Summary: Mrs X complained on behalf of her late husband, Mr X, about care and support charges for respite care. Mrs X said the Council did not tell her the cost of respite care and took over a year to complete Mr X’s financial assessment. This resulted in unexpected, backdated charges of over £4,000. We found the Council at fault for delay completing Mr X’s financial assessment and for failing to provide appropriate and timely charging information. The Council will apologise and provide a symbolic financial remedy for the distress and lost opportunity this caused.

The complaint

1. Mrs X complained on behalf of her late husband, Mr X, about care and support charges for respite care. Mrs X said the Council did not tell her the cost of respite care and took over a year to complete Mr X’s financial assessment. This resulted in unexpected, backdated charges of over £4,000. Mrs X said this caused distress and financial difficulties.
2. Mrs X wanted the Council to refund the earlier costs and only charge from the date of its financial assessment.

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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. As part of the investigation, I considered the complaint and the information Mrs X provided.
6. I made written enquiries of the Council and considered its response along with relevant law and guidance.
7. Mrs 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

Charging for social care

8. 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)
9. 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. A council must not charge more than the cost it incurs to meet a person’s assessed eligible needs.
10. Councils should carry out assessments over a suitable and reasonable timescale considering the urgency of needs and any variation in those needs. Councils should tell people an indicative timescale over which their assessment will be conducted and keep the person informed throughout the assessment process. (Care and Support Statutory Guidance, paragraph 6.29)
11. Councils should ensure there is sufficient information and advice available in a suitable format for the person’s needs, in line with the Equality Act 2010, to ensure that they or their representative are able to understand any contributions they are asked to make. (Care and Support Statutory Guidance, paragraph 8.3)

Carer’s budget and Respite care

12. Respite care means taking a break from caring, while the person someone cares for is looked after by someone else. The person a carer looks after could go to a day care centre, or a paid carer could visit them at home to look after them.
13. The Care Act 2014 says the council may meet the carer’s needs by providing a service directly to the adult needing care. The carer must still receive a support plan which covers their needs, and how the council will meet them. The carer’s personal budget must be an amount that enables the carer to meet their needs to continue to fulfil their caring role. It must also consider what the carer wishes to achieve in their day-to-day life. Part of the planning process should be to agree how the carer will use the personal budget to meet their needs. (Care and Support Statutory Guidance 2014)
14. If someone qualifies for respite care, the Council will complete a financial assessment to work out whether it will pay towards it. If a person qualifies for respite care, they can ask the Council to arrange it, or arrange it themselves through a personal budget or direct payment.

Personal budgets

15. Everyone whose needs the council meets must receive a personal budget as part of the care and support plan. The personal budget gives the person clear information about the money allocated to meet the needs identified in the assessment and recorded in the plan. The council should share an indicative amount with the person, and anybody else involved, at the start of care and support planning. It should confirm the final amount of the personal budget through this process. The detail of how the person will use their personal budget will be in the care and support plan. The personal budget must always be enough to meet the person’s care and support needs.
16. There are three main ways a personal budget can be administered:

• as a managed account held by the council with support provided in line with the person’s wishes;
• as a managed account held by a third party (often called an individual service fund or ISF) with support provided in line with the person’s wishes; or
• as a direct payment.
  (Care and Support Statutory Guidance 2014)

Direct payments

17. 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. The council must ensure people have relevant and timely information about direct payments so they can decide whether to request them. If they do so, the council should support them to use and manage the payment properly.

What happened

18. I have summarised below some key events leading to Mrs X’s complaint. This is not intended to be a detailed account of what took place.
19. Mr X suffered from Alzheimer's and Mrs X acted as his carer. Mr X was in hospital in December 2022 and his condition declined after he returned home.
20. Mrs X contacted the Council about respite care in February 2023 as she was exhausted looking after Mr X.
21. The Council agreed to provide respite on a rolling basis, which there was no charge for. This was for one day a week at a daycare centre.
22. The Council completed a carers assessment for Mrs X in March. She was tired and sleep deprived looking after Mr X, and asked for a residential placement for respite instead of the daycare centre.
23. Mrs X approached the Council again because Mr X suffered separation anxiety at the daycare centre. This caused Mr X distress, and he could no longer attend. Mrs X was struggling to cope looking after Mr X.
24. The Council therefore arranged day time support from outreach workers, starting on 15 May 2023. This was a chargeable service.
25. The Council recorded in Mr X’s support plan that the daycare centre or a care package were unsuitable choices, due to Mr X’s separation anxiety and agitation in unfamiliar surroundings with unfamiliar people. It also said residential respite was not required at that time. The Council recorded Mr X’s estimated budget as £272.59 a week, and his contribution as ‘to be assessed’.
26. Mrs X signed a direct payment agreement with the Council on 11 August 2023.
27. The direct payment agreement gives details of how and when the Council will pay Mr X’s personal budget, and includes a user guide.
28. The user guide section states the person signing the agreement (in this case Mrs X) confirms they have read the Council’s direct payments factsheets.
29. The Council’s factsheet, ‘Financial Implications for Non-Residential Care services’ lists the services a person may have to pay for (including home care, day care, supported living, direct payments, and respite care in a care home). It states a person’s contribution will be worked out by financial assessment, and all charges will be backdated to the start of the services.
30. Mr X started attending a small day care centre for one day a week in November 2023. This was paid for by Mrs X and was in addition to the outreach support visits.
31. The Council completed a financial assessment for Mr X on 28 May 2024 and confirmed what Mr X could afford to pay each week. As Mr X could afford more than the weekly cost of the care package, he had to pay the full cost.
32. The Council sent Mrs X an invoice of £4,114 for Mr X’s care charges, backdated to 15 May 2023.
33. Mrs X complained to the Council. She said when the Council arranged Mr X’s outreach care she was told he may need a financial assessment to see if he should pay a contribution. That did not happen until May 2024 and the Council determined Mr X had to pay the full cost of the outreach support. The Council then backdated the charges to May 2023, with a cost of £4,114. Mrs X said Mr X should only be liable from May 2024 onwards, not the previous year, as the delay was the Council’s fault. Mrs X said the Council never told her the cost of the outreach sessions or warned her Mr X would have to pay the full amount.
34. Mrs X said if she had known Mr X would have to pay, and the charges would be £84 for three hours, she would have cancelled the outreach sessions in October or November 2023 as they were not cost effective. She said five hours at the day care centre cost £57. She also suggested another company only charged £60 for three hours care.
35. The Council’s complaint response referred to a telephone conversation Mrs X had with Mr Y’s social worker in February 2023. The Council said the social worker told Mrs X there would be a charge for Mr X’s care.
36. The Council said initially, Mr X received rolling respite, and there was no charge. Then, on 15 May 2023, the Council commissioned day time support, which was chargeable.
37. The Council said it completed Mr X’s financial assessment on 28 May 2024 to work out what he could afford to contribute. It said his assessed weekly charge was currently defaulting to the cost of the care package. That was because the Council assessed Mr X could afford to pay more than the cost of the care package.
38. The Council apologised for the delay completing a financial assessment. It said this was because the social worker delayed entering the commissioned care package onto the system to prompt a financial assessment.
39. Mr X sadly passed away in August 2024.

My Investigation

40. Mrs X told us the Council gave Mr X one day a week in a day care centre on rolling respite. However, this was not suitable due to Mr X’s extreme attachment to Mrs X. The Council therefore offered outreach support instead, starting for one hour a week and increasing to two and then three hours. Mrs X said this worked and gave her a break from caring. By November 2023, Mr X was able to attend a small day care centre once a week which Mrs X paid for privately.
41. Mrs X said the Council did not tell her the cost of the outreach support, only that she may have to pay a contribution. She said the cost was much higher than the day care centre, and she would have cancelled in November 2023 if she had known. Mrs X thought Mr X’s budget at the time of his rolling respite was still in place. The day centre was £57 a day whereas the outreach support was £84 for three hours.
42. Mrs X said she could not afford to pay the Council’s backdated bill in full, so she paid £500 a month. She hoped her complaint would reduce the amount owed. Following Mr X’s death in August 2023, Mrs X’s income reduced, and she could not afford to pay £500 a month anymore.
43. The Council told us it did not send Mrs X any specific letters communicating that Mr X may have to pay a contribution towards his care, but it provides information leaflets/factsheets which it routinely sends out.
44. Since Mrs X’s complaint, the Council said it has ensured all staff use case notes to record financial contribution discussions and this was discussed in a team meeting to ensure consistent information sharing.
45. It also held training on timely financial assessments, with information courses on effective record keeping.
46. The Council also said it now holds regular four weekly supervisions with all staff and developed an electronic audit tool to understand the status and plan of caseloads.

Analysis

47. The Council accepted there was a delay completing Mr X’s financial assessment. The Care Act 2014 does not specify a timeframe in which councils should complete a financial assessment. However, our view is that it should be completed within an appropriate and reasonable timeframe, in line with the requirements set out in the Care and Support Statutory Guidance (paragraph 6.29). This allows people to know how much they may need to contribute to the costs of their care at the relevant time, so they can make an informed choice about what they want.
48. I appreciate the Council’s financial assessment team completed Mr X’s assessment promptly after receiving his details. However, there was a significant delay by the adult social care team in referring Mr X for a financial assessment. That meant it took the Council about a year to complete Mr X’s financial assessment, from the time Mr X’s outreach support started. That was too long and amounts to fault. This caused Mrs X frustration and uncertainty. It also meant she could not make an informed choice about Mr X’s care at the relevant time.
49. It is important councils give sufficient information about paying for care at an early stage. This is to enable informed decision making. Where a council is not able to complete a prompt financial assessment it should still give appropriate written general information about the likelihood of needing to make a contribution towards care costs.
50. I found the Council told Mrs X it needed to complete a financial assessment. It also told her this was a means tested process, and that it needed to determine Mr X’s contribution.
51. However, following the meeting the May 2023, I would expect the Council to write to Mrs X to confirm the arrangements and explain the process. I have not seen evidence the Council sent any written information to Mrs X about the financial assessment process, or the cost of outreach support visits, at a suitable time to allow her to make an informed decision. That was fault.
52. I found Mr X’s support plan does confirm the cost of the outreach support. However, the plan is undated, and I do not know if the Council sent Mrs X a copy of Mr X’s support plan, or if it confirmed what his estimated personal budget was for outreach support. I also do not know if the Council told Mrs X the likely cost of the outreach support. The fact the Council cannot evidence having provided this information is fault.
53. While Mrs X knew the outreach support was not free, and Mr X may have to contribute to the cost, I do not consider she knew this may be a fully chargeable service which Mr X had a new personal budget for. She thought Mr X’s personal budget remained the same as for the rolling respite and that any charges Mr X may have to contribute to would be at the same rate as the day care centre.
54. The Council has a duty to provide clear information about charging and the financial assessment process, in a format service users can understand. It is also important the Council keeps a record of this.
55. We can decide what we think is more likely than not to have happened but for any fault to determine the extent of the injustice. In this case, I have considered whether, but for the fault, Mrs X would have chosen to cancel the outreach support visits in November 2023 as she asserts. On balance, I do not consider there is enough evidence for me to say she would have.
56. While I appreciate Mr X was able to return to a day care centre in November 2023, he also continued to receive outreach support. If the outreach support stopped, I cannot say Mr X would remain able to attend a day care centre. Also, Mr X was only attending the day care centre one day a week. I cannot say whether this would have been enough to meet Mrs X’s need for a break from her caring role, and I cannot say whether Mr X could have coped with more days at the day care centre. It is possible the Council could have looked into other care providers to see if they could provide cheaper home care, but this would be subject to a new provider confirming they could meet Mr X’s needs. It would also depend on Mr X being able to adapt to a new care provider, as I understand unfamiliar people posed a challenge. I consider there are too many variables for me to say, even on balance, what may have happened.
57. However, the Council’s failure to provide Mrs X with information about how much the outreach support was likely to cost in advance, and its failure to provide a financial assessment within a reasonable time, meant Mrs X lost the opportunity to make an informed decision about Mr X’s care. She also experienced the distress of receiving a large bill. This is her injustice.
58. The Ombudsman’s approach to remedying injustice caused by fault in the information the Council gave about paying for care, is that we will not normally ask the Council to waive the charges. That is because the person received the care and should expect to make some contribution, unless there is compelling evidence of entirely misleading advice. I did not find that was the case here.
59. The Council was entitled to charge Mr X for his care and support, and Mrs X confirmed she knew Mr X may have to contribute. After a financial assessment, the Council is also entitled to backdate the charges to the time the care and support started.
60. As I found Mrs X suffered distress and lost opportunity as a result of the Council’s failings, I will recommend the Council provides her with a symbolic financial remedy.
61. The Council undertook suitable service improvements in response to Mrs X’s complaint. However, in addition to case notes recording financial discussions, the Council should also ensure it sends written charging information to people. The Council told me it has a financial implications document which details charging, and social workers should ask service users to sign a financial information discussion document. The Council needs to ensure officers routinely provide this information and document having done so.

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Agreed Action

62. Within four weeks of my final decision, the Council will:
• Apologise to Mrs X for the delay completing Mr X’s financial assessment, and for failing to provide clear charging advice. 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.
• Pay Mrs X £300 for the distress and lost opportunity this caused.
• Remind staff in its Adult Social Care service to provide service users with the Council’s financial information and discussions documents, and to record having done so.
63. The Council should provide us with evidence it has complied with the above actions.

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Final Decision

64. I found the Council at fault for delay completing Mr X’s financial assessment and for failing to provide appropriate and timely charging information.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman