Council told to deduct £11k from outstanding care home fees after delays in carrying out financial assessment

The Local Government and Social Care Ombudsman has found fault in the way that Essex County Council carried out a financial assessment and a deferred payment process for an elderly man with dementia.

The complainant, Mr X, said the council failed when carrying out a financial assessment and the Deferred Payment Agreement (DPA) process for his late father, Mr Y. He also complained about the way Essex dealt with his complaint.

Mr X said the council’s failings resulted in Mr Y remaining on a higher self-funding rate for his residential care for longer, said the Ombudsman.

Outlining the background to the case, the report said Mr Y was diagnosed with dementia in 2016. Mr X held a Power of Attorney for his father’s health and finance from 2017.

Following his discharge from a hospice, Mr Y was placed at a Nursing Home at the beginning of September 2019.

Until August 2021, Mr Y’s residential care was funded by the Continuing Health Care (CHC). Mr X appealed the NHS decision to withdraw this funding.

In mid-August 2021, Mr Y’s social worker (Social Worker 1) provided Mr X with a weekly fee for Mr Y’s place in the Nursing Home of £891.10. At the end of the month, Mr X asked Social Worker 1 to proceed with a financial assessment.

On 19 January 2022, Mr Y’s funds decreased below £23,250.

In mid-March 2022, Mr X contacted Social Worker 1 and the council’s financial assessment team, asking for an urgent assessment due to Mr Y’s funds decreasing below £14,000.

The Ombudsman noted: “In its response to Mr X’s complaint the council told him it had carried out Mr Y’s financial assessment in the fourth week of March 2022.

“Responding to my enquiries the council told me at the end of March 2022 it had sent Mr Y’s financial assessment document and a DPA form to Mr X. Mr X said he had not received this document or any advice about financial assessments or DPAs.”

From the beginning of September 2021 to the end of May 2022, Mr Y self-funded his residential care at a rate of £165.24 per day.

In view of the lack of funds in Mr Y’s estate from 1 June to 23 August 2022, the Nursing Home continued providing its services to Mr Y despite no payments made. Care fees for this period amounted to £14,307, the report noted.

From 23 August 2022 until Mr Y’s death in early January 2023 the council was paying Mr Y’s Nursing Home fees.

In February 2023, the council’s Income Collection team asked Mr X to pay the outstanding charges for Mr Y’s care in the Nursing Home from the end of August 2022 until the beginning of January 2023 totalling £15,460.20.

In response to Essex’s request for the payment in mid-February, Mr X raised a complaint. He said he had tried to get a financial assessment and DPA for Mr Y from the end of August 2021.

The Ombudsman noted the council responded to Mr X’s complaint in mid-June, partially upholding his complaint but refusing to disregard the outstanding care fees of £15,406.

Following investigation, the Ombudsman found the council failed to:

• Carry out Mr Y’s financial assessment in 2021 after being alerted to the risk of the decrease of his funds;
• Provide Mr X with comprehensive financial information and advice which would allow him to make informed choices about paying for Mr Y’s care;
• Advise Mr X on his right to ask for a DPA in view of the information about Mr Y owning a flat which was rented out.

Turning to the issue of the deferred payment agreement (DPA), the Ombudsman found the following failings in the way the council carried out the process for Mr Y:

• Lack of comprehensive information and advice provided at the beginning of the process.
• Lack of communication between various teams in the council.
• Significant delays in dealing with Mr X’s request.

Finally, the Ombudsman also found issues with the way the council dealt with Mr X’s complaint, as it failed to tell Mr X how long it would take to look into the matters he complained about, and failed to explain its reasons for extending the usual timescale of one month when responding to Mr X’s complaint.

The report said: “The council’s failings, which are fault, caused injustice to Mr X. He was upset by the lack of the council’s communication with him and remained uncertain about the outcome of his complaint.”

To remedy the injustice caused, the Ombudsman told Essex to apologise to Mr X, deduct £11,445 from the outstanding care home fees, and pay £350 to Mr X to recognise the distress, time and trouble caused.

The council was also recommended to review its process of registering referrals for financial assessments and its deferred payment process.

A spokesperson for Essex County Council, said: “We have acknowledged and accepted the findings of the Local Government and Social Care Ombudsman and the recommendations contained in the report.

“We remain dedicated to ensuring all our residents receive the highest quality of care and are committed to learning to improve.”

Lottie Winson