Summary: Mr X complained his mother’s care home billed him for unpaid care charges two and a half years after his mother passed away. Mr X says this situation has caused distress and upset to him and his family. The Ombudsman found fault with the care home for duplicating end-of-life care charges, failing to justify care charges and providing a mistaken refund causing increased underpayments. The Council proposed to clear the debt owed to the care home. The Ombudsman considers this proposal suitable to reflect the fault in this case. The care home agreed to write to Mr X to confirm there is no outstanding balance owed on Mrs Z’s account.

The complaint

1. Mr X complained his mother’s care home billed him for unpaid care charges two and a half years after his mother passed away.
2. Mr X says the care home told him this was for underpayments during Mrs Z’s time in the care home which Mr X disputes.
3. Mr X says the care home has not previously raised concerns about payments and this situation has caused distress and upset to him and his family.

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The Ombudsman’s role and powers

4. We investigate complaints about adult social care providers and decide whether their actions have caused an injustice, or could have caused injustice, to the person making the complaint. I have used the term fault to describe such actions. (Local Government Act 1974, sections 34B and 34C)
5. If an adult social care provider’s actions have caused an injustice, we may suggest a remedy. (Local Government Act 1974, section 34H(4))
6. If we are satisfied with a Care Provider’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

7. I have considered all the information Mr X provided. I have also asked both the care home and Council questions and requested information, and in turn have considered both the care home’s and Council’s response.
8. Mr X and the care home had opportunity to comment on my draft decision.

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What I found

What happened

9. The Council placed Mr X’s mother, Mrs Z, into a care home on 22 June 2017 following her discharge from hospital. Mrs Z originally chose a different care home but because of no availability the Council placed Mrs Z in the resultant care home.
10. When the Council placed Mrs Z into the care home it funded her care under an extended 12-week disregard. The Council did not pay for Mrs Z’s client contribution or top-up cost. Mrs Z, and Mr X on her behalf, paid the care home for these costs.
11. On 22 January 2018, Mrs Z became a self-funder and agreed to a contract with the care home. Mrs Z, and Mr X on her behalf, paid the care home for the full cost of care.
12. By 22 January 2018, Mrs Z owed £1,103.61 to the care home from unpaid care charges.
13. Mrs Z, and Mr X on her behalf, paid for the full care costs to the care home from 22 January 2018 to 20 November 2018. Mrs Z overpaid on her care costs during this time by £614.29. This reduced Mrs Z’s underpayments to £489.32 up to 20 November 2018.
14. Mrs Z was granted end-of-life support from 17 November 2018 covering the cost of her care before she passed away on 27 November 2018. The care home did not charge for care from 21 November 2018 to 27 November 2018 but did charge for care, totalling £278.57, from 17 November 2018 to 20 November 2018.
15. On 15 April 2019, the care home refunded Mr X £928.57 for the end-of-life support care costs from 17 November 2018 to 27 November 2018.
16. The care home sent Mr X a bill for £1,417.89 on 30 April 2021. The care home said this cost was for unpaid care home charges for Mrs Z. The care home outlined the charges and payments received when justifying this balance of £1,417.89.
17. Mr X contacted the care home on 4 May 2021 to query the bill. The care home told Mr X he needed to pay the balance owed. Mr X asked for the invoices to justify this balance.
18. The care home sent Mr X the invoices on 21 May 2021. The care home told Mr X he now owed £1,518.40.
19. Mr X asked the care home for its complaints procedure form on 24 May 2021. The care home provided this to Mr X on the same date.
20. Mr X asked for copies of all “unpaid invoices” from the care home on 25 May 2021. The care home provided Mr X with copies of all invoices again. The care home explained to Mr X the underpayment was not specific to a single invoice but rather general underpayments over the time Mrs Z was in the care home.
21. Mr X disputed the underpayments advising he had made consistent payments during Mrs Z’s time in the care home and the care home never questioned the payments until 2021. Mr X said the care home had not considered all the payments made when reaching the balance owed.
22. Mr X made a formal complaint to the Council on 26 May 2021.
23. The care home provided its complaint response on the same date. The care home said it had reviewed its full records and Mr X owed £1,519.40 to the care home for underpayments towards Mr Z’s care.
24. Mr X complained to the Local Government and Social Care Ombudsman (the Ombudsman). The Ombudsman made enquiries of both the Council and the care home.

Analysis

25. The Council received payments from both the Council and Mrs Z, or Mr X on her behalf, from 22 June 2017 to 22 January 2018. This was because the Council was contributing towards Mrs Z’s cost of care through an extended 12-week disregard.
26. The care home was not responsible for ensuring the Council paid the correct amount towards the cost of Mrs Z’s care. The care home’s responsibility was to ensure it billed Mrs Z correctly for the cost of care it was providing.
27. The care home has provided to both Mr X and the Ombudsman a breakdown of the total charges for Mrs Z’s care from 22 June 2017 to 27 November 2018. The care home has also showed all the payments it has received for Mrs Z’s care.
28. Mr X has shown as many payments as he can from Mrs Z, or himself, for Mrs Z’s care. The care home has recorded all payments by Mrs Z, or Mr X. Despite these payments and the contributions from the Council, Mrs Z’s account was underpaid by £489.32 by 20 November 2018.
29. However, within this £489.32, the care home had charged £278.57 for care costs from 17 November 2018 to 20 November 2018. The care home should not have charged Mrs Z this as Mrs Z received end-of-life support. This was fault.
30. The care home refunded Mr X £928.57 on 15 April 2019 for the end-of-life care support. The care home should not have charged the £278.57 of this £928.57 in the first instance so refunding this money should have corrected the previous fault. But, the care home has added this charge of £278.57 back to the overall debt owed on Mrs Z’s account. This means, the car home is still holding Mrs Z accountable for this £278.57.
31. The care home should not have refunded the remaining £650 from the £928.57. The care home did not charge the £650 from 21 November 2018 to 27 November 2018. This meant the care home has refunded £650 which it did not charge Mrs Z for. This refund of £928.57 resulted in the care home increasing Mrs Z’s underpayments to £1,417.89.
32. In May 2021, the care home increased the underpayments from £1,417.89 to £1,518.40. There is no evidence or justification for this increase of £101.51. Applying this increase of £101.51 is fault.
33. If the increase of £101.51 is removed, the balance returns to £1,416.89. The care home should not be holding Mrs Z accountable for the care charges from 17 November 2018 to 20 November 2018 of £278.57 as this was covered by the end-of-life support. The care home has not accounted for this. This is fault.
34. Removing this £278.57 reduces Mrs Z’s underpayments to £1,138.32. Of the remaining underpayments, the Council has admitted its responsibility for £764.28 in top-ups it should have paid to the care home from 22 June 2017 to 22 January 2018. This means, Mrs Z, or Mr X on her behalf, is only liable for the resultant underpayment of £374.04. While Mr X disputes any underpayment, this is the total underpayment owed to the care home by Mrs Z for her time at the care home.
35. While Mr X owes this underpayment of £374.04 to the care home, the Council has offered to settle this balance with the care home with the top-up charges it failed to pay. The Council will also ensure settlement of the duplicated charge of £278.57 for the end-of-life support and unjustified charge of £101.51.
36. Settlement of the balance between the Council and care home removes any injustice to Mr X and removes £374.04 of valid underpayments. This reflects the inconvenience, distress and frustration Mr X has experienced because of the fault from the care home.

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Agreed action

37. Within one month of the Ombudsman’s final decision the care home should:
• Write to Mr X to confirm there is no outstanding balance owed on Mrs Z’s account.

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Final decision

38. There was fault by the Council as the Council has agreed to my recommendation, I have completed my investigation.

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Investigator's decision on behalf of the Ombudsman