Summary: Mrs Y complained the Council failed to communicate effectively with her regarding her father’s care home charges. The Council was at fault for failing to advise Mrs Y of the outcome of a financial assessment. It has agreed to apologise to Mrs Y and pay her £250 to acknowledge the frustration and distress this caused. It has also agreed to review its procedures.

The complaint

1. Mrs Y complains the Council failed to communicate effectively with her and the care provider regarding the care charges for her father’s care home placement. This meant Mr X was not billed accurately and in a timely way for his care charges causing her distress and frustration and which led to a large demand for payment from the care provider.

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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. 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 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

4. I have considered the information provided by Mrs Y and discussed the complaint with her on the phone. I have considered the information provided by the Council and by the care provider.
5. I gave Mrs Y and the Council the opportunity to comment on a draft of this decision. I considered any comments I received in reaching a final decision.

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What I found

Relevant law and guidance

6. 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.
7. The rules state that people who have savings over the upper capital limit (currently £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.
8. The Mental Capacity Act 2005 introduced the “Lasting Power of Attorney (LPA)”. An LPA is a legal document, which allows a person (‘the donor’) to choose one or more persons to make decisions for them, when they become unable to do so themselves. The 'attorney' or ‘donee’ is the person chosen to make a decision on the donor’s behalf. Any decision has to be in the donor’s best interests.
9. There are two types of LPA: property and finance, which gives the attorney power to make decisions about the person’s finance and property matters, and health and welfare which gives the attorney power to make decisions about the persons health and personal welfare.

What happened

10. Mr X lived at home with his wife Mrs X. Mr X has a diagnosis of dementia. In June 2021 the Council suggested a period of respite for Mr X as Mrs X was finding it difficult to manage Mr X’s care and support needs.
11. The Council identified a respite placement but Mrs X and her daughter Mrs Y were not happy with the proposed placement. The social worker provided them with information on other care homes and Mrs Y identified a care home with a vacancy. The Council confirmed with the care home it had availability but it required a £84 a week top up. The Council spoke with the care provider and noted the care provider said Mrs Y feels Mr X may be a self-funder and the family were looking into Mr X’s finances to establish his savings. The care provider advised the Council its self-funder fee was £918.75 a week.
12. Mr X moved into the care home in late June 2021 for a six week respite placement and the Council issued Mrs X with a financial assessment form.
13. In mid-July 2021 Mrs Y emailed the care provider as she thought Mr X may need support on a permanent basis as Mrs X would not be able to meet his needs. She asked the care provider for information on its fees. The care provider responded ‘cost of self-funding EMI placement is £918.75 a week or if funded by the local authority the third party top up fee would be £84 a week. You would need to discuss a permanent placement with your allocated social worker in the first instance if [Mr X] was to be funded by the local authority, if self-funding then we can discuss a permanent placement ourselves’.
14. The Council had yet to receive the completed financial assessment form and sent a reminder to Mrs X. Mrs Y emailed the Council to advise she was supporting Mrs X to collate the financial information and would sort this as soon as possible.
15. Mrs Y contacted the social worker and asked what they would need to do for the placement to become permanent and the social worker agreed to organise a review. Mrs Y completed and returned the financial assessment form in late July.
16. The Council carried out a reassessment and mental capacity assessment and in early August 2021 and confirmed it was in Mr X’s best interest to remain in the care home in a permanent placement. In August 2021 Mrs Y got LPA for Mr X’s property and finances.
17. In mid-August 2021 the Council completed a financial assessment which showed Mr X was over the financial threshold. It noted it would remove its contract with the care provider. The Council emailed Mrs Y that as Mr X had over the financial threshold he would need to pay the full cost of his respite placement at £592.82 a week up to the date the placement became permanent. It did not provide any information on paying for the placement once it became permanent
18. In early November 2021 the care provider sent Mrs Y a copy of its service user’s handbook. This stated the date of commencement of the contract as late June 2021 at a rate of ‘£678.82 (£594.22 LCC and £84 top up fee)’. The funding source detailed was social services.
19. In mid-January 2022 the care provider contacted the Council as payments for Mr X’s care had ceased. It asked the Council to confirm if there had been a change in funding. The Council confirmed Mr X was a self-funder and should have been since August 2021.
20. In mid February 2022 the care provider wrote to Mrs Y. It confirmed Mr X should be privately funded from 20 August 2021. This generated a balance of £24,102.75 owed on the account as the weekly private rate was £918.75 a week. In a letter issued later that month it explained the rate would be increasing to £987.66 per week from 1 April.
21. Mrs Y asked the care home to explain why the rate was so much higher than that set out in the contract she was provided. The care home explained how the different rates were calculated and in April 2022 the care provider issued a new contract to Mrs Y at a weekly rate of £987.66 which Mrs Y agreed to pay from April 2022. Mrs Y was unhappy the care provider issued her a contract for a lower rate in November 2021 and said she expected the care provider to honour that contract. The care provider responded in July 2022. It said Mr X ceased to be funded by the Council in August 2021 and as a privately funded resident is charged the privately funded rate. It requested Mrs Y settle the arrears on the account and pay the correct rate going forward.
22. In mid July 2022 the care provider confirmed Mr X owed £10,125.89 which was due for payment.
23. In mid October 2022 the care provider contacted the social worker to advise that Mr X’s family had not been paying the self-funder rate and a debt had built up. It asked the social worker to raise this with the family. The social worker emailed the residential charging team to confirm if anything was sent to the family at the time Mr X was confirmed as self-funding. The residential charging team advised they did not send anything out but the family were paying self-charging rates and had been in contact as Mr X’s finances were reaching the threshold.
24. The social worker spoke to Mrs Y who considered Mr X was approaching the financial threshold. The social worker sent Mrs Y a charging leaflet and information about the debt. They explained the placement would require a top up fee of £95 a week as the rate was higher than the Council would pay for a residential placement. If the family could not afford this it should let the Council know as, if not, Mr X may need to move care homes. Mrs Y signed and returned the completed financial assessment form.
25. The social worker emailed the care provider in late October 2022. They said when Mr X ‘was assessed as a self-funder, someone from the Council should have informed you at the time of this, so apologies that it was not done. I’ve only just discovered myself that our residential charging team (who carry out financial assessmnet sand who declared [Mr X] is a self-funder) do not inform families of the outcome of assessments unless they are eligible for LA funding. They presumed his social worker at the time would do so and possible they also presumed the social worker would inform yourselves’. They said they had raised this with their manager. The Council took over Mr X’s funding for care from late October 2022.
26. Mr X moved out of the care home in January 2023.

Findings

27. Due to the complexities of Mr X’s finances, Mrs X did not complete and return the financial assessment form until late July 2021. The Council acted without delay and completed the financial assessment in mid-August 2021. There was no fault in the way it carried out the financial assessment.
28. Mrs Y was aware that Mr X may be required to self-fund his care and when Mrs Y completed the financial assessment the Council advised her of the revised rate for Mr X’s respite stay. However, it failed to inform her that Mr X would be required to start paying for his care as a self-funding permanent resident following this, or what the anticipated costs may be. This was fault.
29. The Council also failed to notify the care provider when it determined that Mr X should be a self-funder, or the date this applied from, so it could not notify Mrs Y of the changes in timely manner. These faults caused Mrs Y distress and frustration and led to a large, backdated care bill.
30. Mr X received the care and remained in the care home even after the family were made aware of the costs of the care so I cannot say they would have acted differently had they known the care costs sooner. However, the Council’s delay caused frustration and time and trouble.

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Agreed action

31. Within one month of the final decision the Council has agreed to apologise to Mrs Y and pay her £250 to acknowledge the frustration and distress caused by its failure to communicate properly with her regarding Mr X’s care charges.
32. Within two months of the final decision the Council has agreed to review its procedures to ensure:
• people are notified when a financial assessment indicates they will be required to self-fund their care; and
• care providers are promptly notified of a change in the financial arrangements of a care package.
33. The Council should provide us with evidence it has complied with the above actions.

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Final decision

34. I have completed my investigation. There was evidence of fault causing injustice which the Council has agreed to remedy. It has also agreed to make service improvements.

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Investigator's decision on behalf of the Ombudsman