Summary: Ms X complained about the Council’s handling of Mr Y’s care charges and financial assessment. She also complained about the Council’s delay in discharging Mr Y from respite care, and said it failed to explain why he could not go home after the initial six-week reablement period. The Council is at fault for delay in making an occupational therapy referral. It is also at fault for the way it communicated with Ms X about the charges. This caused avoidable uncertainty and distress. The Council has agreed to apologise, make a payment, and make a service improvement.

The complaint

1. Ms X, on behalf of Mr Y, says the Council failed to carry out the correct process when charging Mr Y for the residential care services provided to him from December 2023 to April 2024. She says the Council failed to notify them that he would have to pay for the care services provided after the first six weeks of free care following hospital discharge, and they did not become aware he would have to pay any fees until June 2024. Ms X also said the Council failed to explain why Mr Y was kept in residential care beyond the initial six-week period following his discharge from hospital. Ms X said the Council’s communication with her was poor, and she was put to time and trouble trying to clarify the matter.
2. Ms X says the Council’s actions caused both her and Mr Y significant distress, confusion and financial worry, and he incurred debt of over £4000. She wants the Council to waive the fees.

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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. We may investigate a complaint on behalf of someone who has died or who cannot authorise someone to act for them. The complaint may be made by:

• their personal representative (if they have one), or
• someone we consider to be suitable.

(Local Government Act 1974, section 26A(2), 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(1), as amended)

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What I have and have not investigated

6. Ms X was aware of the matters complained of in February 2024, but she did not refer her complaint to us until May 2025. However, I have exercised discretion to investigate events before May 2024 as Ms X did not become aware of the care charges until February 2024. She then queried the charges with the Council, and the invoices were put on hold while it investigated. It is therefore reasonable that Ms X did not approach us before that point as she was waiting for the Council’s decision about whether she had to pay the charges.

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How I considered this complaint

7. I considered evidence provided by Ms X and the Council as well as relevant law, policy and guidance.
8. Ms X and the Council now have an opportunity to comment on my draft decision. I will consider any comments before making a final decision.

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What I found

Relevant legislation and guidance

9. 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)
10. 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.
11. Section 19 of the Care Act 2014 says a local authority may meet an adult's needs for care and support which appear to be urgent without having yet carried out a needs assessment or a financial assessment.
12. 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.
13. 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. (Reg 4, Care and Support (Preventing Needs for Care and Support) Regulations 2014)
14. A council can choose whether to charge a person where it is arranging to meet their needs. In the case of a short-term resident in a care home, the council has discretion to assess and charge as if the person were having their needs met other than by providing accommodation in a care home. Once a council has decided to charge a person, and it has been agreed they are a temporary resident, it must complete the financial assessment in line with the Care and Support (Charging and Assessment of Resources) Regulations 2014 and the Care and Support Statutory Guidance.

What happened

15. This is an overview of what happened and is not intended to be a detailed chronology.
16. Mr Y was admitted to hospital in September 2023.
17. The Council completed Mr Y’s Care Assessment at the end of October 2023. It determined that Mr Y had fluctuating capacity and therefore lacked the ability to make decisions about his discharge and care planning. It also found he had suffered a significant change of needs and reduced mobility and therefore required 24-hour care. The Council recommended a short stay residential placement so it could continue to assess Mr Y’s needs outside of the hospital environment before he could go home. The Council made a referral to a short stay care team.
18. The Council made a care and support plan for Mr Y at the beginning of November. The Council’s case notes show that it informed him he would be required to contribute towards his care charges, and he agreed to the care and support plan.
19. Mr Y was discharged from hospital later in November to a short stay reablement care placement. The Council initially arranged a two-week placement for Mr Y but extended this for a further two weeks without charge when he became ill with an infection, which meant the Council could not assess his needs at that time.
20. Mr Y’s social worker made a referral to an occupational therapist (OT) at the end of November, so it could assess his functionality and care needs.
21. The Council’s case notes show it had a conversation with Ms X at the beginning of December about moving Mr Y to a ‘chargeable bed’, and it explained Mr Y’s care would now become payable. The Council said Ms X agreed to this plan. A further case note indicates the Council had the same conversation with Ms X and Mr Y two days later, and both said they were happy with the plan.
22. The Council sent Ms X a financial assessment via email on 7 December.
23. Ms X completed and submitted the financial assessment the following week. Mr Y was moved on the same day.
24. Mr Y’s social worker resubmitted the referral for an OT the following day, as they had not provided all information required to process the initial referral in November. They followed up on its progress of the referral a few days later.
25. The following week, an occupational therapist visited Mr Y in the care home and said he would be at a high risk of falls and self-neglect if he were discharged. They said he needed 24-hour care, and it was not safe for him to go home. The social worker and care home staff agreed with this, although Ms X and Mr Y expressed their wishes for Mr Y to return home with a care package.
26. The Council sent the outcome letter of the financial assessment to Mr Y’s home address in January 2024. It stated Mr Y needed to make a weekly contribution to his care fees, effective from mid December 2023.
27. The Council completed another OT assessment at the end of January and created an updated care plan. The Council agreed Mr Y could go home with a care package but said it needed to complete an environmental OT assessment to see if any adaptations to his property were needed first.
28. Ms X visited Mr Y’s vacant property at the end of February and found the financial assessment outcome letter. She also found invoices for Mr Y’s care fees.
29. Ms X contacted Mr Y’s social worker and the Council’s financial team and queried the invoices. She said the Council had not told her or Mr Y that his care would become chargeable. She also said that when she had submitted the financial assessment online, she had seen a message that said it was unlikely that Mr Y was going to have to contribute to his care charges.
30. The Council responded and said the invoices needed to be paid and it could put a payment plan into place.
31. Mr Y’s social worker made a referral to the community OT at the end of March.
32. In mid-April, a community OT assessed Mr Y and visited his property to establish whether any adaptations were required to meet his needs, and ensure his home was safe for him to return to.
33. Mr Y was discharged at the end of April and returned home with a package of care.
34. Ms X contacted the Council again and continued to dispute the invoice. The Council’s case notes show a financial officer explained the financial assessment process and offered a payment plan. She said she did not understand why Mr Y’s short term reablement placement had been extended to 20 weeks in total.
35. The Council contacted Ms X at the beginning of June and requested payment of the invoices. Ms X emailed a few days later and disputed the charges again.
36. The Council responded to Ms X in July and said its records confirmed she was told in December 2023 that Mr Y would be transferred to a chargeable bed. It requested payment and offered to set up a payment plan.
37. Ms X said she did not accept the charges and said she intended to submit a formal complaint. The Council placed the invoices on hold in July pending review by a senior officer. Ms X contacted the Council again in September and said she had been given no further information and said the Council had still not answered her query about the invoices.
38. A senior officer reviewed the case in September and advised referral to the Council’s Debt Recovery Team.
39. Mr Y sadly died in November 2024.
40. Ms X continued to dispute the charges with the Council.
41. Ms X submitted a complaint to the Council in March 2025. She said she did not understand why Mr Y’s respite stay had been prolonged when it was initially planned to be a short stay while he was awaiting an OT assessment. Ms X said as a result, Mr Y had incurred fees of over £4000, which had caused him significant stress. She also said the Council’s communication with her had been poor and it did not clearly explain why the fees were owed.
42. The Council issued its complaint response at the end of March. It said it had explained to Ms X that Mr Y’s short respite stay had been extended so it could carry out a further assessment of his needs. It said it had initially been extended for two weeks while it arranged an OT assessment, and then there was a further delay in securing the OT input. It said it then became necessary to move Mr Y to a chargeable bed while it waited for OT availability. The Council said it said it had explained this to Ms X and Mr Y at the time. The Council also said it had informed Ms X and Mr Y of the care fees at the time the bed became chargeable. However, it accepted its communication was not always clear with Ms X and apologised.
43. Ms X approached the Ombudsman in May 2025.

Analysis

Financial assessment

44. The Council completed Mr Y’s care plan and started his chargeable care services in December 2023. It completed the financial assessment in January 2024.
45. The Council said it discussed potential care contributions with Ms X and Mr Y on three separate occasions before Ms X completed the financial assessment. I have reviewed the Council’s records and can see the Council has documented these conversations. However, there is no specific detail on what the Council discussed with Ms X and Mr Y, other than that they were ‘happy with the plan’. It is not clear if the Council explained the detail of the plan or discussed what the charges might be. This is fault.
46. The Council said the online financial assessment it sent to Ms X included information about paying for care services. However, since the assessment had not been completed at this stage, any information would not have been specific to Mr Y’s care. Guidance provided to local authorities about Care Act duties says Councils “must provide sufficient information and advice to enable adults to consider the financial aspects of meeting their care and support needs and to make plans for how they might meet any future needs for care and support”. It further specifies that Council should indicate what people “are likely to pay towards their care and support needs”. Though the Council provided information about paying for care services, there is no evidence it gave any estimate of what Mr Y’s care charges were likely to be. This is fault.
47. In addition, neither the Council or Ms X and Mr Y would have known in December 2023, before the financial assessment had been completed, what (if any) financial contribution Mr Y would be required to make. I am satisfied the Council made Ms X and Mr Y aware of the concept of care charges in December. However, they were not aware Mr Y would be liable for a client contribution until Ms X found the financial outcome letter at Mr Y’s property in February. The Council has also not provided any evidence that Ms X and Mr Y were notified of the potential care contributions in writing around this time. This is fault which caused Ms X and Mr Y distress.
48. Further to this, the Council sent the financial assessment outcome letter and invoices to Mr Y’s property despite knowing he was in a care home. This is poor practice and delayed Ms X and Mr Y’s awareness of the fees. This is fault. It is important councils give information about charging at an early stage, to enable people to make informed decisions about their care. However, although Ms X said she and Mr Y wished for him to go home, I could not say that earlier awareness of the charges would have changed this outcome, given that he was not considered fit for discharge until the end of January 2024. This suggests he needed the care he received. However, I do consider the oversights outline above caused Ms X and Mr Y uncertainty and distress. I have recommended a remedy and suitable service improvement to address this injustice below.

Delay in occupational therapy assessment

49. There is fault in the Council’s handling of the occupational therapy referral. The Council completed a new care assessment and care plan for Mr Y in January 2024, which stated Mr Y could return home with a care package, but it would first need to carry out an environmental assessment of his home. This was so it could determine if any adaptations were needed and ensure it would be a safe environment for him to return to.
50. However, the Council’s notes show that Mr Y’s social worker did not make the referral for a community OT assessment for two months. This then meant, due to a further delay caused by OT availability, Mr Y could not go home until mid-April. This delay had significant cost implications for Mr Y as he was being charged for residential care rather than a package of care at home, which is not only lower in cost but was his preferred choice of care. This delay subsequently caused Mr Y and Ms X distress. I have recommended a suitable remedy to address this injustice below.

Communication

51. I have reviewed communication records between Ms X and the Council. I can see she contacted the Council multiple times between February and September 2024 to contest the care charges. She also asked for clarity about why Mr Y had not been discharged after the initial reablement stay. The Council did respond to Ms X about the charges, initially placing the account on hold but later confirming the invoices needed to be paid. However, I can see that some responses were delayed by up to a month. While the Council’s policy does not specify response timescales for emails or queries, so its delay in response is not fault, such delays do not reflect good practice in line with the Ombudsman’s Principles of Good Administrative Practice. The Council should remind staff to respond promptly to correspondence about care fees and invoices.
52. The Council said it told Ms X that Mr Y required an OT assessment and was awaiting availability before he could go home. However, it has provided no evidence that it explained either the initial delay in making the referral or the subsequent delay caused by waiting lists. This lack of clear communication by the Council is fault, which left Ms X and Mr Y unclear about why he could not return home.

Action

53. As Mr Y has died, our guidance says we cannot recommend any injustice caused to him. However, I have made recommendations to remedy injustice caused to Ms X.
54. Within one month of the final decision, the Council has agreed to:
1. Apologise to Ms X for the uncertainty and distress caused by the identified fault.
2. Make a £500 payment to Ms X for uncertainty and distress caused by the identified fault.
3. Offer Ms X an affordable repayment plan for the remaining outstanding care costs.
55. Within two months of the final decision, the Council has agreed to send written reminders to relevant staff of the importance of providing clear information about charging and the financial assessment process to service users. In line with the Care Act guidance, this information should include what people are likely to pay towards their care and support needs. The Council should ensure they accurately record, in detail, any discussions and advice given around this.
56. The Council should provide us with evidence it has complied with the above actions.

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Decision

57. I find fault causing injustice for which I have recommended a remedy.

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Investigator's decision on behalf of the Ombudsman