Summary: Mr Y complained about the Council’s delay in telling his late mother, Mrs Z, about her care charges and that it calculated her charges incorrectly. The Council was at fault for significant delay. There was no fault in the way it calculated the care charges. The Council has agreed to apologise to Mr Y and make a payment to acknowledge the frustration and uncertainty he was caused. It has also agreed to review the way its finance and social work teams communicate to prevent similar delays in future.

The complaint

1. Mrs X, on behalf of Mr Y, complained the Council failed to tell Mr Y or his late mother Mrs Z about her care home charges until 18 months after her placement started. This led to a large and unexpected care bill Mrs Z could not afford to pay and caused her and them distress. Mr Y complained the Council then failed to clearly explain the charges and there were inaccuracies in the dates it charged for. Mr Y wanted the Council to reassess the charges and to clear the unnecessary debt.

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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. 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

4. I considered evidence provided by Mrs X and the Council as well as relevant law, policy and guidance.
5. I gave Mrs X and the Council an opportunity to comment on my draft decision. I considered any comments before making a final decision.

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What I found

The relevant law and guidance

6. 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.
7. 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.
8. 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 (£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 (£14,250) they will not need to contribute to the cost of their care and support from their capital. However, they will still need to contribute from their income.
9. For permanent care home residents most of their income is taken into account, minus an amount for personal expenses which is around £30 a week. If a person’s stay is expected to be temporary (not exceeding 52 weeks) and the person intends to return home, the value of the person’s home will be disregarded in the financial assessment.

What happened

10. Mrs Z lived in her own home. She had a fall which resulted in a hospital admission then a stay in a rehabilitation placement. In January 2022 the rehabilitation placement assessed Mrs Z and recommended a short stay bed in a care home to offer further therapy and rehabilitation. The assessment noted that initially this would be funded by enhanced discharge funding (NHS funding provided to assist with leaving hospital). This would be for four weeks at no cost to Mrs Z. It stated the allocated worker would need to carry out a review before the end of this period to assess Mrs Z’s long term needs. Mrs Z moved to a care home for the short stay.
11. Social worker 1 visited Mrs Z in February 2022. They noted Mrs Z wanted to return home but felt she was not yet ready and would prefer to stay at the care home for a bit longer. The social worker noted they reiterated the funding position and that Mrs Z understood this was the last week for enhanced discharged funding. They noted she was due a back operation assessment the following month. They noted Mrs Z said Mr Y supported her with her finances and paperwork. She said she had received the financial assessment paperwork but had concerns about what it meant. She said she had less than £23,250 and owned her own home. Social worker 1 noted they had asked Mr Y to look at the paperwork, complete it and return it to the finance team. Mr Y does not recall any discussion with him at this point about finances or care charges. The Finance Team case notes do not record that a financial assessment was requested by the social care team. An officer in the Finance Team noted a respite care plan was showing but there was no financial assessment request.
12. In March 2022 social worker 2 completed a review of Mrs Z’s care plan. This noted Mrs Z was happy with the care she was receiving and was happy to stay at the care home.
13. In September 2022 social worker 1 reviewed Mrs Z’s care plan. They noted she had no access to a downstairs toilet at home. She was at high risk of falls.
14. Around this time a Council officer noted Mrs Z had not yet been assessed for her care charges. The note says financial assessment forms were supplied but not returned. The Council has not provided evidence of when the forms were supplied or to whom. The note recommended a visit to Mrs Z.
15. In October 2022 social worker 1 spoke with Mr Y. The social worker noted Mr Y said the property was unsuitable in its current state. There was no downstairs toilet or stairlift. Mr Y reported the property was for sale as they would prefer a bungalow for Mrs Z.
16. Mrs Z contacted the social worker again the following month as she wanted to return home. The social worker spoke again to Mr Y who said the property in its current state was not suitable for Mrs Z. The social worker spoke to Mrs Z whose mobility was improving. Social worker 1 completed a review in November 2022. They noted Mrs Z wanted to return home but agreed it was not suitable at the current time.
17. In February 2023 a finance officer visited Mrs Z at the care home. Mrs Z could not provide much information as her documents were at home. The officer noted they left the Council’s address and their telephone number with Mrs Z to pass on to Mr Y.
18. In March 2023 the social worker noted the family had been carrying out work on Mrs Z’s central heating. Once this was done they would look at getting a stairlift. In mid April the social worker spoke again to Mr Y. He reported the heating as not yet sorted. Social worker 1 visited Mrs Z and discussed the works to her home. They noted Mrs Z hoped the heating would be sorted the following week and then work on a stairlift would start. Social worker 1 left the team and another social worker, social worker 2 visited Mrs Z in June 2023.
19. Social worker 2 discussed Mrs Z’s long term plans and she said she wanted to return home. The social worker noted there were still issues with the central heating and until this was sorted, as floorboards may need lifting, the stairlift could not be installed. Social worker 2 asked who was paying for her care and Mrs Z said she thought it was the health authority. Social worker 2 spoke to Mr Y who confirmed there were still issues with the central heating. They also noted Mr Y thought Mrs Z had previously had a financial assessment and said he had dropped bank statements off.
20. Social worker 2 spoke to the finance officer in July 2023. The finance officer reported that Mrs Z had not being paying anything towards her care. They said they had tried to contact social worker 1 to resolve the issues but social worker 1 did not respond.
21. In August 2023 the finance officer completed a financial assessment based on the information they had, which they sent to Mrs Z.
22. Social worker 2 visited Mrs Z with the finance officer. Mr Y was also present. The notes record the finance officer explained charging to Mr Y and that they had not been able to complete a full assessment without further information from Mrs Z. Social worker 2 noted Mr Y and Mrs Z were shocked at the size of the debt. The social worker spoke to Mrs Z about going home. Mrs Z agreed to have a bed moved downstairs at home. Mr Y said the heating was now sorted but not a stairlift. Social worker 2 said they would refer Mrs Z to the occupational therapist and physiotherapist to assess whether a stairlift would be suitable. They explained Mrs Z would need a package of home care and a separate financial assessment for that.
23. In early October 2023 the physiotherapist confirmed they were happy for Mrs Z to return home if she was living downstairs and they would carry out an assessment once she was home. Mrs Z returned home later that month.
24. In January 2024 the Council recalculated Mrs Z’s care charges and made allowance for some of the costs associated with maintaining her home whilst she was in the care home. Mrs Z owes the Council around £17,000.
25. Mrs Z passed away in January 2024.
26. Mrs X submitted a formal complaint in August 2024. She said the charges were not discussed with Mrs Z until after she received the first bill. She said no financial assessments were completed until January 2024, leaving Mrs Z with a large unexpected care bill.
27. The Council responded the following month. It said the financial assessment process was explained to Mrs Z and she had capacity to make decisions about money and her care. Mrs Z made the decision to stay in the care home. It said Mrs Z did call the Council to say she wished to return home but Mr Y indicated the home was not suitable at that time as it needed some work and a stairlift. It said at no point would it have advised Mrs Z that the care was free.
28. It explained that as Mrs Z’s capital was already below £14,250 any money spent on the repairs and on equipment for her return home made no difference to the financial assessment. It had included some household expenditure Mrs Z was still paying towards, in her financial assessment. It apologised that the financial assessment was not completed in an timely manner.
29. Mrs X remained unhappy and complained to us.

Findings

30. Mrs Z’s care home was initially funded by enhanced discharge funding. Once this ended the Council became responsible for Mrs Z’s care charges. Although Mrs Z remained under the care of the hospital further several more months, this was as an outpatient, and had no impact or relevance to her care charges. We would have expected the Council to have completed Mrs Z’s financial assessment before the end of the enhanced discharge funding. Its failure to do this was fault.
31. The Council’s case notes record the social worker spoke to Mrs Z and Mr Y about a financial assessment in February 2022, when the enhanced discharge funding was due to end, and suggest either Mrs Z or Mr Y were provided with some paperwork. Mr Y says finances were never discussed with him. The notes of the conversation between Mr Y and a social worker in June 2023, where he referred to having dropped off bank statements previously, suggest he had some awareness of the need for a financial assessment. However, there is not enough information in the notes to say exactly what was discussed and with whom. The Council has not provided any evidence to show what written information was given to Mrs Z about care costs or that she had any understanding that the majority of her income would be taken into account in paying for her care. The Council’s failure to clearly explain to Mrs Z that she would be required to pay towards her care was fault.
32. The Council was entitled to charge Mrs Z a contribution to her care home costs from February 2022 onwards. The Council’s finance case notes show an officer noted in February 2022 that there was no financial assessment request. The notes show the Council was aware in September 2022 that Mrs Z was not paying towards her care charges and yet it was not until February 2023 that a finance officer contacted Mrs Z about her care charges. It was then, not until August 2023, that the officer completed a financial assessment based on the information they had at that time. The significant delay in completing a financial assessment was fault and caused Mrs Z distress when she received a large, unexpected care bill.
33. The Council calculated Mrs Z’s contribution to her care charges in line with the law and statutory guidance. It later revised the charges to include some of the household expenses Mrs Z continued to pay whilst in the care home. This was appropriate. Although Mr Y had used some of Mrs Z’s funds to carry out repairs and buy equipment, this made no difference to Mrs Z’s financial assessment. This is because Mrs Z already had less than £14,250 in capital at that point, so only her income was taken into account in assessing what she could afford to pay each week towards her care costs. The Council was not at fault in how it decided what Mrs Z should pay towards her care.
34. Mrs Z received the benefit of care from the care home and I have seen no evidence she was unhappy there. Whilst the records show Mrs Z was keen to go home, they also show that Mr Y did not initially consider the property was in a suitable state and that there were later issues with the heating which further delayed Mrs Z’s ability to go home. I cannot say, even on balance, that had Mrs Z been aware of the costs earlier she would have returned home sooner. Mrs Z has since died so we cannot remedy any injustice caused to her. However, the delay leaves Mr Y with a sense of uncertainty over what may have happened.
35. Mrs Z has since died. The Council has therefore contacted Mr Y as Mrs Z’s executor regarding the debt. It is entitled to do this so was not at fault.

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Agreed Action

36. Within one month of the final decision, the Council has agreed to apologise to Mr Y and pay him £500 to acknowledge the frustration and uncertainty he was caused by the Council’s delays. 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.
37. Within three months of the final decision the Council has agreed to review it processes to ensure better communication and follow up between social workers and its finance team where it appears that financial assessments may be necessary and are not showing as completed.
38. The Council should provide us with evidence it has complied with the above actions.

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Decision

39. I find fault causing injustice which the Council has agreed to remedy.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman