Summary: Mrs X complained on behalf of her late aunt, Mrs Y about the way the Council handled her care contribution fees. We have found no fault with how the Council reached its decision not to waive Mrs Y’s fees.

The complaint

1. Mrs X complained on behalf of her late aunt, Mrs Y. She said the Council told her aunt that she would not need to pay for care but then invoiced her. She said the Council said it would waive the fees but then changed its mind.

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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 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)
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 Mrs X’s complaint and have spoken to her about it.
5. I have also considered the Council’s response to Mrs X and to my enquiries.
6. Mrs X and the Council had an opportunity to comment on my draft decision. I considered any comments received before making a final decision.

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What I found

Care charging

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 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).

Hospital discharge

8. Schedule 3 to the Care Act 2014 and the Care and Support (Discharge of Hospital Patients) Regulations 2014 set out arrangements for the discharge of hospital patients with care and support needs.

Intermediate Care and Reablement

9. Intermediate care and reablement support services are for people usually after they have left hospital or when they are at risk of having to go into hospital. They are time-limited and aim to help a person to preserve or regain the ability to live independently. The National Audit of Intermediate Care lists four types of intermediate care:
• crisis response – services providing short-term care (up to 48 hours);
• home-based intermediate care – services provided to people in their own homes by a team with different specialties but mainly health professionals such as nurses and therapists;
• bed-based intermediate care – services delivered away from home, for example in a community hospital; and
• reablement – services to help people live independently which are provided in the person’s own home by a team of mainly care and support professionals.
10. Regulations require intermediate care and reablement to be provided without charge for up to six weeks. This is for all adults, whether or not they have eligible needs for ongoing care and support. Councils may charge where services are provided beyond the first six weeks but should consider continuing providing them without charge because of the preventive benefits. (Reg 4, Care and Support (Preventing Needs for Care and Support) Regulations 2014)

What happened

Background

11. Mrs X’s late aunt (Mrs Y) received care from the Council in 2018/19. Mrs Y signed a client charging notification (CCN) form which said she understood she would need to contribute to her care costs. Mrs Y struggled to pay for the care so she cancelled the package and the Council set up a repayment plan for her.

2021 discharge from hospital

12. In September 2021, Mrs Y was admitted to hospital. Her discharge assessment identified the care and support Mrs Y needed when she returned home, it also noted that Mrs Y had capacity and did not need an advocate. Initially the cost of the care was met through the reablement programme.
13. On 17 September 2021, Mrs Y was discharged from hospital. The Council visited Mrs Y and she signed a client charging notification (CCN) form. This should show that Mrs Y understood that she would need to contribute to her care costs once the reablement package ends. In hindsight, it appeared that Mrs Y did not understand.
14. The Council’s notes suggest that Mrs Y was happy to have long term care via an agency. The agency began Mrs Y’s care package on 11 October 2021. On 15 October the client contribution team contacted Mrs Y and explained that a financial assessment would be required to determine how much Mrs Y would need to contribute to her care fees.
15. On the 27 October, the Council visited Mrs Y and explained that reablement had stopped and care had been transferred to a care agency.
16. Despite several phone calls and the delivery of a postal financial assessment form, the Council was unable to obtain the details needs to carry out a financial assessment of Mrs Y. Eventually on 2 December, Mrs Y’s son contacted the Council. He said he thought the financial assessment had already been carried out. The Council arranged a telephone assessment for the next day. The Council sent a letter advising Mrs Y of the charges the same day.

Client contribution concerns

17. In January 2022, the Council sent Mrs Y the first invoice for the care she had received after being discharged from hospital. The Council explained that invoices for adult social care services are issued on a 4-5 week cycle so this was the earliest it could send one to Mrs Y following her financial assessment.
18. In February 2022, Mrs Y raised concerns over her client contribution. She said in the past, she had been told that she did not need to pay for care. Upon investigation, the Council discovered that Mrs Y was referring to a conversation with someone from the reablement team. The Council explained this was a period of free care but when it became a long term arrangement and Mrs Y signed the CCN form, she would then have been means tested and required to contribute.
19. Mrs Y said she could not afford to pay what the Council was asking to contribute. She said she was considering cancelling her care. The Council spoke to Mrs Y’s son who had concerns that his mother would not be able to cope without care.
20. In early March 2022, Mrs X cancelled her care package.

Mrs X disputes care contribution

21. A week later, Mrs X (Mrs Y’s niece) contacted the Council. She wanted to discuss why her aunt’s care had been cancelled. Mrs X met with the Council to discuss her aunt’s care fees.
22. Mrs X took from this meeting that the Council had agreed to waive Mrs Y’s outstanding care fees. The Council clarified that it would try but could not guarantee the fees would be waived.
23. On 5 October 2022, a Council officer contacted Mrs X to inform her that they were awaiting a signed waiver form and that once it had been received, they would process the write off. An internal Council email showed that on 13 October, an officer asked a senior officer to authorise the waiver so they could process the write off for Mrs Y.
24. The Council said that any waiver requests are agreed by the Head of Service or Assistant Director/ Director and therefore an officer could not make the decision to waive fees.
25. The Council did not agree to waive Mrs Y’s care fees as there were too many unanswered questions. The Council said there was not enough evidence that Mrs Y did not understand the process of paying despite signing the CCN form. The Council recommended that Mrs X pursue this through the Council complaints process to allow a full investigation.

Formal complaint

26. Mrs X submitted a complaint to the Council. She said she believed this was just a formality to get the fees waived. In February 2023, the Council responded to Mrs X’s complaint. It recognised that there could have been some confusion relating to the period of reablement from 17 September to 10 October 2021 as charges did not apply to this service for this period.
27. The Council said that there was no evidence that the Council had told Mrs Y that she did not need to pay for care. It also added that every effort had been made to carry out a financial assessment much sooner than it was made. It said that had there been engagement sooner in the financial assessment process, bother the assessment and the invoice would have been completed and received at an earlier date.
28. The Council did not uphold Mrs X’s complaint. It did however write off any charges incurred before contact from the client contribution team on 15 October. This was in recognition that there could have been some confusion during the transition between reablement and ongoing care.

At the time of Mrs X’s complaint to the Ombudsman, the outstanding balance on Mrs Y’s account was £3,567.78.

My findings

29. The Council spoke to Mrs Y about care charges, and she signed a CCN form acknowledging she understood in September 2021. The Council followed this up in October when the reablement care ended and the care became chargeable. I have found no fault with the Council’s actions here.
30. Although the financial assessment was delayed, so the exact care contribution was not known until December 2021, I am satisfied that the Council had informed Mrs Y that she would need to pay for her care.
31. Therefore, it should not have come as a surprise when she received the invoice in January 2022. The Council explained why she did not receive an invoice until January. There was no fault here.
32. The Council recognised there may have been some confusion during the transition between reablement and chargeable care. It used its discretion to write off the care contributions for this early part of Mrs Y’s care. I support this.
33. I note that Mrs X said that the Council advised Mrs Y that she did not need to pay and that an officer told Mrs X the fees were waived. However, in the absence of evidence to support this, on balance, I consider the Council to have followed correct procedures and reached its decision regarding Mrs Y’s care contributions without fault.

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Final decision

34. I have completed my investigation. I have found no fault with how the Council reached its decision to not waive Mrs Y’s care fees.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman