Summary: The Council has admitted that there was delay in its assessment of Mrs D’s needs when she was staying in a care home after a hospital discharge. There was also a delay in finding a placement to move to and in chasing the debt. The Council has offered to reduce the outstanding debt from £3,100 to £1,777 and this is an appropriate remedy for the injustice.

The complaint

1. Mr C complains on behalf of his mother, Mrs D who has died. He says the Council should not have charged Mrs D for the time she spent in a care home after a hospital discharge. He also says the Council failed to chase the debt for 18 months after Mrs D died.

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The Ombudsman’s role and powers

2. 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)
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. 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

5. I have discussed the complaint with Mr C. I have considered the documents that he and the Council have sent, the relevant law, guidance and policies and both sides’ comments on the draft decision.

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What I found

Law, guidance and policies

6. The Care Act 2014, the Care and Support Statutory Guidance 2014 (updated 2017) and the Care and Support (Charging and Assessment of Resources) Regulations 2014 set out the Council’s duties towards adults who require care and support and its powers to charge. The Council also has its own policies.

Financial assessment

7. Where a local authority has decided to charge, it must carry out a financial assessment of what the person can afford to pay.
8. If a person’s capital is below the threshold (£23,250) they are eligible for council funding for their care and support, but may still need to make a contribution from their income.

Income

9. Local authorities must ensure that a person’s income is not reduced below a specified minimum after charges (the contribution from income) have been deducted. However, this minimum is different depending on whether a person receives care at home or in a residential care home.

Care provided at home

10. If care is provided at home, a person must be left with the minimum income guarantee which is set out in the regulations.
11. The purpose of the minimum income guarantee is to promote independence and social inclusion and ensure that they have sufficient funds to meet basic needs such as purchasing food, utility costs or insurance. This must be after any housing costs such as rent and council tax net of any benefits provided to support these costs – and after any disability related expenditure.

Residential care

12. If a person is living at a residential care home, they should be left with the personal expenses allowance. This is a lot lower than the minimum income guarantee.
13. Where a person is a short-term or temporary resident at a care home there is a degree of discretion or modified charging rules to take account of this.

Intermediate and reablement care

14. The council must provide intermediate care and reablement care free of charge for up to six weeks, even if the person is above the capital threshold.
15. Intermediate care services are provided to people, usually older people, after they have left hospital or when they are at risk of being sent to hospital. Intermediate care is a programme of care provided for a limited time to assist a person to maintain or regain the ability to live independently.
16. ‘Reablement’ is a particular type of intermediate care, which has a stronger focus on helping the person to regain skills and capabilities to reduce their needs, in particular through the use of therapy or minor adaptations. There is a tendency for the terms ‘reablement’, ‘rehabilitation’ and ‘intermediate care’ to be used interchangeably.

What happened

17. Mrs D was an elderly woman with care and support needs. She lived on her own in a sheltered housing bungalow and was supported by the Council with a package of care. Carers attended 4 times a day every day and Mrs D also went to a day centre two days a week.
18. Mrs D was admitted to hospital in April 2017. The Council’s social worker assessed Mrs D on 8 May 2017 as Mrs D was ready for discharge from hospital. The social worker agreed that it would not be safe for Mrs D to return to her bungalow and that she may need more support. The social worker said Mrs D could move to a planning bed while further assessments were carried out to decide the long-term plan.
19. On 17 May 2017, Mrs D moved to care home K which had a planning bed. Mr C contacted the Council on 5 June 2017 as he was worried that Mrs D was still at care home K where there were a lot of dementia patients and he said this affected her mental wellbeing. The social worker tried to ring Mr C on 12 June 2017. Mr C returned her call on 13 June 2017 and they discussed Mrs D’s case.
20. The social worker carried out an assessment of Mrs D’s needs on 15 June 2017 and recommended that Mrs D move to extra care housing with a package of care. The plan was for Mr C and Mrs D to visit a few of the extra care housing facilities in the area and choose the one they preferred. Mrs D said she wanted to stay at care home K until an extra care housing place was found rather than return to live at her bungalow. The social worker discussed the costs of care home K with Mrs D and gave Mrs D a plastic envelope with financial information.
21. The Council wrote to Mrs D on 29 June 2017 and informed her that the contribution she had to pay toward her care costs while she received care at home would be £80 per week.
22. On 17 July 2017, the social worker and Mr C discussed the costs Mrs D would pay once she moved to extra care housing. The social worker explained that Mrs D would have to pay her rent and council tax and the Council had authorised funding to pay for the cost of the care package. Mr C said Mrs D did not have to pay those costs previously. He said that, when Mrs D visited the extra care housing facility, she had been told that her financial situation would not change.
23. The Council wrote to Mrs D on 27 July 2017 and said her contribution towards the costs at care home K would be £204 a week.
24. Mr C and the social worker discussed finances again on 8 August 2017. Mr C said Mrs D had been told that the planning bed at care home K would be free for the first few weeks. The social worker said that was correct but, once Mrs D had been assessed, she could have gone back to her bungalow but chose to stay at care home K so she had to pay a contribution.
25. Mrs D moved to extra care housing L on 21 August 2017. She had been at care home K for 13 weeks and 5 days.
26. On 23 August 2017, the Council sent Mrs D an invoice for her contribution towards care home K. The amount was £1982 to pay for costs from 14 June 2017 until 20 August 2017. Mrs D also received an invoice for £347 for costs towards the care package at the bungalow.
27. Mr C contacted the Council on 30 August 2017 and said Mrs D was distressed by the invoices. The Council reduced Mrs D’s invoice for the care she received at the bungalow to make sure she was not charged for care while she was at care home K.
28. The Council also asked Mrs D to send any information regarding costs she incurred relating to the bungalow while at care home K as this may affect its calculation of her contribution.
29. Mr C spoke to Council officers on 4, 8, 18 and 19 September 2017. Mr C said Mrs D said the first 4 weeks at care home K would be free, but the social worker said that was not correct and it was only the first 2 weeks.
30. Mr C said Mrs D would not pay the invoices until the charges had been resolved. He made a complaint on 5 October 2017 and said Mrs D had been told that she would only be at care home K for 4 weeks and the first 2 weeks would be free. He said the Council delayed finding an alternative placement sooner and therefore should pay the cost of placement K.
31. The Council sent an invoice to Mrs D for £2,196 on 4 and 14 October 2017. Mr C continued to question the invoices and the invoices were not paid. The Council also asked Mrs D for any evidence of expenses of costs such as rent or council tax.
32. The Council sent an invoice to Mrs D on 4 December 2017 for £323 which was the contribution towards her care costs at extra care housing L.
33. The Council sent a holding letter regarding Mr C ’s complaint on 27 December 2017 and said the Council was waiting for further information from Mrs D.
34. Sadly, Mrs D died on 28 December 2017. Mr C informed the Council on 2 January 2018. He said Mrs D had been worried about the invoice for care home K. He disputed the charges because of the delay in the assessment. He said Mrs D had sent all the information about her expenses in November 2017 and there was nothing further to send. He was not clear what else could be required as Mrs D was on benefits.
35. The complaints officer said that, because of Mrs D’s recent death and Mr C’s level of distress, she would ask the finance team not to send further correspondence to Mr C until this was clarified.
36. The finance team rang Mr C on 3 January 2018 and left him a message asking him to contact them.
37. The Council sent invoices to Mr C on 25 January 2018 and 23 February 2018 which related to extra care housing L charges. It also sent two credit notes in January 2018 for small amounts.
38. The Council sent an invoice to Mr C for £3,345 on 30 May 2019 and 8 August 2019. This included costs relating to the care at the bungalow, care home K and extra care housing L. It was my understanding that Mrs D had not paid any invoices after August 2017.
39. Mr C complained on 29 August 2019. He said:
• When Mrs D moved to the planning bed at care home K, she was told she would only be there for 2 weeks and it would be free during that time.
• They were assured that they would not have to pay anything as the reason why Mrs D was in care home K for a lot longer was because the assessment was delayed and was not Mrs D’s fault.
• The Council should have sent him the invoice soon after Mrs D’s death, not 18 months later.
40. The Council replied and said:
• Mr C contacted the Council in October 2017 to dispute the invoices. The Council asked Mrs D for some further financial information. Mr C spoke to the complaints officer on 2 January 2018 and said Mrs D had sent all the information and was not clear what further information was needed. The officer said no further correspondence would be sent until this could be clarified. The Council officer rang Mr C on 3 January 2018 and left a voicemail for Mr C to call the team to discuss.
• The finance team did not contact him again because of the hold that had been put on his account by the complaints team. The Council apologised for the oversight.
• The outstanding invoice was £3,100.
41. In its reply to the Ombudsman the Council said:
• It had planned to assess Mrs D within the two-week timeframe but that was not possible because of pressures on the service. Therefore, the Council agreed that there had been a delay in the assessment and the Council agreed to cancel the charges for the first 6 weeks at care home K.
• Ideally, Mrs D should have been assessed within 2 weeks and found a placement to move to without delay. As a gesture of goodwill, the Council agreed to charge the remaining 5 weeks at care home K at the rate of placement L at £80 a week as opposed to the actual respite rate of £183 a week.
• This reduced the outstanding invoice to £1,777.

Analysis

Charges at care home K

42. Mr C says that he had been told that the first 2 weeks at care home K would be free and that Mrs D would only be at the home for 2 weeks so the whole stay would be free. He says the Council then delayed assessing Mrs D so he feels that the Council should have paid for the entire cost.
43. I cannot say what the social worker initially told Mrs D and Mr C about the costs at care home K, but certainly there was an expectation that the stay would be short and that the first 2 weeks would be free.
44. The NHS paid for the first 2 weeks of Mrs D’s stay at care home K and the Council paid the next 2 weeks so Mrs D did not pay anything for the first 4 weeks from 17 May 2017 until 14 June 2017. The Council invoiced Mrs D for charges from 14 June 2017 onwards (total of 9 weeks).
45. In its response the Ombudsman, the Council agreed that it had been at fault as there had been a delay in assessing Mrs D and she was at the care home for 4 weeks before the assessment took place. The Council has therefore agreed to pay the first 6 weeks of Mrs D’s stay and I agree that this is an appropriate remedy for the fault. Mrs D therefore will not pay for 8 weeks of her stay at care home D (as the first 2 weeks were paid by the NHS).
46. Mrs D then remained at care home D, partly out of her own choice as she did not want to return to the bungalow before then moving to extra care housing. Mrs D knew that she would have to pay for her stay at care home K and that the cost would be higher than if she returned to the bungalow. The Council acknowledges that it took a long time to find an alternative placement. Mrs D was at care home K for 13 weeks.
47. The Council has offered to reduce the charges for the 5 weeks where Mrs D paid a contribution towards care home K to £80 a week, as a goodwill gesture. This is the same contribution Mrs D paid at extra care housing L and she would have had to pay this wherever she moved. I agree that this is a suitable remedy.

Delay in sending the invoice

48. I agree with Mr C that there was some fault in the delay of sending the invoices after Mrs D died. The Council left a message on Mr C’s telephone on 2 January 2018, but then did not take any further action to chase the debt until May 2019. This appears to be because of an internal communication error where the complaints team had asked the finance team to put a hold on the account. However, that does not justify an 18 months lapse of communication. There should have been some mechanism to regularly review the case and this clearly did not happen.
49. I have considered the injustice Mr C suffered as a result of this fault. Mr C was aware of the outstanding invoices when Mrs D died. He had been in regular communication with the Council about the invoices. I also note the Council sent further invoices to Mr C in January 2018 relating to the costs of the care package at the extra care housing.
50. The Council never said the debt had been cancelled or reduced. Therefore, I am of the view that the injustice is limited. The debt had to be repaid, regardless of whether the Council was actively chasing Mr C or not.
51. Also, Mr C was the executor of Mrs D’s estate and it was his duty to check whether Mrs D had any outstanding debts before he distributed the estate. He could have rung the Council at any time and asked them what the outstanding debt was.

Agreed action

52. The Council has agreed to take the following actions within one month of the final decision. It will:
• Waive the charges for 6 weeks of Mrs D’s stay at care home K and charge Mr C only £80.95 per week for the remainder of her stay at care home K. This will reduce the outstanding debt to £1,777.

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Final decision

53. I have completed my investigation and found fault by the Council. The Council has agreed the remedy to address the injustice.

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Investigator's decision on behalf of the Ombudsman