Summary: Mrs X complained the Council provided incorrect and misleading advice about the cost of her husband’s residential care. We have found no fault by the Council.

The complaint

1. Mrs X complains the Council provided incorrect and misleading advice that it would fund all or most of the cost of her husband’s residential care. Mrs X says she based the decision about her husband’s residential placement based on this advice and now cannot afford the cost.

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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. We may investigate complaints from the person affected by the complaint issues, or from someone else if they have given their consent. If the person affected cannot give their consent, we may investigate a complaint from a person we decide is a suitable representative. (section 26A or 34C, Local Government Act 1974)
4. When considering complaints we make findings based on the balance of probabilities. This means that we look at the available relevant evidence and decide what was more likely to have happened.
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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How I considered this complaint

6. I considered evidence provided by Mrs X and the Council as well as relevant law, policy and guidance.
7. Mrs 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

Background and legislation

8. 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.
9. 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.
10. 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.
11. Discharge to Assess (D2A) is a model whereby people with new or additional health and/or social care needs on discharge from hospital receive post-discharge recovery support, and where assessments of longer-term or ongoing needs (if required) are fully completed only once a person has reached a point of recovery and stability. As discharge to assess is underpinned by simple principles rather than rigid criteria, there is no fixed delivery model.

What happened

12. The following is a summary of key events. It does not include everything that happened.
13. Mrs X was in contact with the Council in early 2022 about day care and respite care for her husband, Mr X, who was living with her at their home.
14. The Council provided Mrs X with a copy of its financial screening form to complete at an assessment visit in April 2022. It is recorded that a copy of a charging form and booklet was sent to Mrs X on 25 April 2022 for both community and residential care.
15. Mrs X spoke with Mr X’s social worker in early May 2022 about not returning the financial screening form as she was seeking financial advice about some pensions and money they had should her husband need a care home. Mrs X was advised that she still needed to complete the form and if she did not do so she would still get a bill from the Council which would be at full cost if was not properly assessed based on full information. Mrs X confirmed she would send the form in as soon as possible.
16. Mrs X telephoned the Council in August 2022 seeking a care needs assessment and financial assessment as she was considering a care home for Mr X. Mrs X advised they had joint savings of roughly £70,000 to £80,000. The Council contacted Mrs X again about returning the financial screening form. During this call Mrs X advised she was not sure what funds they had. The Council explained this would be addressed in a financial assessment but, based on the amount she had previously mentioned, Mr X would be self-funding. Mrs X was also advised she could arrange this privately if she wished.
17. There was a further telephone call with Mrs X towards the end of August 2022 as she had not returned the financial screening form. Mrs X advised she had sought legal advice about the financial situation as there were joint investments involved. The Council explained the financial assessment would work out the calculations accordingly. The Council asked about the care package and re-iterated it would be on a full charge basis based on Mr X being over the threshold. The Council also reiterated the options of it commissioning the care or Mrs X doing so privately.
18. Mrs X advised in early September 2022 that it would be better for Mr X to go into a care home as he was becoming more aggressive and she had been looking at homes and named two. Mrs X explained she had not sent the finance form as she was still not sure and intended to see a financial adviser. Mrs X said although they had over the threshold, she was not sure anymore with the stocks going up and down. The Council advised it was good Mrs X was looking at preferred homes and as a self-funder Mr X would be paying full cost. The financial assessment could only be done when the team had the required information. Mrs X advised she was likely to arrange a placement the following week at her preferred care home.
19. Mr X was admitted to hospital in September. Mrs X contacted the Council in mid-September to explain Mr X had deteriorated and was in hospital and was likely to be sent to a mental health service unit for assessment and treatment before being placed in a care home.
20. The Council spoke with Mrs X in mid-September 2022 to confirm Mr X had been assessed with a recommendation to be discharged to a ‘discharge to assess’ bed and this would be a care home within its area. The Council confirmed this placement would only be non-chargeable for up to four weeks but once Mr X’s care needs were reviewed at any point within the four weeks his care would become chargeable. The Council explained Mr X would have a financial assessment to determine if he was going to pay for all his care or what amount he would be contributing towards his care. Mrs X gave the name of a preferred care home she had contacted. It was explained the Council did not have any ‘discharge to assess’ beds at that care home and asked if Mrs X wished to pay for a short stay bed privately. Mrs X explained she was still in the process of getting access to her husband’s finances and the Lasting Power of Attorney paperwork was still being signed.
21. Mrs X advised at the end of September 2022 that Mr X had been admitted to a mental health unit under section 2 of the Mental Health Act 1983.
22. The Council spoke with Mrs X in early January 2023 about Mr X’s future placement. The Council confirmed there would need to be a financial assessment and that would determine Mr X’s social care contribution with the likely placement being a care home. The Council resent the financial form.
23. The Council returned a telephone call from Mrs X in early January 2023 as she had queried whether her husband was being considered for NHS or a private care home. The Council explained about NHS Continuing Healthcare (CHC) and there would be a decision to determine any NHS funding. Otherwise, it would be funded by social care with Mr X’s contribution.

24. The Council contacted Mrs X towards the end of January 2023 seeking the return of the financial form. Mrs X returned this form at the end of January 2023. The form signed by Mrs X set out there were no savings, capital, or investments over £23,250 and her agreement to a financial assessment to determine how much Mr X would need to pay towards any care services and to supply evidence and confirmation of receipt of the charging booklet. Mrs X had corrected notes on this form to confirm the property was not mortgaged. The notes stated Mr X was in a mental hospital and ready for discharge and required a residential placement as soon as possible.
25. The Council wrote to Mrs X at the end of January 2023 about the above information and set out that Mr X may need to pay towards the cost of his care and so a financial assessment was required to ensure he paid the correct amount. The Council enclosed a form for Mrs X to complete and return with supporting evidence. Mrs X has made a note on this dated 21 February 2023 with a named officer and ‘why?’. Mrs X returned the financial assessment pack and received an acknowledgement dated 24 February 2023. She has written ‘evidence received why?’.
26. The NHS Trust wrote to the Council at the end of February 2023 confirming the criteria for CHC funding was not met and an outcome letter was due to be sent to Mrs X.
27. The Council contacted Mrs X at the end of February 2023 to say a particular care home was due to assess Mr X. The Council spoke to Mrs X in early and mid-March 2023 about visiting the care home. Mrs X visited the care home towards the end of March 2023 and confirmed it had gone well and wanted the assessment to go ahead.
28. In a subsequent email Mrs X advised she thought the care home would be expensive. Mrs X has provided handwritten notes including a chronology of events from September 2022. This included a note dated 23 March 2023 to say a named officer from the Council had telephoned and told her the Council were paying for Mr X’s care and his DWP pension would be stopped except for £27 for toiletries. There is a note dated the following day to say a named person phoned a friend and the Council who confirmed the Council were paying and this was confirmed by the mental health unit.
29. Mrs X emailed the Council at the end of March 2023 to say that before Mr X moved to the care home she must know the financial situation and specifically how much he was expected to pay and the outcome of his financial assessment.
30. The Council telephoned Mrs X and explained in case of any dispute on the contribution, she would have the opportunity to appeal and she should agree for the discharge to go ahead the following day. It was explained that Mr X could not be left in the hospital nor go back home and the only solution was the care home and they could lose the chance of this if he was not transferred soon as it was difficult getting a vacancy in a placement where they accepted local authority rates which would then require her to top up. Mrs X agreed for Mr X’s discharge and the Council would chase up the outcome of the financial assessment.
31. Mr X was transferred to the care home on 30 March 2023.
32. Mrs X sought the outcome of the financial assessment in early April 2023. The Council sent a holding reply advising it would let her know of the contribution as soon as possible.
33. The Council wrote to Mrs X in early May 2023 to say it had determined Mr X was above the threshold and was required to pay the full cost of his residential care. Mrs X wrote to the Council to dispute the outcome of the financial assessment.
34. Mrs X received an invoice dated 14 June 2023. She has made a note on this which says, ‘HCC paying!...doing assessment – why necessary’. Mrs X has made another note dated 20 June 2023 with a named officer which says, ‘HCC paying’.
35. Mrs X received a reminder dated 4 July 2023 for the amount overdue for Mr X’s residential care. Mrs X has provided a note dated 7 July with a named officer which says ‘Ignore! Bin It!’ Mrs X has made another note on this date with a different named officer which says, ‘automatic churn out’.
36. The Council sent Mrs X an invoice dated 12 July 2023 for Mr X’s contribution at the full cost.
37. The Council spoke with Mrs X in July 2023 about the accruing debt and she advised she disagreed with the financial assessment and how three bonds had been wrongly included. The Council confirmed that the bonds should not have been included as they were life assurances. It would provide a revised client contribution in due course with these removed. Mrs X telephoned the Council about invoices she was receiving for Mr X’s care as she was told the Council would be paying for this and they did not have the money to pay. The Council explained Mr X had been assessed to pay based on the evidence Mrs X had provided.
38. Mrs X contacted the Council in early October 2023 about the outcome of the financial assessment and advised they were unable to pay. The Council confirmed it was reviewing the financial assessment. Mrs X has provided a note she made dated 5 October 2023 with a named officer which says ‘ignore’.
39. The Council completed the review in mid-October 2023 and advised that removing the life assurances funds made little difference to the outcome as Mr X had a high income mainly from his occupational pension. Mrs X advised she had to spend £12,000 in repairs and did not have the money to pay the invoices being received. The Council provided details of a money advice line.
40. The Council noted that Mrs X was advising she was not able to afford the cost of Mr X’s care as his funds were used to support the household bills for their shared home and so the debt on the account was large as the invoices were not being paid. It considered reducing Mr X’s occupational pension by half to reduce his contribution to his care costs and support Mrs X. The Council sought information from Mrs X to progress this during November 2023.
41. The Council spoke with Mrs X in January 2024 about the outstanding invoices and she explained she had been told the Council would be paying for Mr X’s care and that it would be his pension minus a weekly allowance and that would be what they would need to pay for his contribution. Mrs X said she had been concerned about the affordability and had spoken with a named officer who advised her the Council would be supporting this which she also confirmed with the care home. The Council confirmed Mr X’s financial assessment was based on his income which included both private and state pensions. It was noted Mrs X expressed frustration over the assessment and explained she was unable to support her own household and pay his care bills and was confused by how the Council did not support the other partner. It was explained that if she were to request his occupational pension be halved each month then this could reduce his contribution and support her with household bills. She said that if this was halved she would be able to pay both Mr X’s bills and the household bills. The Council advised she would need to contact the DWP to advise of this. Mrs X explained she had incurred repair costs due to damage from Mr X and could not pay the outstanding balance. The Council explained it was important to address the ongoing invoices and look into getting the pension halved so she could start to make ongoing payments and then the debt could be discussed. The Council followed this up with an email to say it needed Mrs X to confirm in writing if she wished to proceed with halving Mr X’s pension and reiterated this may affect her own financial situation as it would be subject to tax.
42. Mrs X contacted the Council in April 2024 to say Mr X’s care at the mental health unit had been funded and when he was moved to the care home, she was told this placement would be paid for by the Council. She had advised the Council that Mr X would not be able to afford the cost of this and was told in a telephone call on 23 March 2023 that his contribution would be his state DWP pension and he would be left with £25 per week. Mrs X had spoken to the care home and they had also spoken to the Council which had confirmed it would be funding the placement. It was noted Mrs X had been provided with information about charging ahead of the placement and was aware a financial assessment would be required to decide Mr X’s contribution.
43. Mrs X complained to the Council on 17 January 2025 and set out:

• Mr X was placed at the care home as she was assured by two different sources the Council would be paying for the care.
• She had advised a named officer that the care home was too expensive and was assured Mr X would only have to pay his DWP pension minus £27 which he could keep for necessities.
• She asked the officer to provide sought this information by email but this was not done.
• She telephoned and left several messages about this but received no further contact.
• She had telephoned the care home to confirm the Council would be paying and they telephoned the Council and were told they had confirmed this was the case.
• She started receiving invoices and when she telephoned the accounts department was told to ignore them as they were a computer churn out.
• She telephoned in November on receiving the final demand and was told this was a frequent occurrence.

44. The Council responded to Mrs X’s complaint on 6 February 2025 to say there was no evidence she had been told Mr X would only have to pay his state pension less £27 per week for his care. The Council suggested a repayment plan and highlighted Mrs X’s responsibilities to deal with Mr X’s finances.
45. Mrs X sought to escalate her complaint on 23 March 2025. She noted the Council’s response failed to address her core complaint that multiple organisations including the Council had told her the Council would be funding Mr X’s ongoing care. It was only as a result of these assurances that she agreed to him being discharged to the care home. She had been told the care would be funded by the Council by a named officer, staff at the mental health unit had confirmed they understood the care would be funded by the Council and the care home manager had this confirmed in a telephone call to the Council.

46. The Council provided a final response to Mrs X on 25 March 2025. This set out:

• There was no evidence the named officer had advised Mr X would only have to pay his DWP minus £27.
• It noted Mrs X said the mental health unit and manager of the care home said care would be funded by the Council and suggested there had been a miscommunication/misunderstanding from external sources.
• The care placement was arranged through adult social care and was a directly commissioned service at the agreed local authority weekly rates.
• The Council was making a funding contribution to the placement but this was reduced by the NHS funded nursing care (FNC) and Mr X’s assessed client contribution.
• There was evidence in the Council’s records that Mrs X was fully informed of its charging policy and noted:
• she had been sent the relevant booklet
• had signed the financial screening form on 26 January 2023
• completed the financial declaration pack on 10 February 2023
• a case note on 29 March 2023 highlighted the ongoing financial assessment and Mrs X’s concern about how much Mr X would have to pay towards the cost of care
• There was a significant debt on the account and Mrs X needed to agree a suitable repayment plan.

47. Mrs X received a reminder dated 8 July 2025. She has written a note dated 10 July to say she spoke to a named officer and ‘ignore until resolved’.
48. The Council wrote to Mrs X in early September 2025 to say it had completed a review of the financial assessment and made a retrospective adjustment from 30 March 2023 as at her request it had allocated half of Mr X’s private pension to her as his spouse which had resulted in a reduction of his assessed weekly contribution and the outstanding balance owed. Mrs X has written on this to say, ‘not requested – Ombudsman involved’. Mrs X emailed the Council in mid-September to say she had not requested this action yet as she was dealing with the Ombudsman and no contribution would be made until the outcome of her complaint to the Ombudsman.

My analysis

49. It is important councils give sufficient information to a person 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. The Council has a duty to provide clear information about charging and the financial assessment process, in a format service users can understand.
50. In my view the Council gave sufficient advance information to Mrs X that Mr X’s residential care might be payable. There is good evidence the Council provided early information about charging to Mrs X. This included a copy of its financial screening form and booklet about charging for residential care during 2022.

51. The Council repeatedly sought the return of the completed form and explained Mr X’s contribution would be addressed in a financial assessment but, based on the amounts Mrs X had previously mentioned, he would be self-funding. The case records show that the Council provided consistent advice on this point. There are also several references to Mrs X seeking her own independent financial advice during the relevant period.
52. The form that Mrs X signed at the end of January 2023 set out her agreement to a financial assessment to determine how much Mr X would need to pay towards any care services and confirmation she had received the charging booklet. The Council acknowledged receipt of the form and set out that Mr X may need to pay towards the cost of his care and a financial assessment was required to ensure he paid the correct amount. Mrs X provided supporting evidence for the financial assessment towards the end of February 2023.
53. It was on 23 March 2023 that Mrs X says she was given verbal advice by a Council officer that it would be paying for Mr X’s residential care after his discharge from the mental health unit and he would only have to pay his state pension less a small amount for day to day essentials. Mrs X says this information was confirmed verbally by staff at the mental health unit and the care home.
54. However, I note Mrs X emailed the Council at the end of March to say that before Mr X moved to the care home she must know the financial situation and specifically how much he was expected to pay and the outcome of his financial assessment. As we know Mr X transferred to residential care at the end of March 2023. The Council sent a holding reply to Mrs X in April advising it would let her know of the contribution as soon as possible. The Council sent the outcome of the financial assessment in early May 2023 confirming Mr X was required to pay the full cost of his residential care.
55. I have weighed all the evidence and given weight to the amount of consistent information provided to Mrs X about the need for a financial assessment to determine Mr X’s contribution towards the cost of his care and that he would most likely be assessed as paying the full cost. This is weighed against one piece of verbal advice that Mr X would only have to pay his state pension and the Council would fund the remainder. Any such advice would have been subject to the completion of a financial assessment which identified Mr X was in receipt of a significant occupational pension which would also be assessed as income. On balance, I have not found the Council at fault.
56. I have also considered Mrs X’s notes of her contact with the Council about the invoices and reminders she was receiving. I note these contacts were made after Mrs X had received the outcome of the financial assessment and been informed of the amount Mr X was required to pay towards the cost of his care. I cannot know what information Mrs X provided during these calls. However, it is clear she was disputing the outcome of the financial assessment and the requirement for Mr X to pay towards the cost of his care. In these circumstances, it would have been prudent for Mrs X to have complained to the Council before January 2025 about the invoices and debt that had been accruing from April 2023.
57. The Council has agreed to allocate half of Mr X’s private pension to Mrs X as his spouse which would result in a reduction of his assessed weekly contribution and the outstanding balance owed. It is a matter for Mrs X to decide if she wishes to pursue this course of action. As we would expect to see, the Council has also offered to agree a suitable repayment plan with Mrs X for the outstanding balance.
58. I should explain that even where we find fault causing injustice about information provided by a council about paying for care we do not normally consider it to be appropriate to recommend a council ‘waive’ or reimburse payments for care that has been received. This is because, the person received the care and should be assumed to have expected to make some contribution, unless there is compelling evidence of entirely misleading advice. I have not found this to be the case here.

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Decision

59. I find no fault.

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Investigator's decision on behalf of the Ombudsman