Summary: Mr X complained the Council had failed to tell him his aunt (Miss Y) would be liable for some of the costs of residential care arranged for her by the Council. We found fault with the Council for not providing Mr X with enough information about charging for Miss Y’s residential care services. The Council’s fault caused injustice to Miss Y and Mr X. The Council has agreed to apologise, discuss a payment plan with Mr X and make payments to recognise Miss Y’s and Mr X’s distress. The Council has also agreed to carry out some service improvements.

The complaint

1. Mr X, acting for his aunt Miss Y, complains about the Council’s failure to tell him Miss Y would be liable for some of the costs of care received in a residential home where she was placed after her discharge from hospital. After completing Miss Y’s financial assessment, the Council charged her for the previous ten weeks of residential care. Mr X also complains about the Council charging Miss Y for residential care when she was away from mid-April 2024. The Council’s actions, he says, caused him and Miss Y worry and distress.

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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. We may investigate complaints from the person affected by the complaint issues, or from someone else if they have given their consent. If the person affected cannot give their consent, we may investigate a complaint from a person we decide is a suitable representative. (section 26A or 34C, Local Government Act 1974)
4. When considering complaints we make findings based on the balance of probabilities. This means that we look at the available relevant evidence and decide what was more likely to have happened.
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)

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How I considered this complaint

6. I considered evidence provided by Mr X and the Council as well as relevant law, policy and guidance. I referred to the Council’s “Charging policy”.
7. Mr 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

Legal and administrative framework

Councils’ statutory duties

8. The Care Act 2014 and the Care and Support (Charging and Assessment of Resources) Regulations 2014 (Regulations) provide details of councils’ duties towards their residents with eligible social care needs and rules for charging for the services provided.
9. When exercising their social care functions councils must follow the Care and Support Statutory guidance (Statutory Guidance) issued by the Department of Health and Social Care, which is based on the Care Act 2014, unless they have very good reasons not to. They should also follow the Regulations.

Intermediate care

10. 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. 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. (Care and Support (Preventing Needs for Care and Support) Regulations 2014, Regulation 4)

Financial assessments

11. Where a local authority has decided to charge, it must carry out a financial assessment of what the person can afford to pay and, once complete, it must give a written record of that assessment to the person. This could be provided alongside a person’s care and support plan or separately, including via online means. (Care and Support statutory guidance, paragraph 8.16)
12. Financial information and advice is fundamental to enabling people to make well-informed choices about how they pay for their care. The local authority service should include the following aspects of financial information and advice:
• understanding care charges
• ways to pay
• money management
• making informed financial decisions
• facilitating access to independent financial information and advice
• the cap on care costs, when preparing for its introduction in 2020 (Care and Support statutory guidance, paragraphs 3.36 and 3.41)
13. Councils should ensure that information supplied is clear. Information and advice should only be judged as clear if it is understood and able to be acted upon by the individual receiving it. Information and advice provided within the service should be accurate, up-to-date and consistent with other sources of information and advice. (Care and Support statutory guidance, paragraphs 3.19 and 3.20)

Charging

14. When making decisions on charging local authorities should be clear and transparent so people know what they will be charged. Where a local authority has decided to charge it should explain in the financial assessment how the assessment has been carried out, what the charge will be and how often it will be made. The local authority should ensure this is provided in a manner that the person can easily understand, in line with its duties on providing information and advice. (Care and Support statutory guidance, paragraphs 8.2 & 8.16)
15. Information and advice should only be judged as clear if it is understood and able to be acted upon by the individual receiving it. (Care and Support statutory guidance, paragraph 3.19)

What happened

16. Before going to hospital in December 2023 Miss Y had been receiving a care package consisting of carers supporting her at home twice a day. After Miss Y’s stay in hospital due to high blood pressure, the Council decided she could not return home. Miss Y’s social worker (the Social Worker) secured a place for her in a residential care home (the Care Home) from the beginning of January 2024.
17. In mid-January 2024 the Social Worker decided Miss Y could not consent to a care assessment. Mr X agreed on Miss Y’s behalf to share information with relevant professionals. The Council told him Miss Y’s placement at the Care Home was temporary as the Care Home was a nursing placement for elderly people who needed intensive care.
18. At the end of February the Social Worker contacted Mr X to arrange Miss Y’s financial assessment. The Social Worker did not send any information to Mr X about the Council’s charging rules. Mr X says he did not know Miss Y would have to contribute to her care charges as she had been staying in the Care Home from the beginning of January 2024 and had not been asked to pay.
19. The Social Worker contacted Mr X in mid-March 2024. The Social Worker reminded Mr X about the financial assessment and discussed with Mr X the possibility of a different care home for Miss Y. Mr X was concerned about parking issues and the impact on Miss Y of any changes in her living arrangements.
20. At the beginning of April 2024 Mr X told the Council he had been planning to take Miss Y to her home country for a month. This trip would take place from the fourth week of April. The Council agreed to this.
21. At the end of April 2024 the Council wrote to Mr X, stating Miss Y should pay towards her residential care £338 per week from the fourth week of February 2024 and £357 per week from mid-April 2024. The Council attached an invoice for the care charges due from Miss Y of £3,388 in total.
22. On the same day Mr X asked the Council for an explanation. Three weeks later the Council told Mr X the invoice included Miss Y’s contributions towards her care.
23. At the end of May 2024 the Council sent Mr X another invoice for the four weeks of Miss Y’s Care Home fees from the end of April 2024.
24. At the beginning of June 2024 Mr X told the Social Worker Miss Y would stay abroad until August 2024. The Social Worker said Mr X should discuss Miss Y’s placement with a relevant team at the Care Home.
25. At the same time the financial assessment and charging team’s officer (Officer 1) communicated with Mr X about the Council’s charging. Officer 1 said that although Miss Y was still abroad, the Care Home remained her home, and her belongings were still in the room allocated to her. Therefore the Council continued charging Miss Y her assessed care contributions.
26. Mr X recognised that in March 2024 the Council had told him it would carry out a financial assessment for Miss Y but had not made him aware of the financial implications for her. Mr X said if he had known the charges, he would have explored alternative arrangements for Miss Y’s care. He also raised concerns about the Council not telling him it would charge contributions from Miss Y for the time when she was away.
27. After further correspondence, Miss Y’s placement at the Care Home ended in mid-June 2024. The Council sent Mr X an invoice with Miss Y’s Home Care fees up to this date.

Analysis

28. Councils must assess how much someone should pay towards the cost of services. Individuals can experience distress if councils fail to properly advise on the need to make a financial contribution towards care, or if their decisions are poorly communicated.
29. It is important councils give enough information about paying for care at an early stage. This is to enable informed decision making. Where the council cannot complete a prompt financial assessment it should still give proper written general information about the likelihood of needing to contribute towards care costs.
30. The Council failed to explain to Mr X that the first six weeks at the Care Home would be free for Miss Y as intermediate care but that after this period she would need to contribute towards the cost of her residential care. The Council should have provided this information to Mr X as soon as practicable but certainly before the beginning of the charging period.
31. The Social Worker carried out Miss Y’s care assessment and talked to Mr X in January 2024. This was an opportunity to tell Mr X about the Council’s charging policy. The Council should have also sent Mr X written information about financial assessments and charging to ensure Mr X fully understood the Council’s approach and could make informed decisions about Miss Y’s care.
32. The Council’s failure to give Mr X comprehensive information about care costs and charging is fault. The Council’s fault caused injustice to him and to Miss Y.
33. Miss Y was distressed when she found out the Council would charge for the residential care services already delivered to her. She received a large invoice for over two months of care, which she did not expect. Being unaware of the cost of residential care services at the Care Home before the start of the charging period, prevented her from exploring other options which might have been more acceptable financially to her.
34. The Council’s failure to tell Mr X about the cost of the Care Home and its approach to charging meant he did not look for alternative arrangements for Miss Y. He was not aware that only the six-weeks intermediatory care for Miss Y was free. Although the Social Worker told Mr X he would carry out a financial assessment for Miss Y, he gave no details of how the Council calculated contributions towards the cost of Miss Y’s care.
35. On the balance of probabilities I consider if Mr X had known the Council’s charging policy, he would have sought a different option for Miss Y’s care. This is because once Mr X received an invoice from the Council, on the same day he queried it and expressed his dismay.
36. I do not find the Council was wrong to charge for Miss Y’s place at the Care Home when she was away. Records of Mr X’s correspondence with the Council about Miss Y’s trip show Miss Y was initially going away for a few weeks. Because she had a room allocated to her and left her possessions there it was reasonable for the Care Home to receive its fees, despite Miss Y not being there physically.
37. When arranging Miss Y’s trip Mr X was not aware, however, that she would be paying for her place at the Care Home. We cannot say, even on the balance of probabilities, whether Mr X would have ended Miss Y’s placement at the Care Home sooner if he had known about the charges Miss Y was due to pay.

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Action

38. To remedy the injustice caused by the faults identified, we recommend the Council complete within four weeks of the final decision the following:
• apologise to Miss Y and Mr X for the injustice caused to them by the faults identified. We publish guidance on remedies which sets out our expectations for how organisations should apologise effectively to remedy injustice. The Council should consider this guidance in making the apology I have recommended;
• hold a meeting or a telephone conversation with Mr X, during which the Council will offer a payment plan for Miss Y’s outstanding care charges. The Council will send us minutes of this meeting or telephone conversation and a copy of the payment plan;
• pay Miss Y and Mr X £200 each to recognise the distress caused to them by the Council’s failure to provide timely and comprehensive information about charging for care services.

The Council will provide the evidence that this has happened.

39. We also recommend the Council within three months of the final decision review what information about financial assessments and charging it should give to its residents during their six weeks of intermediate care. The Council will ensure that social workers, as part of the process, explain how residents’ finances will be assessed and what the residents can expect to be charged for. They will also provide relevant written information.

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

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Decision

40. I find fault causing injustice. The Council has accepted my recommendations, so this investigation is at an end.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman