Summary: Mrs T complained the Council said her mother, Mrs X, would not have to pay for her stay in a care home. Mrs T stated the Council completed a financial assessment a year later and charged Mrs X retrospectively. Mrs T said the Council failed to consider if Mrs X could afford to pay the charges. The Council failed to conduct a financial assessment in line with the statutory guidance and failed to tell Mrs T about Mrs X’s contributions for eleven months. The Council agreed to write off the charges until the date of the financial assessment and apologise to Mrs T for the distress it caused.

The complaint

1. Mrs T complained the Council told her in June 2021 Mrs X would not have to pay for her stay in a care home and did not do a financial assessment. She said the Council completed a financial assessment a year later and charged Mrs X retrospectively and failed to consider if she could afford to pay the charges. Mrs T said the Council’s actions put Mrs X in debt and caused Mrs T distress.

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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 an injustice, we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), 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(i), as amended)

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How I considered this complaint

4. I discussed the complaint with Mrs X’s daughter (Mrs T) and granddaughter (Miss Y) on the telephone.
5. I considered the documents the Council provided in response to my enquiries.
6. Mrs T 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

The relevant law and guidance

Charging for care and support

7. 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. 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.
8. A temporary resident is someone admitted to a care or nursing home where the agreed plan is for admission to last for a limited period, such as respite care, or there is doubt a permanent admission is required.
9. 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.
10. Once a placement becomes permanent, the council should complete a new residential financial assessment.
11. The Government has issued ‘Care and support statutory guidance’ (CSSG) on using the Care Act 2014. CSSG says councils must provide information:
• “to help people understand what they may have to pay, when and why and how it relates to people’s individual circumstances”;
• that includes “the charging framework for care and support, how contributions are calculated…top-ups…and how care and support choices may affect costs”.
12. Social care charging arrangements for 2021/22 were set out in a circular issued by the Department of Health. The circular confirmed that for the financial year 2021/22 a person with assets (include property and savings) above £23,250 would not qualify for council support to meet there needs. People who have assets less than £14,250 would only have to contribute to their care from their income.
13. The Personal Expenditure Allowance (PEA) is the weekly amount that people receiving council-arranged care and support in a care home (residents) are assumed to need as a minimum for their personal expenses. It is intended to allow residents to have money for personal use. Based on a financial assessment of their resources, individuals must be left with the full value of their PEA. It is then up to them to determine how they spend it. (Care Act 2014, Section 14(7)). For the financial year 2021/22 PEA for council supported care home residents was £24.90 per week.

The Council’s residential care charging policy

14. The Council’s policy states it will complete the financial assessment before it provides the service, or as soon as possible after it has completed the needs assessment. It will reassess the financial assessment every year.
15. When recovering a debt of unpaid care fees, the Council will discuss and arrange affordable debt repayments between all relevant parties including the debtor, their representative and social worker.

What happened

16. In 2021 Mrs X was in her 80’s and lived at home. Mrs X had several health issues including vascular dementia. Mrs X’s daughter Mrs T had moved in to care for her mother.
17. Mrs T contacted the Council in June 2021. She asked for a home visit to discuss the care that it could provide to Mrs X as Mrs T needed respite from caring for her. She said she had spoken to Care Home D who had a bed for Mrs X.
18. The Council visited Mrs X and assessed her care needs. It recorded Mrs T managed Mrs X’s finances. Mrs X needed support in most areas of her life and needed constant care. It decided Mrs X should receive two weeks in a care home to allow Mrs T respite from her caring role. Mrs T stated the social worker told her Mrs X would not need to pay for her care as she had no savings.
19. Mrs X moved to Care Home D temporarily at the end of June 2021.
20. Mrs T contacted the Council in September 2021 and asked it to complete an assessment for a permanent placement for Mrs X.
21. The Council reassessed Mrs X’s care needs in November 2021 and agreed she needed permanent residential care. The Council’s case notes record it told Mrs T it would be in contact to carry out a financial assessment.
22. Mrs X was admitted to hospital from the care home in April 2022. Hospital staff told the Council Mrs T said she was dissatisfied with Care Home D’s ability to look after Mrs X. Miss Y told the Council she wanted it to consider other care homes for Mrs X.
23. The Council visited Mrs X in hospital. It assessed her needs and decided she needed a nursing placement for her continuing care. Mrs T and Miss Y asked for Care Home E. The Council arranged for Mrs X to be discharged to Care Home E at the end of May 2022.
24. The Council completed the financial assessment for Mrs X with Miss Y and Mrs T over the phone in May 2022. Mrs T told the Council the social worker had said Mrs X would not need to pay for her care as she had low income and no savings.
25. The Council assessed Mrs X’s contributions in three periods:
• June 2021 to December 2021. Respite resident at Care Home D.
• December 2021 to April 2022. Permanent resident at Care Home D
• April 2022 onwards. Permanent resident at Care Home E.
26. The Council wrote to Miss Y with a copy of the financial assessment and told her the amount Mrs X needed to pay. It set out the weekly contribution backdated to June 2021. It asked Miss Y to contact it if she thought the figures were wrong or Mrs X’s circumstances had changed. It provided a copy of its factsheet charging for non-residential services.
27. Miss Y contacted the Council a few days later and asked for Mrs X’s invoice. The Council advised the invoices were not ready and told her the estimated amount.
28. Miss Y complained to the Council. She said the social worker had told Mrs T that Mrs X would not need to pay for her care. The Council had not done a financial assessment when Mrs X moved to the care home and now she had a debt she could not pay. Miss Y said she wanted the Council to waive the fees from before it did the financial assessment and apologise for giving the family the wrong information.
29. The Council sent Mrs T the invoice in June 2022. It set out the itemised weekly contribution Mrs X needed to make for her care since June 2021.
30. The Council responded to Miss X’s complaint in July 2022. It said:
• the social worker said she told Mrs T during the initial assessment Mrs X would be unlikely to pay the full cost of her care;
• the social worker had told Mrs T in November 2021 the Council needed to do a financial assessment to determine Mrs X’s contribution to the care;
• it had delayed in completing a financial assessment because it had set up a new computer system which caused a back-log of assessments. The Council apologised for the delay; and
• advised Miss Y to contact the Council to discuss a repayment plan for Mrs X at an affordable rate.
31. Dissatisfied with the Council’s response to Miss Y, Mrs T complained to us. Mrs T reported that Mrs X had no savings and relies on her PEA. Mrs T stated Mrs X was unaware of the debt as Mrs T dealt with her finances.
32. In response to my enquiries the Council stated it was ‘fully aware that [Mrs X] has no capital or savings, therefore is unlikely to be able to repay the debt in full during her lifetime … [Mrs T and Miss Y] have been encouraged to come to a repayment arrangement from Mrs [X]’s income only. It has been made clear that Mrs [X]’s debt is not their debt’.
33. In response to a draft of this decision the Council said it intends to introduce a system that will allow people to input their details and receive an indication of their likely financial contribution to their care. It intends to have the system available by April 2023.

My findings

34. Mrs T said the Council told her Mrs X would not need to pay towards her care in June 2021. The Council stated it said Mrs X would not need to pay the full costs. However, this is not evidenced in the Council’s case notes. There are no contemporaneous records of the conversation, and I cannot make a finding on exactly what was said. The records show the Council first told Mrs T it would do a financial assessment in November 2021, but it did not at any time give any information about how the charge would be calculated or that Mrs X would need to make a contribution to her care costs. This is fault.
35. The guidance is clear that councils must provide sufficient information to help people understand what they may have to pay, when and why. The Council should have completed a financial assessment for Mrs X when it assessed her needs and before, or shortly after she moved to Care Home D in June 2021. It did not complete a financial assessment or provide Mrs T any information about charging or contributions for 11 months. That was fault and meant Mrs T did not know what Mrs X needed to contribute to her care. Mrs X received a large bill for her contribution that Mrs T was not expecting. This caused Mrs T distress and meant she was unable to manage Mrs X’s finances and to plan for the care costs. The Council has apologised for the delay in completing the financial assessment.
36. There was no fault in the way the Council carried out financial assessments.

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Agreed action

37. Within one month the Council will:
• write to Mrs T and apologise for the distress caused to her by the Council’s failure to complete Mrs X’s financial assessment in a timely way in line with the guidance, or to provide any information on charges until May 2022; and
• write off the charges to Mrs X between June 2021 and when the financial assessment was completed in May 2022.
38. Within three months the Council will ensure it tells relevant officers to provide information leaflets on charging at the earliest opportunity, even where a financial assessment will be delayed.
39. The Council will provide us with evidence it has complied with the above actions.

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Final decision

40. I have completed my investigation. I found fault leading to injustice and the Council agreed to my recommendations to remedy that injustice.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman