Summary: Mrs X complained about the Council’s handling of the financial assessment process after she asked it to take over the commissioning of her father, Mr Y’s, care in a residential care home. We did not find the Council at fault.

The complaint

1. Mrs X complained about the Council’s handling of the financial assessment process after she asked it to take over the commissioning of her father, Mr Y’s, care in a care home. She said the Council failed to give clear information about the process and delayed completing the financial assessment and sending invoices.
2. Mrs X said this meant Mr Y’s finances stayed above the capital threshold longer than necessary and resulted in him paying more in care charges. The process also caused Mrs X worry and distress.
3. Mrs X wanted the Council to waive the outstanding charges.

Back to top

The Ombudsman’s role and powers

4. We investigate complaints of injustice caused by ‘maladministration’ and ‘service failure’. I have used the word fault to refer to these. We consider whether there was fault in the way an organisation made its decision. If there was no fault in how the organisation made its decision, we cannot question the outcome. (Local Government Act 1974, section 34(3), 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)

Back to top

How I considered this complaint

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

Back to top

What I found

9. 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. 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.
10. When the Council arranges a care home placement, it must follow the regulations when undertaking a financial assessment to decide how much a person must pay towards the cost of their residential care.
11. The financial limit, known as the ‘upper capital limit’, exists for the purposes of the financial assessment. This sets out at what point a person can get council support to meet their eligible needs. People who have over the upper capital limit (currently £23,250) must pay the full cost of their residential care home fees. Once their capital has reduced to less than the upper capital limit, they only have to pay an assessed contribution towards their fees. Where a person’s resources are below the lower capital limit (currently £14,250) they will not need to contribute to the cost of their care and support from their capital.

What happened

12. I have summarised below some key events leading to Mrs X’s complaint. This is not intended to be a detailed account of what took place.
13. Mr Y has dementia and resides in a care home. At first, this was on a self-funding private basis. Mrs X has Lasting Power of Attorney and handles Mr Y’s finances.
14. Mrs X contacted the Council in January 2023 because she calculated Mr Y’s savings would fall below the upper capital limit in May. She asked for information about the Council taking over responsibility for Mr Y’s care. The Council sent a letter to Mrs X about charges for residential care and signposted her to a section of its website containing more information. It also included a document about the financial assessment process, and a document explaining how the Council assesses the cost of residential care. Both documents confirm the upper capital limit of £23,250 and state the Council will need to see information about income and capital to calculate a person’s contribution to their care costs.
15. Mrs X got back in touch with the Council in June 2023 when Mr Y’s savings were close to the upper capital limit. She asked the Council to take over Mr Y’s care. The Council explained it would fund Mr Y’s care for three weeks while it assessed his finances. It said this would still be chargeable once it knows the result of Mr Y’s financial assessment. The Council sent Mrs X a financial assessment form to complete. Its letter enclosing the assessment form confirms the upper capital limit of £23,250.
16. The Council then contacted the care home, who confirmed Mr Y’s fees were £1,549.39 a week, including funded nursing care. The rate the Council agreed for Mr Y’s care was £1,000 a week.
17. Mrs X completed a financial assessment form for Mr Y. She included financial statements confirming his capital was above the upper limit.
18. The Council issued an invoice of £3,000 for Mr Y’s care between 30 June and 21 July 2023.
19. Mrs X telephoned the Council on 14 August advising she paid the invoice and Mr Y’s capital should be below the limit. The Council asked her to provide evidence.
20. Mrs X wrote to the Council enclosing Mr Y’s latest financial statements. However, his capital was still above the upper limit.
21. Mrs X telephoned the Council at the end of August chasing an invoice for Mr Y’s permanent care. The Council said it was raising an invoice and Mrs X should contact its financial assessment team if Mr Y’s capital fell below the upper limit. Mrs X sent up to date financial statements.
22. The Council’s financial assessment team re-assessed Mr Y in September, based on the information Mrs X sent. Mr Y’s capital was still above the upper limit.
23. Mrs X contacted the financial assessment team as she was confused about the invoices she received. The Council said it started Mr Y’s permanent package of care from 21 July, meaning it paid the care home from that date and invoiced Mrs X for the charges rather than Mrs X paying the care home.
24. Mrs X telephoned the Council on 2 October 2023. She wanted to make a payment to ensure Mr Y’s capital fell below the upper limit.
25. Mrs X then made a payment and sent up to date financial statements to the Council. However, these showed Mr Y’s capital remained above the upper limit at £23,472.71.
26. Mrs X telephoned the financial assessment team on 1 November 2023. She disagreed Mr Y’s capital was above the upper limit. She thought the upper capital limit was £23,500. The Council told her it is £23,250, as it confirmed in past assessment letters and calls.
27. Mrs X made another payment and again sent up to date financial statements to the Council on 1 November 2023. This time they showed Mr Y’s capital was below the upper limit. The Council updated Mr Y’s financial assessment. As of 1 November 2023, Mr Y no longer had to pay the full costs of his care. Instead, he had to pay an assessed contribution.
28. Mrs X disputed the date Mr Y’s assessed contributions started. She said he should not be responsible for full costs up until 1 November, and she argued the Council’s finance team did not tell her what the upper capital limit was.
29. Mrs X wrote to the Council on 2 December 2023 asking for a review. She said she received an invoice for previous outstanding charges when she was only expecting to receive one for care from 1 November onwards. Mrs X said she contacted the Council in June explaining Mr Y’s finances were near the upper limit and his July care home bill would take him under the limit. The Council then sent her forms to complete, which she did, and sent an invoice for £3,000. Mrs X thought this was to cover the amount Mr Y’s capital was above the upper limit. The Council later told her to pay an amount that would bring Mr Y’s capital under the upper limit. She said if the Council told her at the outset that she needed financial documents showing Mr Y’s capital was below the upper limit she would have paid the care home’s July fees herself and Mr Y’s capital would be well below the upper limit. She asked the Council to cancel the fees from before 1 November, saying she was let down by its process.
30. The Council responded in January 2024. It referred to the Care and Support Statutory Guidance and said its assessments must be based on the current value of Mr Y’s statement balances. It acknowledged Mrs X’s view that if it produced invoices sooner, and she paid Mr Y’s fees sooner, his capital would have fallen below the limit earlier. However, it said Mrs X’s evidence showed Mr Y’s capital did not fall below the limit until 1 November 2023. It said if Mrs X sought a discretionary waiver of the charges, she would need to make a request to the Council’s director of Adult Social Care (ASC).
31. Mrs X did so on 10 January. However, the Council’s director of ASC did not agree to her request. They referred to the Care and Support Statutory Guidance and said the Council used the balances from the statements Mrs X provided. They said the Council’s current assessment and charges were correct.

My investigation

32. Mrs X told me she telephoned the Council when she calculated Mr Y’s finances would fall near the upper capital limit in May 2023. She asked the Council to take over responsibility for arranging Mr Y’s care. She said the Council told her to call back two weeks before Mr Y’s finances reached the upper limit.
33. Mrs X said the Council then sent her two letters. The first was from its ASC service and included a leaflet about the care home placement agreement. The second was from the Council’s finance department.
34. Mrs X said when she chased the Council’s finance department it told her it was preparing an invoice for just over £8,000. Mrs X told the finance department Mr Y’s capital was only £4,000 over the limit. She said the finance department told her to pay a sum to bring Mr Y’s capital down below the upper limit. Mrs X said she followed this advice, but the Council still said Mr Y owes over £5,000. Mrs X has not paid this.
35. The Council told me it considers it gave appropriate and accurate information to Mrs X about the upper capital limit, and of the need to provide evidence Mr Y’s capital was below the limit.
36. The Council said it aims to complete financial assessments within four weeks. While it took a week longer to complete Mr Y’s assessment in July 2023, it implemented subsequent changes well within this timeframe. It said it assessed Mr Y’s finances in line with the Care and Support Statutory Guidance.

Analysis

37. Mrs X paid the Council £3,000 at the end of August 2023. She thought this was to take Mr Y’s capital below the upper limit. However, the Council’s records confirm it explained to Mrs X these were interim fees while it carried out a financial assessment. And Mr Y’s capital did not fall below the upper limit at that time.
38. Mrs X then paid £7,400 to the Council in October 2023 to take Mr Y’s capital below the upper limit. Unfortunately, Mrs X got the upper limit wrong, and Mr Y’s capital remained above it. That was not the fault of the Council. Its initial information documents, and its letter accompanying the financial assessment form, confirm what the upper capital limit was. And, regardless of what Mrs X’s intentions were, the Council can only assess Mr Y based on his actual financial position at the time.
39. Mr Y received pension income at the end of the month, just before Mrs X sent financial statements to the Council. So, despite the payment Mrs X made, Mr Y’s capital did not fall below the upper limit. Mrs X asked the Council to make allowances for this. It is possible for regular income to result in someone’s capital fluctuating just above or below the upper limit, depending on the day a payment is made or received. I appreciate this made things difficult for Mrs X when supplying financial statements. However, the Council could only assess Mr Y based on the evidence it received. It was not at fault for determining Mr Y’s capital was above the upper limit when that is what his financial statements were saying.
40. The Council’s review response focused on the Care and Support Statutory Guidance, and Mr Y’s financial statement balances at the relevant times. While the Council is correct in what it said, I consider it could have done a better job of engaging with the points of Mrs X’s complaint. Mrs X did not say the Council’s assessments were wrong. She complained about a lack of information and clarity from the Council about the assessment process, about the need to supply evidence, and about confirming the correct upper capital limit.
41. However, I did not find fault with the information the Council gave Mrs X. Its notes state it told Mrs X it would initially bill her for care while it was carrying out the financial assessment. I am also satisfied the Council’s records show it sent financial assessment and charging information to Mrs X. This included confirmation that Mrs X must supply evidence for the assessment, and confirms the upper capital limit is £23,250. Later records also confirm the Council told Mrs X to send evidence once Mr Y’s capital was below the upper limit.
42. The Council agreed to consider exercising discretion by offering Mrs X the chance to appeal to its director of ASC. However, the director refused Mrs X’s request. I found there was no fault in the information the Council gave to Mrs X, or in its financial assessments. The Council has a financial responsibility to the wider public, as well as to meet Mr Y’s care needs. To exercise discretion in this case would mean additional costs to the Council arising from no fault of its own. The Council was therefore not at fault for refusing to exercise discretion.
43. Mrs X argued if the Council completed assessments sooner, or if she paid the care home direct, Mr Y’s capital would have fallen below the upper limit earlier.
44. The Council has a duty to provide information about the financial assessment process and charging. However, it does not give financial advice, and it cannot make financial decisions for Mrs X. The decision on when to stop paying the care home direct, and when the Council took over Mr Y’s care, was down to Mrs X, as were the decisions about how much to pay towards the Council’s invoices.
45. The Council accepts it took longer than its target of four weeks to complete Mr Y’s financial assessment in July 2023. However, I do not consider the delay of one week amounts to significant fault. I also did not find this short delay materially impacted events.

Back to top

Final decision

46. I completed my investigation. I found no fault in the Council’s financial assessment process.

Investigator’s decision on behalf of the Ombudsman

Back to top

Investigator's decision on behalf of the Ombudsman