Summary: Mr X complains the Council incorrectly assessed the contributions his late mother, Mrs Y, had to make towards her care which resulted in a backdated invoice and additional contributions. He also says the Council stopped paying its contribution to his mother’s Direct Payment account without telling him. Mr X says this caused him distress and to have to find a large sum of money with no prior notice. We have found fault in the actions of the Council for not advising Mr X payments would stop and recommend an apology and a financial payment.

The complaint

1. Mr X complains the Council incorrectly assessed the contributions his late mother had to make towards her care which resulted in a backdated invoice and additional contributions. He also says the Council stopped paying its contribution to his mother’s Direct Payment account without telling him.
2. Mr X says this caused him distress and to have to find a large sum of money with no prior notice.

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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 have considered the information provided by Mr X and have also discussed the complaint on the phone with him.
6. I have also considered the information the Council supplied in response to enquiries made.
7. Both Mr X and the Council have provided comments my draft decision. Any comments received have been considered before a final decision was issued.

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What I found

8. 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)
9. 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)
10. Where a council has decided to charge, it must carry out a financial assessment of what a person can afford to pay. If a council takes a disability benefit into account when calculating how much a person should contribute towards the cost of their care, they must also assess Disability Related Expenditure (DRE) in the financial assessment. This is because the Care Act statutory guidance says councils must leave individuals with enough money to pay for necessary disability related expenditure to meet any needs not being met by the council. DRE are costs that arise from a disability or long-term health condition. Councils should not be inflexible in the costs it accepts, and should always consider individual circumstances.
11. Direct payments are monetary payments made to individuals who ask for them to meet some or all of their eligible care and support needs. They enable people to arrange their own care and support to meet those needs.

What happened

12. Mrs Y was receiving care at home. The Council assessed Mrs Y’s finances and wrote to Mr X in July 2022 to say the maximum Mrs Y would have to contribute towards her care costs was £31.91 per week.
13. The Council wrote to Mr X in March 2023 to say it had carried out an automatic uplift of the financial assessment. This meant the new maximum Mrs Y would have to contribute to the cost of her care was £36.44 per week.
14. Mr X queried this uplift and provided the Council with a list of expenditure for his mother. Mr X said his mother had a shortage of income to cover her expenditures.
15. The Council completed another financial assessment and wrote to Mr X in May 2023. It explained based on the information he had provided and a pension credit award backdated to July 2022 it had re-assessed the amount Mrs Y would have to contribute to the costs of her care. This included a re-calculation of the amounts paid between July 2022 and April 2023 to £104.15 per week and from April 2023 to £116.20 per week. This resulted in a backdated invoice.
16. The Council stopped making payments into the Direct Payment account in June and July 2023.
17. Mr X sent a complaint to the Council in July 2023. Mr X said he was unhappy about the figures for the contribution payments and also that he had not been asked to provide receipts for expenses.
18. The Council responded to Mr X’s complaint in late July 2023. It told him that regulations set out the amount of income a person needed to retain before they were required to contribute towards their care. The Council explained it had treated the amount of £214.35 per week as an allowance in Mrs Y’s financial assessment.
19. The Council explained that its financial assessment form says along with the form, documents such as bank statements and proof of expenses should be provided. The Council also said payments into the Direct Payment account had stopped due to the backdated assessments and the increased weekly charge.
20. Mr X continued to dispute the financial assessment with the Council. The Council wrote to Mr X in August 2023 and told him if he believed Mrs Y had disability-related expenditure above the £15.00 per week allowance it had allowed, he should provide details and proof of this.

Analysis

21. The Council completed a reassessment of Mrs Y’s finances in May 2023 and received information about a backdated award for Pension Credit. This affected the contribution Mrs Y had to make towards her care from July 2022.
22. There are no timescales in law or guidance about when a Council must complete a financial assessment. A Council is also entitled to charge a backdated assessed contribution to the date that chargeable care and support began.
23. Mr X says the Council did not tell him he would need to include receipts to allow it to assess any DRE. However, the financial assessment form does state receipts for DRE would need to be included. I accept the Council could have gone back to Mr X to ask again if he had any receipts for DRE he wanted included in the assessment but I would not expect it to do so.
24. The Council has told Mr X if he provided the receipts, it would complete a further assessment. I have not found any fault in the way the Council completed the financial assessments or calculated the contributions.
25. I have not been provided with any evidence to show following the reassessment Mr X was told the Council would stop payments into the Direct Payment account. This is fault and would have caused Mr X distress when he logged into the account to discover there were insufficient funds to pay the care charges.
26. I have also considered whether the information shared with Mr X enabled him to understand the charges. The letters from the Council do not fully explain how the Council has reached the totals. It also took several enquiry letters from the Ombudsman to the Council to establish how the Council had calculated the charges. Whilst I am satisfied the amounts charged by the Council were correct, it is clear the information given to Mr X about how the amounts were calculated was not clear and accessible. This was fault by the Council causing Mr X further confusion.

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Agreed action

27. Within one month of a final decision, the Council should:

• Write to Mr X to apologise for the fault identified.
• Pay Mr X £100 for the distress caused to him in not being told payments would not be made into the Direct Payment account, and the confusion about how the amounts had been calculated.

28. The Council should provide us with evidence it has complied with the above actions.

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Final decision

29. I have found fault in the actions of the Council for failing to tell Mr X in advance that payments to the Direct Payment account would stop.

Investigator’s final decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman