Summary: Mr X complained that the Council did not inform him that additional charges may be required to maintain his father, Mr Y’s, care home placement once his capital fell below the funding threshold. We have found no fault. The care home was arranged and funded privately. When Mr Y’s capital later reduced, the Council explained its funding limits and the need for a top-up if he remained in the same home.

The complaint

1. Mr X says the Council did not inform him that it would not fund the full cost of his father, Mr Y’s, care home placement once his savings had dropped below the capital threshold. He says that, had he been aware of this, he would not have chosen the home as he wished to avoid Mr Y having to move.

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The Ombudsman’s role and powers

2. We investigate complaints of injustice caused by ‘maladministration’ and ‘service failure’. I have used the word fault to refer to these. We consider whether there was fault in the way an organisation made its decision. If there was no fault in how the organisation made its decision, we cannot question the outcome. (Local Government Act 1974, section 34(3), 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(1), as amended)

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How I considered this complaint

4. I considered evidence provided by Mr X and the Council as well as relevant law, policy and guidance.
5. Mr X and the Council 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

Law, guidance and policy

Charging

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, or a carer’s 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. 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 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 they will not need to contribute to the cost of their care and support from their capital.
8. 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 (Care and Support (Charging and Assessment of Resources) Regulations 2014)

East Sussex County Council Procedures

Factsheet: Going into residential or nursing care when you own a property

9. The Council pays a set amount for residential and nursing care. These are their ‘usual rates’. If the care home that someone chooses is more expensive, they or another person will need to pay the difference between the care home’s rate and the Council’s usual rate. This is called a ‘top-up’ payment.

Factsheet: Financial assessments for residential care

10. If someone has more than £23,250, they will pay all of their care costs.

What happened

11. In early November 2023, Mr Y was ready to be discharged from hospital. A Care Needs Assessment was completed, and it was agreed he would move to a care home. The Council sent out an information pack which included factsheets to assist them understanding the process. Two of the factsheets are summarised in paragraphs 9 and 10, above.
12. Around the same time, a discharge planning meeting took place. Mr Y’s family confirmed he would be self-funding because of his savings and monthly income.
13. Mr X contacted the Council for details of local care homes, and the Council provided a range of options.
14. At the end of November, Mr X told the Council that their preferred care home wanted proof that Mr Y had a minimum amount of savings, which he could not provide. As a result, that placement was no longer an option. Mr X asked for details of other care homes in the area.
15. A few days later, the Council was told that Mr Y would be discharged to a different care home.
16. In early December, the Council wrote to Mr Y with the outcome of its financial assessment. It confirmed that, because his capital was above the limit set by the Department of Health and Social Care, he would have to pay the full cost of his care and support. The Council said he was a self-funder and advised him to contact it when his capital fell close to the £23,250 threshold.
17. In mid-December, Mr X signed a residency agreement for the care home on Mr Y’s behalf. The agreement explained that, if Mr Y later became eligible for Council funding, a third party might need to pay any difference between the Council’s rate and the home’s fees. It also said the care home could end the placement if payment arrangements could not be agreed.
18. In early February 2024, Mr X’s wife contacted the Council to say Mr Y’s savings were close to the threshold. The Council asked for a copy of the Lasting Power of Attorney, which Mr X’s wife provided in early April 2024.
19. At the end of May, the Council wrote to Mr X with the outcome of Mr Y’s financial assessment. It confirmed Mr Y was eligible for financial support from the end of April 2024 and explained how much he would need to contribute towards his residential care.
20. In June, the Council allocated Mr Y’s case to a social worker. The Council decided the fees charged by the care home were significantly higher than its usual rate for the level of care Mr Y needed. The social worker discussed the possibility of a third-party top-up with Mr Y’s family. The family said they could not afford this and wanted Mr Y to remain at the home.
21. The Council tried to negotiate a lower fee with the care home, but the home refused. The Council’s funding panel then declined to approve the placement because the fees were significantly above its usual rates.
22. In mid-September, Mr X complained to the Council. He said that, when Mr Y was ready to leave hospital, his partner had contacted several care homes, many of which would not accept Mr Y’s financial circumstances. He said they eventually found a home that “agreed to take him given our circumstances”. Mr X said that, after the Council completed its latest financial assessment, the family believed the Council would begin paying towards the placement, but this did not happen. He was concerned about the effect a move to another home would have on Mr Y.
23. In late October, the Council responded to Mr X’s complaint. It said Mr Y’s family had chosen the placement and that it had helped by providing information about available care homes. The Council said it had considered the impact of a move and assessed that Mr Y’s needs could be met by another care provider within its usual rates.

My findings

24. Mr X arranged the care home placement privately and Mr Y entered the home as a self-funder. The Council was not involved in choosing or arranging the placement.
25. When Mr Y’s savings reduced and he became eligible for Council support, the Council carried out a financial assessment in line with its duties under the Care Act 2014. In June 2024, the Council explained that the fees charged by the care home were above its usual rate and discussed the option of a third-party top-up or alternative accommodation.
26. I have seen no evidence that the Council misled Mr X about the funding arrangements or failed to provide information about its responsibilities once it became involved. I therefore find no fault in the way the Council managed the move from self-funded care to Council-funded support.
27. Both the Council and the care home provided information explaining the financial responsibilities of Mr X and Mr Y. The evidence shows there was no fault by the Council.
28. The Council tried to negotiate a lower fee with the care home in line with its usual rates, but this was unsuccessful. It then considered whether Mr Y’s needs could be met in another placement and assessed the impact a move would have on him. I find no fault in the way the Council dealt with this issue.

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Decision

29. I find no fault.

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Investigator's decision on behalf of the Ombudsman