Summary: Miss C complained about the Council failing to explain the costs of her father-in-law Mr X’s care package, failing to reduce the care package when Mr X requested and discharging him from hospital with no care package. This caused Mr X stress and care cost he could not afford. We find fault by the Council. The Council has agreed to our recommendations to address this injustice.

The complaint

1. The complainant, Miss C, complains on behalf of her father-in-law, Mr X. Miss C complains about the following:

• The Council failed to initially explain in full the costs of Mr X’s care package
• The Council failed to reduce the care package when Mr X requested
• Mr X was discharged from hospital with no care package

2. Miss C said this has caused Mr X significant stress and he is unable to afford the care costs.

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The Ombudsman’s role and powers

3. 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)
4. If we are satisfied with an organisation’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

5. I spoke with Miss C about her complaint. I considered any documents provided by Miss C and the Council.
6. Miss C and the Council had an opportunity to comment on my revised draft decision. I considered their comments before making my final decision.

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What I found

What should have happened?

Charging for social care services: the power to charge

7. A council has a duty to arrange care and support for those with eligible needs, and a power to meet both eligible and non-eligible needs in settings other than care homes. A council has discretion to charge for non-residential care following a person’s needs assessment. Where it decides to charge a council must follow the Care and Support (Charging and Assessment of Resources) Regulations 2014 and have regard to the Care Act statutory guidance. (Care Act 2014, section 14 and 17)

How to assess; Thresholds; DRE

8. Where a council has decided to charge, it must carry out a financial assessment to decide what a person can afford to pay. It must then give the person a written record of the completed assessment. Councils have no power to assess couples according to their joint resources. Each person much be treated individually. A council must not charge more than the costs it incurs to meet a person’s assessed eligible needs.
9. People receiving care and support other than in a care home need to retain a certain level of income to cover their living costs. Councils’ financial assessments can take a person’s income and capital into consideration, but not the value of their home. After charging, a person’s income must not reduce below a weekly amount known as the minimum income guarantee (MIG). This is set by national government and reviewed each year. A council can allow people to keep more than the MIG. (Care Act 2014.)

Disability Related Expenditure

10. Where a council takes disability-related benefit into account when calculating how much a person should contribute towards the cost of their care, it should make an assessment to allow the person to keep enough benefit to pay for necessary disability-related expenditure (DRE) to meet any needs the council is not meeting. The Care and Support Statutory Guidance sets out a list of examples but says any reasonable additional costs directly related to a person's disability should be included. What counts as DRE should not be limited to what is necessary for care and support. For example, above average heating costs should be considered.

What did happen?

11. This section sets out the key events in this case and is not intended to be a detailed chronology.
12. Mr X was discharged from hospital in December 2021 following a stroke. He lived with his ex-wife and son. An assessment completed by the Council confirmed Mr X would be discharged with four care calls per day to assist with personal care, mobility and transfers. This was a temporary care package.
13. Mr X’s ex-wife, Mrs Y, asked the Council to reduce the care calls to one a day as she said she would assist with his care needs. Mr X agreed to this.
14. Miss C called the Council the following month. She asked the Council to urgently increase Mr X’s care. Due to a serious incident involving Mrs Y being abusive towards Mr X, police removed her from the address. Miss C said Mrs Y had not been supporting Mr X.
15. On 13 January 2022 it was agreed Mr X would receive four doubled up care calls per day. Double up calls are when two carers are required to meet an individual’s needs.
16. The Council’s notes stated Mrs Y returned to the property the following day. It said it needed to consider any ongoing risks.
17. A Care Act assessment completed the following month stated Mr X required ongoing daily support. It was agreed Mr X would receive support from carers, family and Mrs Y. The assessment noted the Council officer explained Mr X would need a financial assessment to determine his contribution to his care package and any assessed contribution would be backdated.
18. The new care package commenced on 24 February 2022.
19. The Council sent Mr X a letter in April 2022. It said it had referred him for a financial assessment. It said if Mr X was assessed as needing to contribute towards his care package, this would be payable from the start date of the chargeable care service.
20. In the same month the care staff reported issues with Mr X’s care package. The Council’s notes stated Mrs Y had left Mr X with no food at times, not administered his medication and was abusive daily to Mr X and his carers.
21. A Council officer visited Mr X at home and discussed the possibility of him staying with Miss C and getting support for Mrs Y.
22. Miss C and Mr X completed the financial assessment form the following month. The Council’s notes stated Mr X was worried about the care costs and had been cancelling lunchtime care calls.
23. The Council’s letter to Miss C and Mr X dated 18 May 2022 stated Mr X’s maximum assessed weekly contribution would be £108.59 from the date his chargeable services commenced.
24. Miss C told the Council Mr X could not afford the weekly charges and asked if Mr X could cancel or reduce the care. The Council said it was unlikely reducing the calls would affect the cost. It offered to send Miss C a DRE form.
25. On 24 May 2022 Mrs Y was arrested with conditions to not contact Mr X. The Council called Mr X the following day. He said the care package was meeting his needs.
26. Miss C asked the Council for help in completing the DRE form. She said as Mrs Y was no longer at the property, Mr X needed a cleaner. The Council responded and said if DRE costs were not in place, the form cannot be completed.
27. Miss C then complained to the Council. She asked the Council to alter Mr X’s care package to one carer as Mrs Y was no longer at the property.
28. Mr X was awarded attendance allowance in May 2022. This brought his weekly contribution up to £170.29.
29. A Care Act assessment completed in July 2022 stated Mr X wanted to continue having support from carers. It was noted that Mr X’s family are maintaining the home and Mr X’s neighbours and son were supporting him with food and fluid.
30. A Care Act assessment completed the following month stated the doubled-up care calls would remain. It was noted that as Mrs Y may return home, it would be difficult to increase the care back if it was removed.
31. In the same month Mrs Y returned to the home.

My findings

32. The Council have provided evidence that Mr X was discharged from hospital in December 2021 with a temporary care package of four care calls per day. This was later reduced to one care call per day at Mrs Y’s request. But Mr X agreed to this. We cannot criticise the Council for this as Mr X had agreed to reduce the care.
33. Miss C told us the Council failed to initially fully explain the costs of Mr X’s care package and any potential backdated charges. But the Care Act assessment completed 3 February 2022, says the Council officer explained to Miss C and Mr X that any charges Mr X is assessed as having to pay, “will be backdated to the 8th day following the brokerage team receiving the request to source ongoing care”. It was also explained that there were delays in completing the financial assessments and the Council was able to charge for the care retrospectively. The financial assessment letter issued to Mr X on 4 April 2022 also stated any assessed charges would be payable from the start date of the chargeable care service. I am therefore satisfied the Council made Miss C and Mr X aware of the possible charges and how it would be backdated.
34. The Council told us the reason for the doubled-up care calls was for the safety of the carers when Mrs Y was there. It said Mr X’s assessed needs could be managed with single care calls. When Miss C and Mr X asked the Council to reduce the care calls because Mr X could not afford it, the Council said it was unlikely this would affect the cost and said it would be difficult to increase the care back if needed. The Council has provided no evidence it properly explained to Mr X and Miss C why a reduction in care would not reduce the costs. This is fault. When Mrs Y was removed from the property, the Council should have properly considered Mr X’s request to reduce the care. This would have caused uncertainty to Mr X as to whether the costs to him could have been reduced at times. The Council would then have needed to reassess Mr X’s change in circumstances on Mrs Y’s return.
35. Miss C told us Mr X is in debt and unable to meet the care costs. The Council has provided a copy of both of Mr X’s financial assessments. The minimum income guarantee on both assessments is in line with Government guidance. As the care charges were due there are no grounds for us to recommend a waiver of any of the fees. When Miss C raised concerns about the weekly charges, the Council sent her a DRE form. Once evidence of DRE costs had been provided, a further financial assessment was completed which included a DRE allowance of £25.

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Agreed action

36. To address the injustice caused by fault, within one month of my final decision the Council has agreed to:

• Apologise to Miss C and Mr X for not properly considering their request to reduce Mr X’s care.
• Review Mr X’s care package and properly consider his request to see if it would make a difference to his contribution. If it would have made a difference between May and August 2022 when Mrs Y was not at the property, the Council should backdate any reduced costs during this period.

37. The Council should also provide evidence that it has followed the recommendations.

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Final decision

38. There was fault by the Council. The actions the Council has agreed to take remedy the injustice caused. I have completed my investigation.

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Investigator's decision on behalf of the Ombudsman