Summary: Mrs X complained about an error made by the Council in calculating when it would fund her husband’s care home placement. We find the Council at fault for delays and miscalculating capital reduction, which caused Mrs X distress and uncertainty. We recommend the Council apologises and makes a payment to Mrs X.

The complaint

1. Mrs X complained the Council made an error in calculating when her husband’s care home placement would be funded by the Council and failed to properly explain the charging process and payment arrangements.
2. She says this has caused her significant distress and negatively impacted her health.
3. She wants the Council to take responsibility for the miscalculation, fully fund her husband’s care from December 2022, and provide a financial remedy for the distress and upset caused.

Back to top

The Ombudsman’s role and powers

4. 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)
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. I considered the complaint and information Miss X provided.
7. I made written enquiries of the Council and considered its response along with relevant law and guidance.
8. I referred to the Ombudsman Guidance on Remedies, (a copy of which can be found on our website).
9. 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

Charging for permanent residential care

10. 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.
11. 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.
12. 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 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 they will not need to contribute to the cost of their care and support from their capital.

What happened

13. The following provides a summary of relevant events. It does not cover everything that has happened since Mr Y moved into the care home.
14. In June 2022, Mr Y was transferred to a care home following a stay in hospital. At first, the enablement service paid his care home fees.
15. In July, Mr Y became a self-funder, as his savings were over the upper capital limit, requiring him to pay the full cost of his care home fees directly to the care home.
16. In September, Mrs X contacted the Council as she was unaware of the cost of Mr Y’s care home placement. While she understood that Mr Y was responsible for the full cost due to his savings, she was unsure of the amount. The Council advised her to contact the care home directly and said a social worker would also follow up with her. A few days later, the social worker called Mrs X, and told her the care home fees were £1,000 a week, and Mr Y had accrued fees totalling £10,000.
17. Later that month, the social worker contacted Mrs X, reiterating that Mr Y was a self-funder and advising her to reach out to the care home regarding the fees.
18. In October, the Council sent Mrs X a financial declaration pack for her to fill out. The Council could then complete a financial assessment to find out when it would start to provide support towards the cost of the care home fees.
19. In November, Mrs X contacted the Council to advise that she had received invoices from the care home, and when paid, Mr Y’s savings would be below the upper capital limit. The Council told her to complete the financial declaration pack so it could complete the financial assessment.
20. Later that month, Mrs X contacted the Council again. She shared that she had not paid any of the care home fees and was concerned the home might ask Mr Y to leave because of this. The Council told Mrs X that as Mr Y was a self-funder, he was responsible for paying the care home fees. Mrs X later sent the completed financial declaration forms to the Council.
21. Mrs X contacted the Council three times between November and January, raising concerns about the outstanding fees and her belief that Mr Y’s savings had reduced to less than the upper capital limit. However, Council records suggested that Mr Y still had approximately £15,000 over the upper capital limit.
22. In January 2023, the Council asked for further financial documentation from Mrs X, who was in hospital at the time, but arranged for a family member to send the information later that month.
23. In March, the Council used a capital reduction calculator to show when Mr Y’s savings would reduce to less than the upper capital limit. The calculator indicated that this should have happened in January. The Council notified Mrs X and backdated its contract with the care home to January 2023. Mr Y was still responsible for contributing to the cost of his care from his income but no longer from his savings.
24. In May, the Council discovered an error in the capital reduction calculation, having missed a bank account. It immediately contacted Mrs X to explain that because Mr Y had savings above the upper capital limit, he was still responsible for the full cost of his care and would remain so until September. The Council explained the capital reduction was calculated from July 2022, when Mr Y began self-funding his care, and considered the cost of Mr Y’s care since. The Council also sent Mrs X a copy of the new capital reduction calculation and a summary of Mr Y’s expected contributions from September onward. Mrs X said she would discuss the matter with her family and contact the Council if further clarification was needed.
25. Later that month, Mrs X contacted the Council, expressing confusion over the information received. She believed her husband’s savings would reduce to less than the upper capital limit earlier than it had calculated. Mrs X said her family were visiting the following day to look through the information and she asked for a social worker visit to explain the matter. The Council offered to speak to her and her family the next day to explain the matter if needed.
26. In June, the Council called Mrs X to tell her that she would shortly be receiving an invoice covering the cost of Mr Y’s care from January to May that year. Mrs X who was in poor health, expressed difficulty understanding why Mr Y still had to pay the full cost of care and again asked for a social worker to visit her to explain. The invoice was sent to her the same day.
27. Later that month a social worker contacted Mrs X. Mrs X shared her distress over the financial situation, and mentioned multiple hospital stays. The social worker explained they were not involved in the final assessment and advised her to speak to the finance team for further information.
28. The next day, a member of the finance team contacted Mrs X to explain the situation. Mrs X shared that she wasn’t well enough to discuss it but agreed to a call the following week.
29. A few days later, an automatic reminder letter was sent to Mrs X for the unpaid invoice. Another reminder was sent in July.
30. In July, Mrs X complained to the Council about the error made in the first capital reduction calculation and the Council’s following contact. She said that in May she had asked the finance team for a few weeks to recover but was not provided this.
31. In September, the Council responded to her complaint, acknowledging the error and apologising. The Council explained reminder letters are automatically generated by the system due to non-payment and apologised if this caused her any distress. The Council confirmed it would begin to support towards the cost of Mr Y’s care home fees from September, and until then, he would continue to be invoiced for the full cost.
32. In December, Mr Y was admitted into hospital and died later that month.
33. In October 2024, during my investigation, the Council offered a symbolic payment of £250 to recognise the distress and confusion caused by the error and processing delay. Additionally, the Council offered a payment plan for the outstanding fees if needed.

My findings

34. The Council has acknowledged it delayed completing Mr Y’s financial assessment. After receiving the financial declaration, it took the Council another two months to review the information and ask for further documents needed to complete the assessment. The further documents were provided in January, but the Council didn’t complete the financial assessment until March. The Council has explained that part of the delay was because the support plan had not been added onto the system. This delay is fault.
35. Once the Council completed the financial assessment it should have promptly told Mrs X about how much Mr Y needed to continue to contribute towards the cost of his care. The Council told Mrs X this information in May. This delay is fault. These faults left Mrs X unaware of how much Mr Y needed to contribute to the cost of his care for an extended period.
36. The Council has accepted its error in calculating the capital reduction and has apologised. The error is fault and caused Mrs X distress when she learned that Mr Y would need to continue paying the full cost of his care for another nine months.
37. The Council’s delays and miscalculation meant that Mrs X was not fully aware of her husband’s financial responsibilities for his care until May 2023, resulting in distress and uncertainty. However, the Council later assessed Mr Y’s finances accurately, and Mrs X remains legally responsible for the fees incurred.
38. In recognition of the injustice caused by the error and delays, the Council has offered Mrs X a symbolic payment of £250. I have considered whether the Council’s remedy is in line with the expectation in our Guidance on Remedies. I am satisfied the financial remedy is appropriate and therefore make no further financial remedy recommendations.

Back to top

Agreed action

39. To remedy the injustice caused by the above faults, within four weeks of the date of my final decision, the Council has agreed to:
1. apologise to Mrs X for the distress and uncertainty caused by the Council’s faults;
2. pay Mrs X its proposed remedy of £250; and
3. follow up on its offer of a payment plan for the outstanding owed fees.
40. The Council should provide us with evidence it has complied with the above actions.

Back to top

Final decision

41. I have completed my investigation. There was fault by the Council. The Council has agreed to the above action as a suitable remedy for the injustice caused.

Back to top

Investigator's decision on behalf of the Ombudsman