Summary: Mrs C complained her family was not properly advised about the charges involved in securing a placement for her mother in a residential care home. Mrs C said she was not able to make a properly informed decision about her mother’s care and incurred unexpected costs. We found fault by the Council but considered the action it had already proposed of waiving some fees, symbolic payment and service improvements provided a suitable remedy.

The complaint

1. The complainant, whom I shall refer to as Mrs C, complains her family was not properly advised about the charges involved in securing a placement for her mother in a residential care home on being discharged from hospital. Mrs C says the Council sourced the placement and told her it was the only option available with a vacancy that could meet her mother’s needs. Mrs C say she felt pressured into agreeing the placement and was wrongly told it would be at the local authority room rate and she would not need to pay any additional charges for the first twelve weeks.
2. Mrs C says because of the Council’s fault, she was not able to make a properly informed decision about her mother’s care and incurred unexpected 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 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)
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 read the papers provided by Mrs C and discussed the complaint with her. I have also considered information from the Council. I have explained my draft decision to Mrs C and the Council and provided an opportunity for comment.

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What I found

Background and relevant legislation

6. The Care Act 2014 (section 14 and 17) provides a legal framework for charging for care and support. It enables a council to decide whether to charge a person when it is arranging to meet their care and support needs, or a carer’s support needs. The charging rules for residential care are set out in the Care and Support (Charging and Assessment of Resources) Regulations 2014 and councils should have regard to the Care and Support Statutory Guidance.
7. If a person is eligible for council funded care, the council must find them a care home within their personal budget. A person can choose a care home that is more expensive than the amount set out in the personal budget. They will then have to pay a top-up fee which is the difference between the care home fees and the amount set in the personal budget. This top-up fee is normally paid by a third party.
8. In supporting self-funders to arrange care, the local authority may choose to enter into a contract with the preferred provider, or may broker the contract on behalf of the person. The local authority should assure itself that robust contractual arrangements are in place in such circumstances that clearly set out where responsibilities for costs lie and ensure that the person understands those arrangements.
9. A council must disregard the value of a person’s property in their financial assessment for the first 12 weeks of a permanent care home placement.

What happened

10. Mrs C’s mother moved to a residential care home after being discharged from hospital. Mrs C has confirmed her mother still lives at the care home and is happy there. Mrs C says her mother’s property has now been sold and she is a self-funder. Mrs C and her sister hold a power of attorney for their mother’s affairs.
11. The Council sent an email on 3 April to Mrs C’s sister with general information and advice about care charging. Charging information leaflets were also provided to Mrs C on 4 April at the hospital.
12. The family visited the residential home before their mother moved in and the Council understood the manager of the home had informed them of the top-up fees during the 12-week property disregard period and going forward.
13. The Council stated in an email to the family on 27 April that… “This is a local authority rate placement – weekly cost £750” and on 28 April that “You don’t need to find extra money at this stage.” The Council also says in an email on 28 April that it has spoken to the home and asked it to disregard the self-funder application as it was a local authority rate room of £750 per week. This was incorrect.
14. Mrs C’s mother moved to the home on 30 April.
15. The Council telephoned Mrs C on 4 May and confirmed it had provided incorrect information about the top-up requirement during the 12-week property disregard. This would be payable. Two possible options were discussed. The first was to accept the home’s terms and conditions and pay the extra £780 per week in addition to the local authority funding at £750 per week. The alternative was to move Mrs C’s mother to a different placement that did not require a top-up fee.

16. The Council followed this discussion up with an email on 5 May. The Council provided an apology for what had happened and the impact in terms of inconvenience and distress. The Council understood the family had decided to maintain the placement. The Council provided details of how to make a complaint about what had happened. The matter progressed though the Council’s complaint procedure.
17. Mrs C’s sister signed a contract with the care home on 17 May.
18. The residential home wrote to inform the family on 16 June that the Council would pay £750 per week for a period of 12 weeks towards the cost of their mother’s accommodation fees. The letter confirmed the 12-week property disregard period started on 30 April and would end on 22 July. The letter also set out this would leave a weekly amount of £780.89 to pay being the difference between the privately funded charge of £1,530.89 and the £750 per week for the 12 week period. The residential home included an invoice for the period 30 April to 22 July for £9,370.68 which was 12 weeks at £780.89 per week.
19. The Council in its complaint correspondence has acknowledged Mrs C did not know the full cost of the placement when this was offered. I note the Council has changed the procedure in its brokerage team to ensure social workers are given the total cost of a placement and the Council’s contribution with an explanation of any top up payable.
20. The Council offered to pay Mrs C the amount of the top up fee for the period 30 April to 5 May 2023 which was £668.57. The Council also offered Mrs C and her sister £500 each to recognise the distress caused.

My consideration

21. The Council accepts it provided the family with incorrect information relating to the top-up fee following Mrs C’s mother’s move to the residential home. This is fault. Although there is evidence that some information was made available about charging this should have been clearer. It should not have been a surprise to the family that the top up would need to be paid from the outset.
22. When poor advice or inadequate information about care costs is identified as fault, the Ombudsman considers it is usually appropriate to recommend an apology and the provision of a suitable payment plan for any accrued debt where necessary. If there is remaining significant injustice, we may also recommend a symbolic payment in line with our general approach to distress.
23. I consider the fault identified above will have caused Mrs C and her family a degree of distress and frustration during an already difficult time. There is also uncertainty caused as I cannot say, even on balance, whether Mrs C would have declined the placement for her mother had she fully understood the care charges earlier. I do note the charges were made clear within a few days of Mrs C’s mother moving to the home. In these circumstances, I cannot say the charges are not payable or should be waived for the full 12-week period.
24. I am satisfied the Council’s proposals of paying Mrs C the amount of the top up fee for the period 30 April to 5 May 2023 which was £668.57 and paying both Mrs C and her sister £500 each to recognise the distress, frustration and uncertainty caused by not being told about the charges earlier provide a suitable remedy and we would not seek more.
25. The Council has already introduced improvements to the way it deals with this type of charging situation and so I do not consider it necessary to make a service improvement recommendation.

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Final decision

26. I have completed my investigation as there was fault, but I consider the proposed action by the Council provides a suitable remedy.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman