Summary: Mrs X complains the Council failed to deal properly with the charges for her mother-in-law’s stay in a care home and delayed in reviewing her needs. The Council delayed in assessing the mother-in-law’s needs, resulting in her spending 17 weeks longer in the care home than necessary. It has offered to reduce the charge for the care home. It also needs to apologise, pay financial redress to Mrs X for the trouble it has put her to and take act to ensure timely assessments in future.

The complaint

1. The complainant, whom I shall refer to as Mrs X, complains the Council:
• failed to deal properly with the charges for her mother-in-law’s stay in a care home, leaving her with a large bill which she had not expected to receive; and
• delayed in reviewing her needs, resulting in her spending longer in the care home care home than should have been the case

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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 a council’s actions or proposed actions, we can complete our investigation and issue a decision statement. (Local Government Act 1974, sections 30(1B) and 34H(i), as amended)

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How I considered this complaint

4. I have:
• considered the complaint and the documents provided by Mrs X;
• discussed the complaint with Mrs X;
• considered the comments and documents the Council has provided in response to my enquiries; and
• shared a draft of this statement with Mrs X and the Council, and invited comments for me to consider before making my final decision.

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What I found

What happened

5. Mrs X has Lasting Power of Attorney for her mother-in-law’s, Mrs Y’s, property and financial affairs. However, Mrs Y has the capacity to make decisions for herself. Mrs Y went into hospital in November 2018, having lived at home with a package of care provided by the Council. When she left hospital on 11 December she went to stay in a care home. Mrs X says she was told this would be intermediate care, for which there is no charge for up to six weeks.
6. Mrs Y’s 8 December care and support plan says everyone agreed she should “enter a short-term placement”, which would be from 11 December to 8 January 2019. It says:
• “We will make an assessment of your finances to see how much you may pay towards the cost of your care and support. The contribution towards the cost of your care and support starts on the day your service starts.”
7. The care and support plan does not mention intermediate care. It notes how important her home is to Mrs Y.
8. Mrs X asked the Council to complete an NHS Continuing Healthcare checklist for Mrs Y. It told her it could not do this while she was in hospital and would have to wait until she had left.
9. On 21 January 2019, Mrs X told the Council she would not complete the financial assessment forms it had sent to her until Mrs Y had been assessed for NHS Continuing Healthcare.
10. Completion of the NHS Continuing Healthcare checklist for Mrs Y on 25 January resulted in a referral for a full assessment.
11. The Council’s contract with the care home ran out on 5 February.
12. On 11 February Mrs X told the Council Mrs Y was very upset and wanted to return home.
13. On 13 February the Council told Mrs X it would assign a Social Worker for Mrs Y when the NHS contacted it about doing a full assessment for Continuing Healthcare. It said the Social Worker would probably also review/assess Mrs Y’s needs under the Care Act. Mrs X said Mrs Y was unlikely to need a Care Act review/assessment as she would be eligible for NHS Continuing Healthcare. She said they would challenge the decision if she wasn’t.
14. On 18 February the care home told the Council it understood the Intermediate Care Team had placed Mrs Y there.
15. On 20 February Mrs X told the Council Mrs Y was being kept against her will at the care home. The NHS told the Council it would assess Mrs Y for Continuing Healthcare by the end of March.
16. An assessment on 6 March found Mrs Y did not qualify for NHS Continuing Healthcare.
17. On 21 March the Council told Mrs X it would extend Mrs Y’s stay at the care home to allow time to assign someone to assess her and arrange her return home.
18. On 1 April the Council told Mrs X it had completed Mrs Y’s care and support plan but now needed to assign someone to complete a full assessment.
19. Mrs X appealed the NHS decision on Continuing Healthcare.
20. The Council arranged to assess Mrs Y on 29 April. At the assessment Mrs X said she was challenging the decision that Mrs Y had to contribute towards the cost of the care home, as it was an intermediate care placement. The Council referred Mrs Y for an Occupational Therapy assessment.
21. On 2 May the Council told Mrs X there was no evidence the Intermediate Care Team placed Mrs Y in the care home. Mrs X said people at the hospital and care home had told her the placement was intermediate care and she had a document referring to this. The care home told the Council it had a referral from the Intermediate Care Team for Mrs Y’s placement.
22. The Council’s records show the arrangements for Mrs Y to return home were complicated because of:
• her high needs;
• the need to manage risks; and
• the need to provide suitable equipment (and trial it before her return).
23. Mrs X complained to the Council on 20 May about the time Mrs Y had had to spend in residential care, including:
• a five-month delay in assigning a Social Worker;
• not referring her for intermediate care.
24. Mrs Y’s care and support plan dated 3 June 2019 says she was discharged from hospital to an intermediate care placement. The Council says this was a mistake.
25. Mrs Y remained in the care home until 1 July.
26. When Council replied to Mrs X’s complaint on 2 July it:
• apologised for the breakdown in communication between departments which caused confusion;
• said Mrs Y did not qualify for intermediate care funding;
• apologised for misrepresenting this in the June care and support plan;
• apologised for the delay in assigning a Social Worker, which was because it had not felt Mrs Y to be at significant risk in the community.
27. On 11 November 2019 the Council wrote to Mrs X saying Mrs Y would have to pay £165.44 a week for the care home from 11 December 2018 and £170.64 from 8 April 2019.
28. The Council accepts a delay in reviewing Mrs Y may have contributed to her spending longer in the care home than necessary. It has offered to reduce the charges to what Mrs Y would have paid for care if she had returned home on 11 December 2018. This will reduce the charge by £1,442.80, leaving £2,207.19 to be paid.

Is there evidence of fault by the Council which caused injustice?

29. It is clear there was some confusion over whether the placement in the care home would be funded as intermediate care. However, I have seen no evidence to suggest the Council was responsible for that confusion in December 2018. There is nothing in the care and support plan from December 2018 to say Mrs Y would receive intermediate care or that there would be no charge for her care. Although the Council contributed to the confusion by referring to intermediate care in Mrs Y’s June 2019 care and support plan, that does not mean she should not have to pay anything for her residential care.
30. There is no dispute over the fact Mrs Y stayed in the care home far longer than should have been the case.
31. The delay in assessing Mrs Y’s needs prevented her from having her needs met in the way that she wanted, at home. When the Council arranges a short-term placement in a care home before arranging care at home, its aim should be to keep the placement as short as possible. In Mrs Y’s case, it seems likely she would have had to stay in the care home for at least 12 weeks, given the complexity of her needs.
32. The Council has offered to reduce Mrs Y’s charges by £1,442.80. This will leave her paying what she would have paid if she had received care in her own home after she left hospital. However, even if the Council had done a timely assessment, given the complexity of her circumstances, it seems likely Mrs Y would have had to spend at least 12 weeks in the care home. This means she spent around 17 weeks longer in the care home than she should have done.
33. The Council’s offer means Mrs Y will have to pay £476 less than she would have had to pay if it had charged her for residential accommodation for the first 12 weeks of her stay. The question is whether this is enough to remedy the injustice caused to Mrs Y from spending 17 weeks longer in the care than she should have done. My view is that it is.
34. However, this does not remedy the injustice to Mrs X as a result of the time and trouble the Council has put her to by not recognising the need to provide a remedy for the injustice caused to Mrs Y at an earlier stage.

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Agreed action

35. I recommended the Council:
• within the next four weeks writes to Mrs X apologising for the trouble it has put her to, confirms the £1,442.80 reduction in Mrs Y’s charge and pays Mrs X £150. And apologises to Mrs Y for the delays which resulted in her spending 17 weeks longer on the care home than she should have done; and
• within the next eight weeks takes action to ensure it does timely assessments of people placed temporarily in residential accommodation, when this is not where they want to be.

The Council has agreed to do this.

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Final decision

36. I have completed my investigation as the Council has agreed to take the action I recommended.

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Investigator's decision on behalf of the Ombudsman