and will be liable for his financial contribution from the end of those three months.
• should Mr X move, pay him £400 towards the costs associated with this.
• ensure that the service charges for living in extra care housing are explained to potential tenants and information is provided in writing to them about the charges before they move in.

Back to top

Final decision

31. I have completed my investigation. There was evidence of fault leading to injustice which the Council has agreed to remedy.

Back to top

Investigator's decision on behalf of the Ombudsman