Dudley Council criticised over care home top-up fee system

A local government watchdog has accused Dudley Council of absolving itself of its responsibilities and putting vulnerable people at risk by refusing to handle top-up fees for nursing homes.

The rebuke comes after the authority and Lincolnshire County Council rejected an ombudsman’s recommendation on how families pay additional costs for the care of their loved ones.

The fees cover the difference when people eligible for council-funded residential or nursing care choose a home which is above the ordinary rate the council would pay.

When the cost exceeds the council's chosen rate, a third party can "top-up" the difference to pay for extras such as a room with a nice view.

Michael King, Local Government and Social Care Ombudsman, said councils should put care home residents first by paying the top-up fees themselves before recouping the money.

But Dudley Council has said changing the present system so it reclaims families’ contributions would mean having to cover any debts if relatives fail to pay.

“Councils are encouraged to administer the top-up fees, and recoup the money from relatives, because it gives the best security for vulnerable people living in care homes should there be any problems with payments," Mr King said.

“The reasons both councils have given for departing from the guidance – the financial cost of doing things properly – is irrelevant.

“At the heart of the matter, we have two councils absolving themselves of their responsibilities to offer the public its basic protections set out in law.

“We also issued guidance to councils back in 2015 on administering these fees, and were quite clear that leaving the administration of top-up fees to care homes was wrong.”

His comments came after Dudley Council was ordered to pay compensation to relatives following a 2017 investigation into an elderly woman’s care arrangements.

The council said it accepted the majority of the recommendations made at the time but defended its decision not to to change how top fees are paid.

A report to the council’s cabinet discussed this week said legal guidance gives councils three options on how fees are paid and families don’t have to have been given a choice between them.

Council officers warn that implementing the ombudsman's recommendation would cost Dudley over £105,00 a year.

“If the council assumes responsibility for assuming liability to pay the top-up alongside the care fee (a gross payment) then it will be required to collect the third-party payment. This will cause increased administrative costs, staffing costs and a rise in bad debt levels.”

“At this point in time the authority’s financial position cannot sustain or justify such a change in practice.”

Dudley has said it is agreeing revised contracts with care providers which limits increases in fees to only once a year, while a proposed cap on any rise gives relatives enhanced protection and allows the council greater control over costs.

Councillor Nicolas Barlow, cabinet member for health and adult social care, said the ombudsman had unfairly singled out Dudley Council despite many authorities following the same procedures.

He added: “While we take the recommendations of the ombudsman seriously and have adhered to almost all of them, having taken legal advice we are confident our processes are appropriate and are in the best interests of all parties.

"If we were to change the way we administer top-up fees, it could have a real detrimental impact on the council’s finances.

“What we have done since the original report was issued, is to take action to ensure the people responsible for paying top-up fees are fully informed of the arrangements.

“We’re also putting measures in place to protect third-party users from price increases which haven’t been agreed with the authority and developing standardised mechanisms for applying the third-party contributions, including how and when increases are applied.”