Summary: The Council delayed completing a financial assessment to decide what Mrs C should pay towards her residential care fees. The Council’s delay meant Mrs C accrued a large debt, it was a shock to receive an invoice for over £23,000 having never been in debt in her life. The Council delayed dealing with the complaint. Mrs C wants the Council to waive the debt, but this is a debt for which she is liable, The Council will offer Mrs C a reasonable repayment plan. The Council will apologise for its delay, pay £200 each to Mrs C and Mr B, and improve its procedures.

The complaint

1. The complainant, who I will call Mr B, says the Council delayed completing a financial assessment for his mother’s (Mrs C’s) care fees. The Council then sent Mrs C a bill for over £23,000. This came as a huge shock to Mrs C; she is very upset at being in debt in the later stages of her life when she has never been in debt before. Mr B says the Council delayed his complaint and sent him a cheque for a derogatory amount. Mr B said any payment should be to Mrs C, the Council then sent Mrs C a cheque with no cover letter or explanation, Mrs C returned it. Mr B says the Council should waive Mrs C’s debt.

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The Ombudsman’s role and powers

2. We may investigate complaints made on behalf of someone else if they have given their consent. (Local Government Act 1974, section 26A(1), as amended). Mrs C has given consent for Mr B to raise this complaint on her behalf.
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 an injustice, we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
4. If we are satisfied with a council’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. I considered:
• Information provided by Mr B, including the Council’s response to his complaint.
• The Care Act 2014 and associated statutory guidance.
• The Care and Support (Charging and Assessment of Resources) Regulations 2014.
• The Ombudsman’s guidance on remedies, available on our website.
6. Mr B 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

7. Mrs C lived alone in her own home. Following a stay in hospital Mrs C went for a temporary stay in a residential care home. This stay later became permanent.

What should happen?

8. The Council and hospital should work together to plan somebody’s discharge from hospital. The Council will complete an assessment of the person’s care and support needs, and then plan how best those needs might be met. The Council should share a copy of the assessment, and care and support plan, with the person and any relevant representative they wish.
9. The Council must then complete a financial assessment to decide what, if anything, the person should pay towards their care. The Council should share the outcome and copy of the financial assessment with the person.
10. There are no timescales in which a council must complete a care and support needs assessment, and a financial assessment.
11. The charging rules for residential care are set out in the “Care and Support (Charging and Assessment of Resources) Regulations 2014”, and the “Care and Support Statutory Guidance 2014”. When the Council arranges a care home placement, it must follow these rules when undertaking a financial assessment to decide how much a person must pay towards the costs of their residential care.
12. A temporary resident is someone admitted to a care or nursing home where the agreed plan is for it to last for a limited period, such as respite care, or there is doubt that permanent admission is required. The Care and Support (Charging and Assessment of Resources) Regulations 2014 and the Care and Support Statutory Guidance 2014 set out charging rules for temporary residential care. When the Council arranges a temporary care home placement, it must follow these rules when undertaking a financial assessment to determine how much a person must pay towards the costs of this stay. The Council can either charge the person under the rules for temporary residential charging or treat the person as if they are still living in the community (i.e. the non-residential rules for charging).
13. The rules state that people who have over the upper capital limit are expected to pay for the full cost of their permanent residential care home fees. However, once their capital has reduced to less than the upper capital limit, they only must pay an assessed contribution towards their fees. The upper capital limit is currently £23,250.
14. The Council may disregard the value of the person’s property for the first twelve weeks in the care home, to allow time for the person to decide what to do with the property to pay their care fees. The person may decide to sell their property, rent it out, or apply for a Deferred Payment Agreement (DPA).
15. A DPA is a long-term loan from the Council that you can use to pay your care fees. The loan incurs interest and administration fees. The council will pay the care home fees and secure the loan against the property. The loan will be repaid once the property is sold, if the person dies, or if they choose to end the scheme and repay the loan.
16. The Council’s complaints procedure says it will acknowledge complaints within three working days and will send a Complaint Action Plan within five working days which will provide a timescale for responding to the complaint.

What did happen?

17. Mrs C lived at the care home on a temporary basis for three months before the Council completed her care needs assessment and decided she needed permanent residential care. The Council sent a copy of the assessment to Mrs C. The Council confirmed in an e-mail to Mr B at the end of October 2019 that the temporary stay was not chargeable to Mrs C and the Council would pay for this period of her care. The Council would now complete a financial assessment for the permanent stay. The Council said any charge would apply from 10 October when Mrs C’s stay became permanent.
18. The Council did not complete the financial assessment until July 2020. It wrote to Mr B (as Mrs C’s power of attorney for finances) with the outcome on 6 July. The Council applied the 12-week property disregard from 10 October when Mrs C’s stay became permanent, so asked for a contribution towards her care costs based on her income. After the 12 weeks Mrs C was responsible for the full cost of her residential care as her property and income meant she is above the financial threshold.
19. The Council charged Mrs C £23,160.64 for her care stay from 10 October to 15 July. The Council said from 16 July Mrs C should pay her care fees direct to the Care Provider. The invoice had standard terms of payment within 28 days. The covering letter with the invoice offered a Deferred Payment Agreement (DPA). The Council’s letter made no reference to the Council’s delay in completing the financial assessment and made no offer of a reasonable repayment plan.
20. Mr B promptly put in a complaint to the Council about its delay and subsequently the large invoice. Mr B asked the Council to apologise to Mrs C, put systems in place to generate financial assessments, a written explanation of the delay, write off the debt and only charge from the date of the financial assessment.
21. The Council responded two months later with the Complaint Action Plan and confirmation of a full response by 25 September; the Council gave its full response on this date.
22. The Council explained when it completed the care needs assessment in October it made a referral to the finance team for a financial assessment. There was an error on the form, so the finance team returned it, the case was then wrongly closed. The Council has changed its electronic system to ensure cases remain open until the financial assessment is complete. The Council acknowledged its error caused significant delay and apologised. The Council recognised its delay has caused significant arrears and said it would consider any reasonable proposal of repayment. The Council noted Mrs C’s house was up for sale and said it would await repayment until after the sale, not charge any interest on the debt, and could pay the care home charges in the interim. The Council apologised that it had not acted on correspondence from the care home that could have triggered financial assessment, and it had delayed dealing with Mr B’s complaint.
23. The Council recognised learning points from the complaint; that it should communicate in a timely way and not add to peoples upset in stressful situations. As well as apologising the Council offered Mr B £200 for having to bring the complaint to its attention.
24. Mr B thanked the Council for upholding his complaint, for its apology, and for taking steps to prevent future problems. However, Mr B explained the apology should be directed to Mrs C. Mr B said the sum of £200 was patronising and insulting, it is Mrs C who is upset and stressed at being in debt when she has never been before. Mr B again asked the Council to waive the debt. Mr B confirmed Mrs C has been paying her care fees to the care home since July 2020 as has no dispute those fees are due.
25. The Council then sent Mrs C a cheque for £200 with no covering letter, apology, or explanation. Mrs C returned the cheque.

Was there fault by the Council causing injustice?

26. The Ombudsman must now consider whether there was fault by the Council which caused an injustice to Mr B and Mrs C. If I decide that is the case, I must consider what injustice is caused by the Council’s fault, and what action by the Council is appropriate to acknowledge and remedy that.
27. The Council was at fault when it delayed completing the financial assessment. Although there are no set timescales in law and guidance, eight months is clearly too long. The Council accepts the delay was caused by a failure in its process; it should have completed the financial assessment much sooner.
28. Mr B was aware from the Council’s e-mail in October 2019 that it would charge Mrs C from 10 October 2019, any charge would be decided by the financial assessment. Therefore, despite not hearing from the Council for a long time about the financial assessment Mr B and Mrs C knew Mrs C would likely have to pay towards her care costs during that period.
29. I accept that receiving a bill for over £23,000 would be a shock and would be worrying about how you will repay such a large debt. The Council sent standard correspondence, making no mention of its actions allowing such a large debt to accrue, and making no mention of a repayment plan. Mr B should not have had to complain to get acknowledgement and reassurance on this point. The Council says it did apologise for the delay before it completed the financial assessment but accepts it should have reiterated this in the letter giving the outcome.
30. Mr B says the Council should waive the debt. I do not agree the care fee debt is caused by fault of the Council. The debt is a direct result of Mrs C’s need for residential care to meet her care needs. If there was no delay by the Council Mrs C would have received the financial assessment sooner and would have been paying these fees to the care home. The care home fees are rightly due by Mrs C. The Council’s delay has meant rather than paying these fees regularly they have been allowed to accrue into a large debt. To remedy this, it would be fair to allow Mrs C to pay the debt in instalments, as she would have done, rather than expecting a lump sum payment.
31. Because of the Council’s delay Mrs C was shocked and upset to be in debt of a large amount of money. Mrs C then received a cheque she was not expecting. The Council should apologise to her for its delay, poor communication, and make a payment to acknowledge her upset.
32. The Council delayed dealing with Mr B’s complaint, which added to his frustration. Despite initially providing a thorough response and acknowledging its errors, the correspondence following this was poor. The Council sent a cheque to Mrs C with no covering letter or explanation because its systems do not allow for this. Mr B says the Council has never apologised directly to Mrs C.
33. Because of the Council’s errors Mr B had the time and trouble of dealing with a complaint and supporting his mother through her distress.

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Agreed action

34. I am satisfied with the actions the Council has taken to improve its service. It has identified faults in its process and improved its procedures. It has been open to learning lessons from Mr B’s complaint and provided a full and transparent response to his complaint. In addition to the actions the Council has already taken, the Council will:
1. Apologise to Mrs C for its delay completing a financial assessment, for sending standard correspondence confirming the outcome of the financial assessment without acknowledging the impact of its delay and offering a repayment plan, and for sending a cheque with no covering letter or explanation. Make a payment of £200 to Mrs C to acknowledge her associated distress, this payment can be offset from the arrears if they remain outstanding.
2. If the debt remains outstanding contact Mrs C, or Mr B on her behalf, to discuss reasonable repayment options. No contact should be made until 26 July, due to an absence by Mr B.
3. Apologise to Mr B for its delay dealing with his complaint. Make a payment of £200 to acknowledge his time, trouble, and distress.
4. Remind relevant staff to send tailored letters where there is any failure in the Council’s service. And specifically, where there is a delay in financial assessment which leads to arrears accruing. In these circumstances the Council should ensure to apologise for its delay and offer repayment by instalments. I note the invoice to Mrs C has a box called ‘Payment Terms: (if not standard 28 days).’ This was left blank, but something could have been inserted here to reassure Mrs C she would not need to pay over £23,000 in 28 days.
5. Review the process for sending cheques to find a way to also send a covering letter when necessary. In this case a letter could have been generated and sent to Mrs C in advance of the cheque so she would have been expecting it and would understand what it was for. Therefore, the Council may need to remind relevant staff to take this action where necessary.
35. Mr B found the Council’s offer of £200 patronising and insulting, yet I have recommended this amount. The reason for my recommendation is that I find it is in line with the Ombudsman’s guidance on remedies. The guidance explains someone’s unnecessary distress cannot generally be remedied by a payment, so we may seek a symbolic amount to acknowledge the impact on the complainant. A remedy payment for distress is often a moderate sum of between £100 and £300. The same range is used for a person’s time and trouble that is above what is considered usual.
36. The Council should complete the recommended actions within two months of the Ombudsman’s final decision and provide the Ombudsman with evidence of its compliance. The Council should make no contact with Mr B or Mrs C until 26 July at the earliest, as Mr B is currently not available.

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Final decision

37. I have completed my investigation on the basis the actions taken by the Council, and the actions agreed above, are enough to acknowledge the impact of the Council’s fault and prevent future problems.

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Investigator's decision on behalf of the Ombudsman