Summary: Mr X complained about the Council’s financial assessment for his father, Mr Y’s, care and support charges. The Council failed to properly consider maintenance costs for Mr Y’s stairlift. The Council has offered to do so now. I found the Council properly considered the rest of Mr Y’s expenditure.

The complaint

1. Mr X complained about the Council’s financial assessment for his father, Mr Y’s, care and support charges.
2. Mr X said the Council has not left Mr Y with enough money to cover the costs of expenses.
3. Specifically, Mr X referred to expenses Mr Y incurred for cigarettes, pet insurance, social outings, and maintenance of his stairlift. Mr X considers the Council should allow for these expenses as disability relates expenditure (DRE) due to Mr Y’s dementia.

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The Ombudsman’s role and powers

4. 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 significant injustice, or that could cause injustice to others in the future we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
5. 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

6. As part of the investigation, I considered the complaint and the information Mr X provided.
7. I made written enquiries of the Council and considered its response along with relevant law and guidance.
8. Mr X and the Council had an opportunity to comment on my draft decision before I reached a final decision.

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What I found

Charging for social care

9. Councils have a duty to arrange care and support for those with eligible needs, and a power to meet both eligible and non-eligible needs in places other than care homes. A council can choose to charge for non-residential care following a person’s needs assessment. Where it decides to charge, the 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)
10. Where a council has decided to charge for care, 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. A council must not charge more than the cost it incurs to meet a person’s assessed eligible needs.
11. People receiving care and support other than in a care home need to keep 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

12. Councils can take disability-related benefit into account when calculating how much someone should pay towards the cost of their care. When doing so, a council should make an assessment to allow the person to keep enough benefit to pay for necessary disability-related expenditure (DRE) to meet any needs it is not meeting. The Care and Support Statutory Guidance sets out a list of examples of such expenditure. It 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.
13. The Council’s financial assessment policy
14. The Council’s policy sets out what it will generally fund or allow for, and what it generally will not. It will exercise discretion and consider reasonable additional costs directly related to a person’s disability.
15. The Council aims to use public funds wisely and will not make awards ‘the man in the street’ would consider overgenerous or unreasonable.
16. The Council also aims to ensure allowances for DRE do not duplicate services or funding it is already providing.
17. The Council’s policy confirms the national Disabled Facilities Grant (DFG) scheme provides funding for adaptations and equipment. The Council will therefore refer people to the DFG for major adaptations and disability equipment. The policy also confirms the DFG will not fund maintenance of equipment, such as stairlifts.
18. The Council’s policy states keeping pets is a personal choice. It will not fund or allow DRE for pet costs.

What happened

19. I have summarised below some key events leading to Mr X’s complaint. This is not intended to be a detailed account of what took place.
20. The Council carried out a new financial assessment for Mr Y in October 2022. As a result of the assessment, the Council reduced the contribution Mr Y had to pay towards the cost of his care and support.
21. Mr X did not agree with the result of the assessment. He said there was a lot more information the Council must consider about Mr Y’s disability and the extra care his dementia entails.
22. The Council sent Mr X a DRE form to complete.
23. Mr X sent details of Mr Y’s DRE in November 2022. This included expenditure for chiropody, mileage costs for Mr X to do Mr Y’s cleaning and gardening, cigarettes, broadband, battery powered motion lights, heating costs, and hearing aid batteries.
24. The Council completed its review in February 2023. It allowed Mr Y’s expenditure for chiropody, mileage for cleaning and gardening, and hearing aid batteries. The Council reduced Mr Y’s contribution to his care charges, backdated to 7 June 2022.
25. Mr X complained to the Council on 20 March 2023. He said adjustments made after the appeal were not enough to help Mr Y and the Council had not taken account of Mr Y’s daily needs, the need to keep him safe in his home, and to keep him calm and relaxed. He asked for the following costs to be included:
• Smoking. Mr Y is obsessed with cigarettes and smoking, which Mr X said is an effect of his dementia. Mr Y gets agitated and confused if he runs out of cigarettes.
• Hearing aid batteries. Mr Y uses more batteries than the Council allowed for and will often throw working batteries away.
• Stairlift service contract. Mr Y’s stairlift needs to be serviced regularly to keep it working safely.
• Pet insurance. Mr Y’s dog is a great companion which reduces his anxiety.
• Broadband. This is necessary to operate cameras so the family can keep an eye on Mr Y, to speak to him via a wireless speaker, and to adjust the heating remotely.
• Batteries for motion lights. Mr Y gets up in the night but does not turn lights on, so is at risk of falls.
• Heating costs. The family must keep the heating on during the day or Mr Y gets cold and tries to access the boiler or the gas cooker himself.
• One weekly trip out. Mr X wanted to take Mr Y out once a week and he needed money for things like coffee.
26. Mr X said he would also like to add costs associated with personal care and incontinence, as Mr Y has had several accidents recently.
27. The Council wrote to Mr X in June 2023 with a new decision after considering his complaint.
28. It allowed more for hearing aid batteries. It also allowed expenditure for broadband and batteries for motion lights.
29. It did not allow anything for washing or sanitary products, as Mr Y’s care plan does not specify incontinence within his care needs. It said sanitary products can be obtained from the National Health Service.
30. It did not allow expenditure for cigarettes or trips out, as it said they should be paid for from Mr Y’s available income. It said if Mr X felt Mr Y needs more support to access the community, he should contact the social work team.
31. It did not allow expenditure for pet insurance. It said it does not fund the cost of pets as companions.
32. It did not allow stairlift maintenance. It said it does not allow for service and repair of disability equipment, only its installation.
33. It also did not allow anything for gas, electricity, or water as Mr Y’s expenditure for these was not above the national average.
34. The Council reduced Mr Y’s contributions again, backdated to 2 May 2022.
35. Mr X remained unhappy the Council did not allow expenditure for Mr Y’s cigarettes, pet insurance, social outings, and maintenance of his stairlift. He therefore brought his complaint to the Ombudsman.

My investigation

36. The Council told me it conducted a financial assessment in line with the Care Act and its policy. Apart from stairlift maintenance, the Council considers the other expenditure claimed are general living expenses to be paid for from Mr Y’s income.
37. The Council said smoking is not considered an assessed need and would not improve overall health or wellbeing. Mr Y’s smoking is a lifestyle choice, not related to his disability and predates his diagnosis of dementia. It also referred to an email from Mr X, dated 8 April 2023, stating Mr Y’s smoking reduced.
38. The Council also said to allow expenditure for a smoking addiction for someone with care and support needs would be unfair on those with a smoking addiction who do not have care and support needs.
39. The Council said its policy does not cover pet expenses. Without evidence a pet provides assistance with disability related needs, such as trained assistance dogs, it would not allow pet costs as DRE. It said there is no evidence in Mr Y’s care plans that his dog assists with his disability. Again, it said Mr Y’s dog was a lifestyle choice preceding his dementia diagnosis.
40. The Council said it provides social care, via carers, for 5 hours a week. It tried a day centre, but it was not suitable. It considers it has provided for Mr Y’s assessed needs for social interaction. In line with its policy, it will not allow DRE for services it already funds. The costs of the activities chosen for Mr Y are the same as for other members of the public, they are not increased due to Mr Y’s disability. The Council therefore considers the activities to be general living expenses.
41. The Council told me, after recent clarification on the wording of its policy, it will now consider Mr Y’s stairlift maintenance. It will ask Mr X for more information about this.

Analysis

42. The statutory guidance says DRE should not be limited to things that are necessary for care and support, so the Council can consider the extras Mr X requested. However, additional costs should be reasonable and should be linked to a person’s disability.
43. The Council considers Mr Y’s smoking is a lifestyle choice which has been ongoing for many years. I appreciate Mr Y’s condition means he cannot regulate how much he smokes, but the Council considers it can be controlled by carers and family. I did not find evidence of fault in the Council’s decision-making.
44. Likewise, I did not find fault with the Council’s decision not to allow expenditure for pet insurance. The decision is consistent with the Council’s policy. While I appreciate pets can help with anxiety, this is not linked to any care needs resulting from Mr Y’s disability in his care and support plan. Mr Y’s pet is not an assistance pet, he has had it since before his dementia diagnosis. There is also no evidence Mr Y pays higher than average pet insurance costs due to his disability.
45. The Council’s position on expenditure for social outings is that it is already funding care and support for Mr Y’s social needs. If Mr Y needs more support for this, the Council said it should be considered as part of his care needs assessment. The Council gave considered reasons why it would not allow for added expenditure here, and I did not find fault in its decision-making.
46. The statutory guidance specifically states councils should consider allowing expenditure for above average heating costs. While I appreciate Mr Y may pay more for gas, electricity, and water after his dementia diagnosis, the Council does not consider the costs are above average. I did not see evidence of fault in this decision.
47. The Council told Mr X its policy only allows for the costs of installing disability aids, such as stairlifts, not their maintenance. However, the Council has confirmed that was not a correct reading of its policy. That was fault. I found the Council’s policy only says the DFG will now allow maintenance costs for stairlifts. It does not say the Council cannot consider these costs. The fault caused uncertainty about whether this expenditure is allowed. The Council will now consider the maintenance costs for Mr Y’s stairlift. I consider that is a suitable remedy for the injustice.

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Agreed action

48. Within four weeks of my final decision, the Council will seek relevant details from Mr X about the maintenance costs for Mr Y’s stairlift.
49. Within eight weeks of my final decision, the Council will provide Mr X with a decision on whether it will allow maintenance costs for Mr Y’s stairlift as DRE.
50. The Council should provide us with evidence it has complied with the above actions.

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Final decision

51. I have completed my investigation. The Council failed to properly consider maintenance costs for Mr Y’s stairlift. The Council has offered to do so now. The Council properly considered the rest of Mr Y’s expenditure.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman