Summary: Mrs X complains the Council failed to provide the care and support at home that her mother-in-law Mrs Y needed when she was discharged from hospital. There is no fault by the Council.

The complaint

1. Mrs X complains the Council has failed to properly consider her late mother in law, Mrs Y’s needs and wellbeing. As a result, Mrs Y was left without the social interaction she needed. Mrs X also says that:
• the Council did not properly consider her role as carer and did not provide respite.
• the Council did not provide continuity of care when Mrs Y moved into the area from another local authority. This led to delays in providing care.

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The Ombudsman’s role and powers

2. We investigate complaints of injustice caused by ‘maladministration’ and ‘service failure’. I have used the word fault to refer to these. We consider whether there was fault in the way an organisation made its decision. If there was no fault in how the organisation made its decision, we cannot question the outcome. (Local Government Act 1974, section 34(3), as amended)
3. 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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How I considered this complaint

4. I have discussed the complaint with Mrs X and considered the information she provided. I have made enquiries of the Council and considered the comments and documents it provided. Mrs X and the Council had an opportunity to comment on my draft decision. I considered their comments before making a final decision.

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What I found

Intermediate Care and Reablement

5. Intermediate care and reablement support services are for people usually after they have left hospital or when they are at risk of having to go into hospital. They are time-limited and aim to help a person to preserve or regain the ability to live independently.
6. Regulations require intermediate care and reablement to be provided without charge for up to six weeks. This is for all adults, whether or not they have eligible needs for ongoing care and support. Councils may charge where services are provided beyond the first six weeks but should consider continuing providing them without charge because of the preventive benefits. (Reg 4, Care and Support (Preventing Needs for Care and Support) Regulations 2014)

Assessment

7. Sections 9 and 10 of the Care Act 2014 require councils to carry out an assessment for any adult with an appearance of need for care and support. They must provide an assessment to everyone regardless of their finances or whether the council thinks the person has eligible needs. The assessment must be of the adult’s needs and how they impact on their wellbeing and the results they want to achieve. It must also involve the individual and where suitable their carer or any other person they might want involved.
8. Councils must carry out assessments over a suitable and reasonable timescale considering the urgency of needs and any variation in those needs. Councils should tell people when their assessment will take place and keep them informed throughout the assessment.

Carer’s Assessment

9. Where somebody provides or intends to provide care for another adult and it appears the carer may have any needs for support, the council must carry out a carer’s assessment. A carer’s assessment must seek to find out not only the carer’s needs for support, but also the sustainability of the caring role itself. This includes the practical and emotional support the carer provides to the adult.
10. As part of the carer’s assessment, the council must consider the carer’s potential future needs for support. It must also consider whether the carer is, and will continue to be, able and willing to care for the adult needing care. (Care and Support Statutory Guidance 2014).

Best interest decision making

11. A key principle of the Mental Capacity Act 2005 is that any act done for, or any decision made on behalf of a person who lacks capacity must be in that person’s best interests. The decision-maker also has to consider if there is a less restrictive choice available that can achieve the same outcome. Section 4 of the Act provides a checklist of steps decision-makers must follow to determine what is in a person’s best interests.
12. If there is a conflict about what is in a person’s best interests, and all efforts to resolve the dispute have failed, the Court of Protection might need to decide what is in the person’s best interests.

What happened

13. Mrs Y who had physical and mental disabilities, was discharged from hospital in 2023 to her son and daughter in law’s home. She had previously lived in another local authority area with her husband. Mrs Y had a package of care arranged by her former Council, and her husband also provided care for her. However, Mr Y sadly passed away.
14. At first the Council’s Stabilise and Make Safe (SAMS) scheme provided a package of care and support for Mrs Y. This reablement care for people who have left hospital, was provided free of charge for six weeks. Two carers visited four times a day.
15. Within a week of Mrs Y’s hospital discharge the Council started assessing her long term needs as required by the Care Act 2014. It assessed that Mrs Y had eligible needs and required support. The Council also caried out a Mental Capacity Assessment regarding Mrs Y’s capacity. It considered Mrs Y did not have capacity to make decisions about her care and support needs.
16. In late July 2023 the Council advised it assessed that Mrs Y needed 24-hour care, and this could be provided in a residential care home. A nursing needs assessment also recommended that Mrs Y’s needs would be best met in a 24 hour care home. The Council said it had identified a care home outside the borough and the cost of this would be £645 per week. It later agreed a higher figure of £657 per week which was its rate for a care home within the borough that would meet Mrs Y’s needs.
17. However, the family wanted Mrs Y to remain at their home rather than move to a care home. In their view it was in Mrs Y’s best interests that she remained in the family home and supported by the family.
18. Mrs X requested care and support at night as she was finding it difficult caring for Mrs Y. The family also asked the Council to provide day care at a centre five days per week as this was the support Mrs Y had in her previous home.
19. The Council considered nighttime care and day centre care. The total care costs for the requested care would be over £4500 per week.
20. In August 2023 the Council held a best interest meeting with the family. The Council explained it could take value for money and affordability into consideration as well as promoting wellbeing, desired outcomes and preferences. It said paragraph 10.27 of The Care and Support Statutory Guidance (The Guidance) states that when determining how to meet needs, the LA [Local Authority] may also take into reasonable consideration its own finances and budgetary position, and weigh up the total costs of different potential options for meeting needs. The Guidance said the LA could include the costs as a relevant factor in deciding between suitable alternative options for meeting needs.
21. The Council said the family could use £657 per week as a personal budget to meet Mrs Y’s needs. The family felt that the personal budget did not allow flexibility in meeting Mrs Y’s needs. The family agreed to try and identify a more cost-effective care package which could meet Mrs Y’s assessed needs.
22. Later the family suggested day care five days a week and two care visits a day instead of four. This would cost £1018 per week. However, the Council maintained its view that Mrs Y’s needs could be met in a 24 hour care home placement. The Council offered Mrs Y £657 per week as a direct payment, to put towards the cost of her care.
23. Mr X complained that the personal budget the Council suggested did not cover the cost of the carers currently in place or provide any day care services, which she had in her previous home. He said that:
• The Council had blatantly disregarded the Care Act in its assessment.
• There were significant delays by the Council in replicating the previous service Mrs Y had received before she moved to this area.
• The family were left to provide all the care for Mrs Y.
• The Council had no regard to Mrs Y’s unmet needs.
• The Council had not taken account of al the care the family provided and had not arranged the requested two care visits a day and day care.
• The Council had not considered Mrs Y’s complex needs or culturally appropriate care.
24. The Council considered Mr X’s complaint as an appeal against its decision. Following a best interests decision, the Council offered an increase in Mrs Y’s personal budget to £825 per week. This was calculated based on the four visits a day that it assessed Mrs Y required.
25. In its response to Mr X’s complaint the Council said it had offered an increased personal budget of £825 which was akin to the cost of the home care Mrs Y received. The Council said it had taken account of Article 8 of the Human Rights Act. The Council reconsidered this, but it did not agree it should increase the budget. The Council said the family had the right to use this budget flexibly to meet Mrs Y’s needs. It said that any care in excess of the personal budget would need to be paid for by the family.
26. In December 2023 the Council advised Mrs X that it had completed a financial assessment to work out Mrs Y’s contribution for the care costs. It considered Mrs Y’s capital was over the upper capital limit. Therefore, she was required to pay for her care costs in full.
27. Since Mrs X made her complaint, Mrs Y has sadly passed away.

Analysis

28. Based on the information and evidence I have seen, there was no fault by the Council. The Council considered Mrs Y’s needs and the care and support required to meet those needs. Its view was that 24 hour care in a care home would meet those needs, including social inclusion.
29. I understand Mr and Mrs X disagreed, and they wanted Mrs Y to remain at home. The Council considered this wish and maintained its view that Mrs Y’s needs would best be met in a care home. There was no fault in the Council taking account of the cost of provision as this is a relevant factor, set out in the Guidance.
30. The Council reconsidered the matter and made a best interests decision taking account of the family’s views and the points they raised. While the Council did not agree to all the care provision requested, it significantly increased the personal budget. The family could use this flexibly to meet Mrs Y’s needs. There is no fault here.
31. The Council arranged and paid for Mrs Y’s care provision. Following a financial assessment the Council deemed that Mrs Y was a full cost payer

Carer’s respite

32. Mrs X complains the Council has not provided respite care or support to her as Mrs Y’s main carer. She has found this very demanding and states that it is very difficult or impossible for her to exercise or attend to other matters such as medical appointments.
33. In its response to my enquiries the Council has confirmed it made a referral for a carer’s assessment, and it provided information about carer support. The Council also arranged day care provision for Mrs Y for six weeks while Mrs X recovered from an operation.
34. There is no apparent fault by the Council in the way that it has responded to Mrs X’s requests for carer support.

Continuity of care

35. Mr X had complained the Council did not provide continuity of care when Mrs Y moved from one local authority to another. The type and amount of care the was different. He also complained the Council delayed putting care provision in place.
36. In its response to my enquiries the Council advised that:
• The SAMS (reablement) package of care was to assess Mrs Y’s needs. However, it could not assess her night time needs as this takes place in a residential home setting. While the Council (SAMS) offered to assess Mrs Y, the family did not agree to this because did not want Mrs Y to go into a home.
• The Council considered the family’s requests for additional support and appeals regarding the amount of care based on the cost of a care home. It and ultimately agreed to “match” the level of support with the amount of care that was provided at home by SAMS.
• The Council considered it offered options which would meet Mrs Y’s assessed needs in line with the Guidance.
• The Council said it could not compare different packages of care from other local authorities as all authorities provide different interventions and services. In addition, Mrs Y’s needs may have changed following her stay in hospital.
• The Council commented that the delays in finalising the long term package of care were as a result of the family’s request for continued support from the SAMS provider, and not due to fault by the Council.
37. The family disagree with the Council’s comment that it wanted the SAMS provider to continue its provision.
38. I do not consider there is evidence of fault by the Council as Mrs X suggests. It appears the Council completed an assessment which the family disagreed with. The Council then took steps to consider the family’s request for further care and its appeals regarding the matter. There was no significant avoidable delay here.

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Final decision

39. I have not found fault by the Council. I have completed my investigation and closed the complaint.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman