Summary: Mrs X complained that the Council was unclear about the charges her mother (Mrs A) would pay for her care. The evidence shows the Council was not at fault in the way it charged Mrs A or alerted her to the possible charges.

The complaint

Mrs X (as I shall call the complainant) says the Council did not give her sufficient information about the amount her mother Mrs A would pay towards the cost of her home care. She says as a result she was shocked and distressed when she received a large bill for care received after probate following Mrs A’s husband’s death was granted.

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The Ombudsman’s role and powers

1. 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)
2. 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

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

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What I found

Relevant law and guidance

5. 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).
6. 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.
7. The Care and Support Statutory Guidance says (at Annex B) “Capital which is not immediately realisable …. should be taken into account in the normal way at its face value. This will be the value at the time of the financial assessment. It may need to be confirmed and adjusted when the capital is realised.”
8. Direct payments are monetary payments made to individuals who ask for them to meet some or all of their eligible care and support needs. They enable people to arrange their own care and support to meet those needs.

What happened

9. Mrs A lived in her own home. She had dementia and was supported with care on a private basis by the care provider of her choice. Mrs A’s husband died in 2023.
10. In September 2023 Mrs X contacted the Council to ask for help with Mrs A’s care. A needs assessment was carried out in October. The social worker explained that the Council would look for a care provider at a lower rate than the existing care provider (which was more expensive than the Council’s usual rate). Mrs X said her mother would prefer to remain with the care provider she knew and agreed to pay a top-up fee. Mrs X also explained that once probate was granted Mrs A would fund her own care again but was currently low on funds.
11. The social worker also explained that if Mrs A was eligible for assistance with companionship support as well as the care package currently provided this would probably be arranged through a Direct Payment separate from the commissioned care agency. The social worker emailed Mrs X during this time to say, “it may be that once the probate comes through, (Mrs A) will be asked to pay back for the support that the council have put in place.” The social worker gave her details of how to set up a Direct Payments account. Mrs X says the social worker should have explained the Care and Statutory Support Guidance to her at this time.
12. As the Council was initially unable to find a care provider at a lower rate than the existing care provider, it told Mrs X that it would fund the entirety of the cost. In the same email it said, “it may be that (Mrs A) only has to fund the contribution amount for this or that the Council we request the full amount back when the probate comes in, just to make you aware”. Mrs X asked if that meant Mrs A would have to repay the whole amount. The social worker responded, “! am unable to confirm if the council will definitely request the full amount back but I have been advised that it may be an option that they look at.” She gave Mrs X contact details for the finance team who would be able to advise further.
13. In early December the Council was able to find a care provider who would take over Mrs A’s care at a rate which did not require a top-up, but Mrs X declined this as her mother was happy with her existing provider and Mrs X says it would not have been in her best interests to change carers. The social worker emailed her on 14 December and said, “The costing plan has now been agreed and is with our brokerage team to complete after speaking with (the existing provider) - this will cover the period 12.10.23-4.12.23. From the 5.12.23 we will be looking for a 3rd part top up to be paid - as discussed - in order to keep (the existing provider) on board (as we did find a better value package of care on the 4th but was declined as you would like to do the 3rd party top up).”
14. Mrs A was admitted to hospital at the end of December 2023. On discharge her care arrangements were made by the hospital social work team and a different care agency was put in place.
15. The Council says that in February 2024 Mrs X advised a financial assessment officer that probate had been granted (and Mrs A’s assets were now above the upper threshold of £23,250). Mrs X says in fact probate was not granted until March. In any event the Council wrote to Mrs X and said Mrs A was now assessed as able to pay the full cost of her care from 12 October 2023 to 04 December 2023. It sent an invoice for £4105.
16. In March Mrs A was admitted to a care home and the care package recommenced on discharge until Mrs X informed the Council in April that she could manage Mrs A’s needs herself. Mrs X told the duty social worker she had received an invoice for £4000 but nobody had discussed the finances with her.

The complaint

17. In May Mrs X complained to the Council. She said there was a lack of clarity about the arrangements she had to make about the third-party top-up; the allocated social worker went on leave and she had no contact; she received an unexpected invoice for over £4000.
18. The Council responded in June. The team manager explained that the social worker was right to say initially that Mrs X would have to pay a top-up but when the Council could not source a less expensive care provider, the top-up fee was waived. However, a less expensive care provider was then found but Mrs X refused it. She said, “The situation regarding the third-party request changed when we were able to procure the support via an agency which accepted Council rates. This should have been clearly communicated to you and I apologise that this was not the case.”
19. The team manager said the records showed that a financial assessment officer had spoken to Mrs X on 15 February once she was aware that probate had been granted, and said that Mrs A now had assets above the threshold amount and would be classed as a self-funder for the period 12 October 2023 to 4 December 2023. The records showed the officer had said an invoice would be sent out for the relevant amount. The team manager said the Council had now paid the care company for that period of time and Mrs X should reclaim the money from the care provider.
20. Mrs X complained again. She said the Council had told her in October 2023 she would need to pay £125 towards the cost of Mrs A’s weekly care. She said it was not until February 2024 that the Council had sent an invoice for £4000 which she was not satisfied she should pay, as her mother had already paid the care company for that period.
21. A team leader explained that the provisional financial assessment undertaken in October 2023 was based on Mrs A’s income and expenditure as the level of capital then declared on the assessment forms was lower than the upper threshold amount. She explained this was in accordance with the statutory guidance. However once probate was granted in February the financial assessment was revised and the amount became payable.
22. The team leader added, “Charges cannot be raised until the funding provision has been authorised. The funding provision set up to pay (the care provider) for the period 12 October 2023 to 4 December 2023 was authorised on our system on 12 February 2024. Therefore we were unable to raise the invoice any earlier than the next scheduled billing run which was completed on 22 February 2024.” She did not uphold the complaint.
23. Mrs X complained to the Ombudsman. She said the unexpected invoice had been a shock to her. She also said that her mother’s care needs had not been reviewed following her most recent discharge from hospital.
24. The Council has provided the relevant case recording showing the emails between Mrs X and the social worker. It says the social worker’s absence on leave “did not impact on the support that (Mrs A) received as she was admitted to hospital on 28.12.23. Our records show that the social work team had not been contacted for any support by (Mrs X) whilst (the social worker) was on leave. Her support needs were subsequently met by the Hospital Social Work team”.
25. The Council has also provided records showing that Mrs A’s care needs were reassessed four times between February and April. Mrs X says that there has still not been an assessment for NHS funding as she requested.
26. Mrs X says although repayment was discussed as a possibility it was never clarified until probate was granted. She says she did not contact the finance team as suggested by the social worker as it was likely that they could not clarify it for her either.

Analysis

27. In my view the Council gave sufficient advance information to Mrs X that the period of care from October to December might be payable. The social worker explained that possibility at least twice during the early assessment period in October. She also gave the finance team’s contact details to Mrs X for her to pursue the matter, but Mrs X chose not to do so. There is no evidence of fault on the part of the Council.
28. The information about the need for a third-party top-up was not always clear, as the Council acknowledged, but was largely due to a changing situation with the availability of a care provider within the Council’s usual rates. The team manager apologised for the confusion this had caused.
29. The evidence shows that Mrs A’s needs were reassessed appropriately.

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Decision

30. I have completed this investigation as I have not found fault by the Council.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman