Summary: Mr X complained the Council issued a bill for £13,000 in 2024 for his mother’s unpaid care fees up to the point she passed away in 2020. Mr X says he was unaware he would need to pay any care fees until the Council contacted him. The Council made Mr X aware his mother would need to contribute towards her care fees in 2019. The Council is entitled to bill for the care fees as the fees are based on the financial information Mr X made available to the Council. We found fault with the Council for delays in contacting Mr X about the outstanding balance. The Council agreed to apologise to Mr X, apply a reduction to the balance of £750 as a gesture of goodwill for the distress its delays caused Mr X and offer him a payment arrangement to repay the outstanding balance. The Council also agreed to reiterate to Mr X what financial information it needs from him to complete a review of the outstanding balance.

The complaint

1. Mr X complained the Council issued a bill for £13,000 in 2024 for his mother’s unpaid care fees up to the point she passed away in 2020.
2. Mr X says he was unaware he would need to pay any care fees for his mother’s care home and settled her will in 2020 six months after she passed away. Mr X says there is no money left to pay for these charges.

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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 significant injustice, or that could cause injustice to others in the future we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
4. We cannot investigate late complaints unless we decide there are good reasons. Late complaints are when someone takes more than 12 months to complain to us about something a council has done. (Local Government Act 1974, sections 26B and 34D, as amended)
5. 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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What I have and have not investigated

6. We cannot investigate a complaint which is about events known to Mr X for more than 12 months without good reason.
7. Mr X was aware the Council completed a financial assessment for his mother in 2019 to decide her contribution towards her care fees. Mr X has not provided any good reasons why he did not complain to us sooner with this part of the complaint. Any dispute about this financial assessment is not a matter the Ombudsman can investigate now.
8. I am also not investigating any matters about payments to the care home or the dispute between the two councils over who should have funded Mr X’s mother’s care. Again, these matters took place before April 2019 and are outside the jurisdiction of the Ombudsman to investigate.
9. We can investigate Mr X’s complaint about delays in producing the billing for Mr X’s mother’s care fees accumulated from 8 April 2019. This is because Mr X first became aware of the outstanding balance owed in September 2023.

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How I considered this complaint

10. I have considered all the information Mr X provided. I have also asked the Council questions and requested information, and in turn have considered the Council’s response.
11. Mr X and the Council had opportunity to comment on my draft decision before I made my final decision.

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What I found

Charging for permanent residential care

12. 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, or a carer’s 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.
13. When the Council arranges a care home placement, it must follow the regulations when undertaking a financial assessment to decide how much a person must pay towards the cost of their residential care.
14. The financial limit, known as the ‘upper capital limit’, exists for the purposes of the financial assessment. This sets out at what point a person can get council support to meet their eligible needs. People who have over the upper capital limit must pay the full cost of their residential care home fees. Once their capital has reduced to less than the upper capital limit, they only have to pay an assessed contribution towards their fees. Where a person’s resources are below the lower capital limit they will not need to contribute to the cost of their care and support from their capital.

What happened

15. In 2016, Mr X’s mother moved into a care home and paid for her care privately.
16. In 2018, Mr X’s wife told the Council that Mr X’s mother’s finances had dropped below the upper threshold and they were seeking assistance with funding her care.
17. In 2018 and 2019 there was a dispute between this council and another council about who should fund Mr X’s mother’s care.
18. On 20 May 2019, the Council wrote to Mr X to advise that from 8 April 2019 all client contributions for Mr X’s mother’s care would become payable to the Council. The Council said Mr X needed to pay £251.01 per week to fund his mother’s care. The Council asked Mr X to provide information about his mother’s finances to ensure it had correctly calculated her client contribution.
19. Mr X provided the Council with his mother’s financial information on 29 May 2019.
20. The Council completed a financial assessment of Mr X’s mother finances and care contributions using the new information Mr X provided. On 6 June 2019, the Council wrote to Mr X to confirm that Mr X needed to pay £257.95 per week for his mother’s client care contributions to the Council.
21. On 25 June 2019, Mr X wrote to the Council seeking a review of the financial assessment completed on 6 June 2019.
22. In March 2020, Mr X’s mother passed away.
23. Mr X told the Council about his mother passing away on 17 April 2020. Mr X says he executed his mother’s will later in 2020.
24. On 14 September 2023, the Council tried to contact Mr X and left a voicemail message advising it needed to discuss the outstanding balance owed for his mother’s care fees with him.
25. On 18 January 2024, the Council sent Mr X a letter confirming Mr X owed £12,713.25 for his mother’s unpaid care fees. The Council apologised for the delay in sending this letter and asked Mr X for information about his mother’s finances when she passed away so it could review this balance.
26. From 25 January 2024 to 1 May 2024, Mr X (or his wife on his behalf) and the Council liaised about the balance owed for Mr X’s mother’s care fees. The Council requested the closing bank statements from Mr X and advised it would keep the matter on hold. Mr X made a goodwill payment of £650 to the Council and provided the closing bank statements for one of his mother’s bank accounts but not the other.
27. In May 2024, Mr X told the Council he did not consider he owed the debt because the Council failed to tell him sooner. The Council responded to advise it considered the outstanding balance was payable and reiterated its request for the relevant bank statements so it could review the balance.
28. Mr X made a formal complaint to the Council on 18 June 2024.
29. On 13 August 2024, the Council issued its complaint response. The Council said it told Mr X in 2019 that his mother would need to contribute towards her care fees. The Council apologised for the delay in confirming the outstanding balance owed but settling debts is an executor’s responsibility. The Council reiterated its request for bank statements from Mr X so it could review his mother’s financial situation to decide if it needed to amend the charges owed.

Analysis

Validity of debt

30. The Council sent a letter the Mr X on 6 June 2019 stating his mother would need to pay £257.95 per week for his mother’s client care contributions following its financial assessment. The Council based this financial assessment on the information Mr X provided.
31. The Council produced three bills for Mr X’s mother’s care fees. This billing details charges from 8 April 2019 up to the date Mr X’s mother passed away. This billing is based on the assessed care charges detailed in the letter sent by the Council on 6 June 2019. The Council has only billed for the care that Mr X’s mother received.
32. The billing produced by the Council is accurate and valid based on the evidence available to the Council.
33. An executor is responsible for settling any bills owed by an estate before distribution of an estate. The Council had not sent Mr X any billing for his mother’s care fees when he executed the will in 2020. While the Council had not issued any billing for Mr X’s mother’s care fees, this does not mean she was not responsible for the care fees.
34. The Council sent two letters to Mr X in 2019 telling him that his mother would need to contribute to the care fee for her care home. The Council sent both letters having completed financial assessments of Mr X’s mother’s finances. Both letters confirmed that Mr X’s mother would need to pay the Council for these fees.
35. Mr X contacted the Council in response to both letters the Council sent. In Mr X’s responses to the Council, he enclosed the letters sent by the Council.
36. The Council acted correctly to tell Mr X that his mother would need to contribute towards the cost of her care. I have seen evidence that Mr X received the letters detailing this information.
37. Since Mr X was aware that his mother needed to pay for her care fees, he should have known an outstanding balance would have been owed to the Council. As the executor of the estate, he was responsible for confirming any existing balance and settling this before executing his mother’s will.
38. The Council made Mr X aware that his mother would be liable for care fees, detailed what these weekly care fees would be and has billed Mr X’s mother for the duration of her stay at the care home based on these care fees. I cannot find fault with the validity of the billing.
39. Mr X has told the Council his mother’s finances had dropped below the lower threshold when she passed away. This means the balance owed by Mr X’s mother may be lower than the Council has billed for. The Council asked Mr X to provide evidence of his mother’s finances so it can review the charges. Mr X has not provided the full evidence requested to the Council.
40. The Council has acted correctly to make its offer to review Mr X’s mother’s care charges. The Council can only do this if it receives the relevant information from Mr X. I cannot find fault with the Council for its actions. However, we would recommend the Council writes to Mr X to confirm specifically what financial information it needs from him to complete a review of his mother’s care fees.

Delays in billing

41. While the billing produced by the Council is valid, the Council failed to send any billing to Mr X from 8 April 2019 until January 2024.
42. This meant the Council delayed for nearly five years in confirming the exact care charges owed for his mother’s care. This was fault.
43. The Council also failed to try to contact Mr X, through any medium, for three and a half years, following his mother passing away, to advise that a balance was owed for her care fees.
44. The Council’s delay in communicating with Mr X has contributed towards the situation in which Mr X has executed the will before settling the debt owed to the Council. The Council’s prolonged delay has caused Mr X distress and inconvenience.
45. While the Council’s delay has caused Mr X distress and inconvenience, it has not changed the validity or amount of the balance owed. Mr X would have owed the same money in March 2020 as the Council requested in January 2024. The Council has kept this debt on hold since January 2024 preventing any further distress or debt collection charges being applied.
46. The Ombudsman can award goodwill gestures when a council’s fault has put a person to distress. The Ombudsman would normally look to award goodwill gestures up to £500. However, in circumstances where distress is severe or matters are prolonged, we can recommend higher payments.
47. The Council’s delay through confirming the outstanding balance is prolonged. And, the distress caused by issuing a bill for £12,713.25 without prior notice of the accruing debt is severe. I consider the Council should provide a goodwill award of £750 as a reduction to the care fees owed. The Council should also provide an apology in writing to Mr X and offer him a payment arrangement to repay the remaining outstanding balance.

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Agreed action

48. Within one month of the Ombudsman’s final decision the Council should:
• Write to Mr X to confirm specifically what financial information it needs from him to complete a review of his mother’s care fees.
• Provide an apology in writing to Mr X and apply a credit of £750 to the outstanding balance as a gesture of goodwill for the injustice caused by its fault. This is for the prolonged delay in confirming the outstanding balance owed and the severe distress caused to Mr X through this delay given the large outstanding balance owed.
• Offer Mr X a payment arrangement to repay the outstanding balance owed for his mother’s care fees.
49. The Council should provide us with evidence it has complied with the above actions.

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Final decision

50. There was fault leading to injustice. As the Council has agreed to my recommendations, I have completed my investigation.

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Investigator's decision on behalf of the Ombudsman