Summary: Mr D complained about the increase in care fees for his mother, Mrs E, who is a self-funding resident at the Council’s care home. We find fault with the Council as it delayed providing Mr D with written notification of the care fees. However, this did not cause Mr D or Mrs E an injustice.

The complaint

1. Mr D complained about the increase in care fees for his mother, Mrs E, who is a self-funding resident at the Council’s care home. He says the Council has failed to provide justification for the increase in care fees every year.
2. Mr D says the additional financial expense has caused stress and anxiety. He says Mrs E now has a shortfall each month and he has been using his savings to fund her place at the care home.

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The Ombudsman’s role and powers

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. 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)
5. 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

6. I considered information Mr D submitted with his complaint. I made written enquiries of the Council and considered information it provided in response.
7. Mr D 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 Care Act 2014

8. The Care Act 2014 states councils have discretion to charge people for the care they receive. Charges many only cover the cost the council incurs. If a council decides to charge for care, it must complete a financial assessment to decide how much a person has to pay toward the costs of their care.
9. The rules state that people who have over the upper capital limit (£23,250) are expected to pay for the full cost of their residential care home fees. However, once their capital has reduced to less than the upper capital limit, they only have to pay an assessed contribution towards their fees.

Deferred Payment Agreement

10. The Care and Support Regulations 2014 allow a person in a care home to enter into a deferred payment agreement (DPA) with a council.
11. A DPA is a formal legal agreement with a council that lets people use the value of their homes to help pay for their care home costs. It is designed to prevent people being forced to sell their homes during their lifetime to fund their care.
12. Under a DPA, the council pays the costs of a person’s care and defers repayment until their property is sold.

What happened

13. Mrs E became a permanent resident at the Council’s care home on 21 May 2018, after a period of short-term care.
14. Mr D has Lasting Power of Attorney of Mrs E’s health and welfare and property and financial affairs. These are legal documents that lets a person appoint one of more people to help make decisions or make decisions on their behalf if they have lost mental capacity. The Council told Mr D it would need to complete a financial assessment to decide how much Mrs E needed to pay towards the cost of her care. Mr D said he did not want social worker involvement and that he would fund Mrs E’s care privately.
15. The Council wrote to Mr D on 18 June 2018 and confirmed the care fees were £536.20 per week. It wrote to him on 1 April 2019 and said the care fees would increase to £560.84 per week from 29 April because of changes in state benefits and allowances.
16. The Council wrote to Mr D on 31 March 2020 and said the care fees would increase to £587.44 per week from 27 April.
17. Mr D called the Council on 3 April. He said he had received its letter about the increase in care fees. He asked whether it was in line with pension increases. The Council explained that it increased the cost of its fees because state benefits had increased.
18. Mr D said Mrs E’s benefits had only increased £30 per month, whereas the Council’s fees had increased at over £100 per month. He said it was not sustainable and the Council was not providing any financial support. The Council said it was not providing financial support because Mrs E was a self-funding client through non-declaration of finances. It said it could help if Mr D allowed it to complete a financial assessment. It agreed to send Mr D more information in an email.
19. The Council emailed Mr D on 6 April. It provided more information about the financial assessment process. It also explained that if Mrs E had capital above the funding threshold of £23,250, but it was not readily available, it could enter into a DPA.
20. Mr D emailed the Council on 6 July. He said the increase in the care fees was getting out of hand. He said over the past two years the costs had increased by £204.96 a month, which was £2,459.52 a year. This was an approximate increase of 9% over a two-year period. He explained the cost of living over the same period had only increased by 4%. Finally, he said that Mrs E had been overcharged by £988.66.
21. The Council responded to Mr D’s email. It repeated its offer of a financial assessment. It explained the living wage had increased over the last two years by 11%, and that is why care fees had increased. It also said the weekly cost of it providing care at the care home was £751.73, so the amount it charged Mrs E was less than the unit cost.
22. Mr D wrote a detailed email back to the Council on 22 July. He said it had previously told him that the increase in care fees was due to the rise in inflation and not the living wage increase. He said the increase in care fees was excessive and not justified by the comments. Finally, he questioned why the Council was charging a quality premium payment.
23. Mr D chased the Council for a response on 8 October. He said Mrs E’s financial situation had worsened, and he had requested a financial assessment. The Council responded and said it would complete a financial assessment. It telephoned Mr D on 12,26 and 29 October to complete the financial assessment but it could not get through. It contacted Mr D again on 9 November and agreed to complete the financial assessment on 24 November.
24. The Council responded to Mr D’s email from 22 July on 9 November. It apologised for the delay in responding. It explained that the weekly charge of £587.44 a week was lower than the actual unit costs. It also provided him with the budgeted costs for running the care home. It said the increase in care fees was due to many variables. In relation to the quality premium payment, it said the rate was only for private/independent care homes.
25. Mr D responded to the Council on 11 November. He said:

• In July, the Council stated the actual unit costs per week were £751.73.
• The budget showed the cost of the care should be £594.84 per week.
• The weekly fee Mrs E was paying was £587.44, but on the Council’s website it said it was £586.39.
• The budget for staffing costs was excessively high and more than other care industries.
• He needed a breakdown of all staffing costs.
• There was no transparency between the difference in private and council run care homes.

26. The Council telephoned Mr D on 24 November to carry out the financial assessment. Mr D confirmed that Mrs E jointly owned a property with him that was being used a holiday let. The Council said it would need further information to complete the financial assessment, including property valuations and a proof of ownership.
27. The Council responded to Mr D’s email from 11 November on 3 December. It said:

• The monthly actual cost is based on projected costs for the year and occupancy that month.
• The £659.13 figure was based on the budget at the start of the year and 90% occupancy. The £751.73 figure related to projected actual costs at the end of the year.
• It was incorrectly charging Mrs E £587.44 per week when it should have been £586.39. It confirmed it would update her account to reflect the overcharge of £1.05 per week.
• The staffing costs are based on the needs of individuals and health and safety requirements.
• It was subsiding each placement by £164.29 per week.
• All its care homes meet the requirement for a quality premium payment. It apologised for the confusion.
• He could contact the Ombudsman if he was not happy with its response.

28. The Council corrected the amount Mrs E owed in its invoice on 5 December.
29. Mr D emailed the Council on 30 December. He said his main concern was still about the significant increase in fees. He said in relation to the staffing costs there was £300,000 that had been unaccounted for. He also said Mrs E was charged a quality premium payment, but after a recent inspection the care home was rated as requiring improvement.
30. The Council wrote to Mr D on 4 January 2021 and confirmed that he would still need to provide the property valuations and other documents to complete the financial assessment. It replied to Mr D’s further questions on 25 January. It provided him with spreadsheets which showed a breakdown of the budget, staffing costs and how resources had been spent. Finally, it said all care homes pay the quality premium payment and it is to ensure they meet certain standards.
31. The Council emailed Mr D on 26 January and asked whether he wanted to enter into a DPA for Mrs E’s care fees. The Council chased him for a response on 3 March. Mr D responded on 14 March and said he was privately arranging the payment of Mrs E’s care fees.

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Analysis

32. Mr D says his main concern is the annual increase in care fees is way above any inflation rates and the Council has not justified the increase. He says the Council has given him contradictory information.
33. The Ombudsman’s role is to consider whether the Council has provided the service user or their representative with clear and timely information about the care fees and whether it has provided sufficient notice about the increase in care fees.
34. The Council wrote to Mr D on 18 June 2018 and confirmed the cost of the care fees. This was a month after Mrs E had become a long-term resident. This is fault. It is normal practice for written information about costs to be given before the placement starts. I appreciate Mrs E had already received some short-term care at the care home, but the Council should have provided Mr D with written information about the costs much sooner.
35. I do not consider this fault caused Mr D or Mrs E an injustice. This is because Mr D would have had some awareness of the costs when he agreed for Mrs E to stay in the care home on a long-term basis. Mr D has also confirmed he was happy with the care fees when Mrs E first became a resident.
36. In relation to the increase in care fees, the Council updated Mr D appropriately and gave him sufficient notice.
37. I have seen some occasions when the Council could have provided further clarity or more detail in its responses. The Council initially told Mr D that the increase in care fees was due to state benefits increasing. It later told him that the increase in care fees was due to many variables, not just state benefits increasing. There was also some confusion about whether the quality premium payment applied or not, but the Council subsequently clarified this.
38. While I have identified some occasions when the Council’s communication could have been better, I do not find it significant enough to be fault. The evidence shows the Council largely responded to Mr D’s detailed queries in an appropriate manner.

Final decision

39. I have completed my investigation. There was fault by the Council, but this did not cause an injustice to Mr D or Mrs E.

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Investigator's decision on behalf of the Ombudsman