Summary: Mr W complained the Council has wrongly issued a bill for his late mother’s brief stay in a care home. He says the Council did not explain it would charge for the stay and has billed a higher sum than it paid to the care home. We found the Council at fault for not carrying out a proper financial assessment. We do not consider the Council to be at fault for issuing a bill. The Council has agreed to reissue its bill, apologise to Mr W, and review its processes to improve its service.

The complaint

1. Mr W complains the Council has wrongly issued an invoice for his late mother’s stay in a care home. He says the period billed for should be free while his mother’s care needs were being assessed. Mr W says the Council told him his mother’s care would be free as she would be at the care home on a ‘discharge to assess’ basis.
2. Mr W also says the Council has invoiced for a higher sum than it paid to the home and is therefore making a gain.

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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 information provided by the Council and Mr W, alongside the relevant law and guidance.
6. Mr W and the Council have had the chance to comment on a draft decision before this final decision was made. All comments received have been considered.

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What I found

Law and Guidance

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)
8. 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. Councils have no power to assess couples according to their joint financial resources. A council must treat each person individually. A council must not charge more than the cost it incurs to meet a person’s assessed eligible needs.
9. Sections 9 and 10 of the Care Act 2014 require councils to carry out an assessment for any adult with an appearance of need for care and support. They must provide an assessment to everyone regardless of their finances or whether the council thinks the person has eligible needs. The assessment must be of the adult’s needs and how they impact on their wellbeing and the results they want to achieve. It must also involve the individual and where suitable their carer or any other person they might want involved.
10. Councils must carry out assessments over a suitable and reasonable timescale considering the urgency of needs and any variation in those needs. Councils should tell people when their assessment will take place and keep them informed throughout the assessment.
11. The Care Act 2014 gives councils a legal responsibility to provide a care and support plan (or a support plan for a carer). The care and support plan should consider what needs the person has, what they want to achieve, what they can do by themselves or with existing support and what care and support may be available in the local area. When preparing a care and support plan the council must involve any carer the adult has. The support plan must include a personal budget, which is the money the council has worked out it will cost to arrange the necessary care and support for that person.
12. The Care and Support Statutory Guidance says that an assessment should be carried out over an appropriate and reasonable timescale, considering the urgency of needs and any fluctuation in them. We expect councils to complete assessments in a timescale that is proportionate to the complexity of the issues, and normally within 4-6 weeks. Councils should tell the individual how long their assessment will take and keep them informed about this throughout the process. If it is a particularly complex assessment, then the council should tell the person how long is likely to take. If, during the course of an assessment, it becomes clear more time is needed, the council should explain this to the person.

What happened

13. The Council received a referral from the hospital for Mr W’s mother, Mrs A, in January 2023. The hospital raised a concern that she may have care needs.
14. The Council assigned a social worker to help with Mrs A’s discharge from hospital. The social worker spoke to Mr W in February. Mr W explained he did not feel his mother’s needs could be met at home, and he was looking into nursing homes near his father so they could visit her.
15. The Council’s notes say the social worker asked Mr W if his mother had savings of up to £23,250. The notes say Mr W said he wasn’t sure, and the social worker explained to him that if his mother had more than this sum, she would pay for her own care. The social worker explained the council would help to source a nursing home and carry out a financial assessment to decide A’s contribution toward her care.
16. Mr W told the social worker he had been told his mother could be discharged to an NHS bed. The notes say the social worker told him the only NHS beds available were not near his father. Mr W said they would much prefer a placement in York so they could visit both parents regularly.
17. The social worker visited Mrs A in hospital to assess her mental capacity in March 2023. It also sent assessments to two care homes which had available beds.
18. Mr W contacted the Council a few days later to ask for an update on his mother’s discharge. Mr W’s email said “When we spoke, we discussed the opportunity and importance of when my mother is placed to ‘Discharge to Assessment’, that this is undertaken in York…”
19. The Council went back and forth with the care home about the cost of care. The Care home told the Council that Mr W believed the ‘funding plan’ was “d2a” and asked the Council if this was correct.
20. The Council did not respond to Mr W or to the home about his understanding of the discharge to assess scheme.
21. The Council agreed a weekly rate with the home, and Mrs A was discharged to its care.
22. Two weeks later, the Council called Mr W to discuss a financial assessment for A. He said the placement was not chargeable for six weeks and was being funded by the Council for this time. The Council clarified that this is not the case.
23. Mr W complained that although Mrs A had capital with exceeded the threshold for funding, he had been led to believe the initial six weeks of care would not be charged for.
24. The Council provided a detailed response explaining the purpose of the financial assessment, what would happen if Mrs A had more than the threshold, and what it meant if she had less. It clarified that it did not have a policy whereby she would be entitled to six weeks care, free of charge regardless of the financial assessment.
25. Four weeks after Mrs A moved into the care home she passed away.
26. Two months later the Council issued a bill to Mr W which is at the rate agreed with the care home, for a period of just under five weeks. Billing starts from the date Mrs A was initially intended to be discharged, rather than her actual discharge date which was five days later.

Analysis and Findings

27. The Council were aware Mrs A had potential care needs and that a financial assessment was required as of January 2023. Mrs A passed away in May 2023, and the financial assessment had not been carried out by that time. The delay in carrying out an assessment is a fault. Had this been done in a timely manner, the Council could have confirmed that Mrs A would be self-funding her care.
28. During the initial call with Mr W, the Council told him that if his mother had capital of over £23,250, she would self-fund her care. He was told that if she had less than this, a financial assessment would be carried out to determine how much she would contribute toward her care fees. This is a reasonable explanation of the funding situation.
29. The notes from a call on 25 February state Mr W said a doctor had told him Mrs A could be discharged to an NHS bed. This information did therefore not come from the Council. During this call, the Council said NHS beds were not available in York. Mr W said Mrs A would need to go to a care home in York, knowing this.
30. I do not have any records of the Council telling Mr W that the first six weeks of care would be free. Nor is this information on the Council’s website.
31. In a telephone call on 27 April, the Council explained to Mr W that Mrs A would have to contribute to her care if she had capital over the threshold. Mr W complained that the Council had involved itself in agreeing care fees with the care home, even though Mrs A had to fund the care herself. This suggests he knew Mrs A had capital over the threshold.
32. Therefore, the evidence shows Mr W was told by a doctor that Mrs A may not have to pay for her first six weeks of care. The Council told Mr A she would have to self-fund her care if her savings exceeded the threshold.
33. However, Mr W continued to reference the discharge to assess scheme, and the Council did not take the opportunity to explain the scheme to him. While I am critical that the Council did not pick up on this, I am aware that he did not directly refer to free care, so the Council may well have thought he had correctly understood its discharge to assess scheme, which does not include any free care.
34. Although there is some confusion here, I cannot say the Council did not provide Mr W with the relevant information regarding funding. The Council could not know that he was referencing its scheme under a false understanding that his mother’s initial care would be free. Crucially, the Council did not ever say that it would be free.
35. I would expect the Council to have picked up on the fact Mr W kept referencing the discharge to assess scheme and would have expected them to ask him what he understood this to mean. Had the Council asked this question, the misunderstanding could have been identified and corrected sooner than it was.
36. Even if the Council had done this, the care fees would have applied. As Mr W confirms Mrs A had capital over the threshold, the Council is not at fault for applying the charges.
37. There does appear to be an error in the date from which the care fees should be charged, and this should be corrected.
38. The weekly rate applied is the rate which was agreed with the care home, so there is no fault in the rate used.

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Agreed action

39. Within four weeks of the decision, the Council has agreed to:

• Apologise to Mr W for the delay in carrying out the financial assessment;
• Reissue a new bill with the correct dates of care and an adjusted figure to reflect this.

40. Within three months of the decision, the Council has agreed to:

• Review why the financial assessment was not carried out sooner in this matter and take steps to ensure the issues are not repeated in future.

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

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Final decision

42. We found some fault in the Council’s actions, and it has agreed to carry out our recommended actions to address the injustice caused.

Investigator’s final decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman