Summary: Mrs X complains about failings and lack of support from the Council’s adult social care services when her late sister, Miss Y, was discharged from hospital into residential care. Mrs X said the care homes where Miss Y stayed were unsuitable and the Council did not provide adequate charging information. Mrs X was left with a large invoice for Miss Y’s care. We found the Council was not at fault in sourcing residential care placements, or in the charging information it gave. The Council accepted it took too long to allocate a social care assessor and apologised.

The complaint

1. Mrs X complains about failings by the Council’s adult social care services when supporting her late sister, Miss Y.
2. Mrs X said the Council discharged Miss Y from hospital into an unsuitable care home lacking equipment to meet her needs. Mrs X also said there was a lack of support from Miss Y’s social worker, and the Council did not provide proper advice and information about care charges and the financial assessment process.
3. Mrs X was left with a large invoice to pay for Miss Y’s care.

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The Ombudsman’s role and powers

4. 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)
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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How I considered this complaint

6. As part of the investigation, I considered the complaint and the information Mrs X provided.
7. I made written enquiries of the Council and considered its response along with relevant law and guidance.
8. Mrs X and the Council had an opportunity to comment on my draft decision. I considered any comments received before making a final decision.

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What I found

Hospital discharge

9. Schedule 3 to the Care Act 2014 and the Care and Support (Discharge of Hospital Patients) Regulations 2014 set out arrangements for the discharge of hospital patients with care and support needs. The NHS can claim money back from councils that have caused delays transferring patients. The NHS must issue a notice to the council where it considers an NHS hospital patient receiving acute care may need care and support as part of a transfer from an acute setting regardless of whether it intends to claim repayment.
10. The NHS should try to give the council as much notice as possible of a patient’s impending discharge. This is so the council has as much notice as possible of its duty to start a needs assessment. The Care and Support Statutory Guidance says local agreements should be in place between NHS bodies, councils and other relevant partners to set out each organisation’s responsibilities to achieve timely and safe hospital discharge.
11. On receiving an assessment notice, the council must assess the person’s care and support needs and (where applicable) those of a carer to determine whether it considers the patient and carer have needs. The council must then decide whether any of these identified needs meet the eligibility criteria. If so, it should confirm how it proposes to meet any of those needs. The council must inform the NHS of the outcome of its assessment and decisions.

Charging for temporary residential care

12. A temporary resident is someone admitted to a care or nursing home where the agreed plan is for it to last for a limited period, such as respite care, or there is doubt a permanent admission is required. The person’s stay should be unlikely to exceed 52 weeks, or in exceptional circumstances, unlikely to substantially exceed 52 weeks. A decision to treat a person as a temporary resident must be agreed with the person and/or their representative and written into their care plan.
13. A council can choose whether to charge a person where it is arranging to meet their needs. In the case of a short-term resident in a care home, the council has discretion to assess and charge as if the person were having their needs met other than by providing accommodation in a care home. Once a council has decided to charge a person, and it has been agreed they are a temporary resident, it must complete the financial assessment in line with the Care and Support (Charging and Assessment of Resources) Regulations 2014 and the Care and Support Statutory Guidance.

What happened

14. I have summarised below some key events leading to Mrs X’s complaint. This is not intended to be a detailed account of what took place.
15. Miss Y was hospitalised in late 2021. Before being in hospital, she lived with her mother. She owned a house, but rented it out and never lived in it. When Miss Y was ready to leave hospital, she could not return to her mother’s house, as it was no longer suitable for her needs. Miss Y’s mother also had her own care and support needs. The house Miss Y owned was also unsuitable for her needs.
16. The hospital contacted the Council for an assessment of Miss Y’s needs and to support with discharge planning.
17. A social worker visited Miss Y in hospital on 10 September 2022. They noted a temporary setting on discharge had already been discussed with Miss Y. Miss Y eventually wanted to be rehoused as her mother’s home was not suitable. The social worker told Miss Y rehousing was not an option for discharge. She would need to contact the Council’s housing service to enquire. Miss Y lived downstairs before hospital admission and was likely to need care. The social worker discussed care contributions being means tested. Miss Y worried she may not afford this.
18. The social worker spoke to the Council’s housing service. The housing service said if Miss Y has a house elsewhere this makes her ineligible for accommodation, even if she did not live there. The housing service also said the temporary accommodation it offers is likely to be a room only, which may not be accessible for Miss Y, and carers are not allowed. The housing service advised Miss Y should seek legal advice about selling her house. She could then bid for housing with the Council, if the equity from her home was under £30,000.
19. The social worker advised Miss Y of the information received from the Council’s housing service. Miss Y was not happy with the advice. The social worker said if Miss Y could not return to her mother’s house, then the only option for discharge was a short-term stay in a care home. They advised the costs of this could be high. Miss Y felt this was unfair and the NHS should pay the costs of her care. The social worker referred Miss Y for a financial assessment.
20. The Council completed an assessment of Miss Y’s care and support needs on 1 October 2022. The plan was to look at a respite care home setting. The Council found Miss Y did not have a qualifying primary healthcare need, so the NHS would not fund her care. The NHS consulted 15 care homes, but they could not meet Mrs Y’s needs. Oak Grange care home confirmed it could meet her needs. However, it did not have a suitable bed or chair. Oak Grange arranged a suitable bariatric bed, and the NHS agreed to support Miss Y with a recliner chair in the short-term. Miss Y had to fund her own chair in the long-term.
21. The social worker telephoned Miss Y on 3 October to discuss the care home placement. Miss Y was unhappy at being expected to pay towards care when she had not been told. The social worker referred to documents and conversations from September 2022 telling Miss Y about charges. Miss Y said she had not consented to move to Oak Grange and would rather consider using the money to rent privately. The social worker said finding an accessible private property to meet Miss Y’s needs would be difficult.
22. Miss Y left hospital and went into Oak Grange care home on 5 October 2022.
23. The social worker spoke to Miss Y on 7 October. Miss Y said she was not happy the Council had not told her thoroughly about the process. The social worker pointed out they gave Miss Y all necessary information at their first visit. They also gave Miss Y forms outlining the funding policy, and spoke to the housing service on her behalf before feeding back their advice.
24. The Council completed a care plan for Miss Y on 13 October 2022 following her needs assessment. The Council identified Miss Y had several eligible needs for daily support, including accessing the community, managing nutrition, managing personal care, and using the home safely. Miss Y needed help from a carer to meet her needs.
25. The Council discussed funding with Miss Y, who stated her capital was below the threshold. The Council noted Miss Y owned a house in another local authority area which she rented out. Miss Y wanted the Council to rehouse her in a bungalow. The Council advised Miss Y to sell her house first and then register with its housing service. The Council noted Miss Y had little expenses and her income appeared disposable, which meant she would likely have to pay a high contribution towards the cost of her care. Miss Y expressed she was not happy to have to pay towards the cost of her care, she felt the NHS should pay. The Council gave Miss Y a copy of its funding policy document.
26. The Council sent Miss Y a financial assessment form to complete on 3 November 2022 so it could decide how much she could afford to contribute towards care services.
27. The Council wrote to Miss Y on 25 November 2022. It said residents in long or short-term care must contribute subject to financial assessment. It assessed Miss Y had to pay the standard price as it considered she had capital/savings above £23,250. This was due to Miss Y owning a share in a property other than where she normally lives. The Council said the charges would be effective from 5 October 2022 and Miss Y’s maximum weekly contribution would be £1,229.
28. The social worker spoke to the hospital discharge team in December 2022 about the chair the NHS was funding. The discharge team said the hospital therapy team funded the chair short-term but could no longer do so, as Miss Y had been out of hospital for some time. Funding ended on 18 December.
29. Miss Y’s Occupational Therapist (OT) spoke to Oak Grange about Miss Y’s chair on 3 January 2023. Oak Grange confirmed Miss Y had been advised she will be invoiced for the cost of the chair, and she was happy with this.
30. The OT visited Miss Y on 5 January and advised she would be invoiced to rent the chair. The OT discussed a financial assessment with Miss Y. Miss Y did not know what her financial situation was as the paperwork was at her mother’s house. The OT also discussed Miss Y’s housing situation. Miss Y said she owned a house in another local authority area but never lived in it. She did not think it would need many adaptations as there is a bathroom downstairs. The OT planned to contact the local authority where Miss Y owned a house to find out about rehousing options or adaptations to her home.
31. The OT spoke with the other local authority on 10 January 2023. The other local authority said Miss Y needed to complete a housing application form and a medical form for it to assess her. It agreed to send forms out to Miss Y.
32. Oak Grange spoke to the Council on 26 January 2023 with concerns about Miss Y not opening her mail, missing hospital appointments, and not paying bills. Miss Y had a bill for over £1,000 for her chair, but denied having agreed to pay for it. The Council said it needed Miss Y to complete a financial assessment as she was being charged full costs and would have unpaid bills. Oak Grange also had concerns Miss Y would deny having had conversations about things. Staff were initialling her post as Miss Y denied having received it.
33. The Council sent Miss Y another financial assessment form to complete.
34. The chair provider said it would remove Miss Y’s chair on 7 February if she did not pay.
35. Miss Y telephoned the Council on 7 February. She was distressed the chair provider took the chair away without telling her. Miss Y wanted the other local authority housing services to visit her. The Council told her she needed to complete their housing application form.
36. The Council spoke to Oak Grange care home. Oak Grange confirmed the chair was taken away and Miss Y again said she had not been told. Oak Grange offered Miss Y help to use her bed instead, but she declined.
37. A social care assessor and OT visited Miss Y on 8 February 2023. They helped her complete the housing application form for the other local authority. They also went through Miss Y’s letters about her financial assessment and told her she owed over £10,000, but having a financial assessment should reduce this. They agreed to return the following week to help Miss Y complete the financial assessment forms.
38. Miss Y said she had not agreed to pay the fees at Oak Grange as no one discussed this with her. She also said she was not told her chair would be removed and she did not agree to pay for it. The assessor and OT reminded Miss Y care home staff, the OT, and the Council all recently advised her about this.
39. Oak Grange told the Council Miss Y’s family bought her a new chair on 24 February 2023. Miss Y had been sitting, sleeping in, and operating the chair with no difficulties or concerns.
40. Miss Y then spent time in hospital. A social care assessor visited again on 27 February 2023 to give Miss Y copies of her assessments and medical form. They advised Miss Y complete and send off the forms, including the financial assessment form, as soon as possible or she will continue to receive large bills.
41. The Council wrote to Miss Y on 21 March 2023 confirming she was required to pay the standard costs of her care package because the Council considered she had capital above £23,250.
42. While Miss Y was in hospital, Oak Grange served notice on her placement, saying it could no longer meet her needs.
43. Miss Y told a social worker she wanted the Council to provide her a bungalow. She had also looked at two care homes, including one called Manor Park, which may have availability and was close to family. The social worker explained the financial assessment process if Miss Y wanted a Council commissioned care home placement. Miss Y asked the social worker to contact the other local authority about housing there.
44. The social worker telephoned the other local authority. They did not have Miss Y’s housing application on their system, but they had a backlog of applications and said they would send Miss Y a paper form to complete.
45. The Council consulted six care homes in June and July 2023, but they either could not meet Miss Y’s needs or had no availability. The Council also consulted Manor Park in July. It did not usually accept people of Miss Y’s age, but could if management approved. It confirmed it would assess Miss Y and had spoken to her several times already.
46. The Council consulted two further care homes in August, but they could not meet Miss Y’s needs.
47. Manor Park accepted Miss Y in early August. Miss Y was concerned about not having her own bathroom and having to share facilities. The Council said this was so Miss Y could have a larger room to fit her equipment. Miss Y asked what would happen if she turned down the offer, and said it had been sprung on her. The Council said it had been searching for placements for two months and Miss Y had been contacting the care home regularly, stating it was her preference. Miss Y again asked about costs, which the Council said was subject to financial assessment.
48. Miss Y was discharged from hospital to Manor Park in mid-August 2023.
49. Miss Y was hospitalised again in September 2023.
50. Mrs X complained to the Council on Miss Y’s behalf on 7 December 2023 about Miss Y’s treatment and care after discharge from hospital in 2022. Miss Y said:
• She had to sell the rental property she owned, which was difficult due to her situation.
• She had an outstanding debt with the Council for care home stays and felt abandoned after she was discharged from hospital, with no social worker for months.
• She could not get answers about potential fees and was given different information.
• She felt the Council did not conduct financial statements for her income.
• She had a special chair on arrival at Oak Grange which was ideal for her medical conditions, but it was removed without giving her the chance to find a replacement. She then became ill and was hospitalised, which she blamed on the poor approach of the Council’s adult social care department.
• She felt the Council handled arrangements poorly and with little regard for her welfare.
51. Miss Y sadly passed away at the end of 2023 before the Council responded to her complaint.
52. The Council wrote to Mrs X on 2 February 2024, offering its condolences and telling her there was an outstanding balance of £47,473.62 on Miss Y’s account for care services received up to 9 September 2023.
53. The Council sent a complaint response to Mrs X on 23 April 2024. It apologised for the delay and said:
• It advised Miss Y to contact housing services, and an assessor helped her complete a housing application.
• There is documented evidence several officers held discussions with Miss Y where she was told there would be a financial assessment, and that respite care is not free. An officer documented discussions about the financial assessment, going through the forms three times, and advising failure to complete the form would result in the Council sending large bills. Despite attempts, there was a lack of engagement from Miss Y.
• It accepted it took longer than it would aim to achieve to assign a social care assessor. It apologised for this.
• Miss Y did not want to invest in paying for a chair, and the hospital therapy team agreed to fund this in the short-term. Miss Y wanted to wait until she knew the physical space she would be moving into. The Council advised Miss Y it would not fund the chair, and Miss Y was choosing to sleep in it instead of a bed that was considered suitable for her condition. There is documented evidence Miss Y agreed to fund the chair after ongoing discussions, but when the chair company did not receive payment, it removed the chair.
• Miss Y did not engage in therapy, meaning therapy staff could not establish her short-term goals.

My investigation

54. Mrs X told us the Council’s failure to promptly assign a social worker when Miss Y was discharged from hospital meant it was difficult for Miss Y to contact the Council about the financial situation.
55. Mrs X said the Council did not help Miss Y find another care home that she could choose for herself, and there was a lack of oversight by the Council at the outset.
56. Mrs X also told us Miss Y had to evict tenants to sell the house she owned. This meant she was responsible for mortgage payments with no rental income while the house was for sale.
57. Mrs X said the removal of Miss Y’s chair in February 2023 forced her to use the bed instead. This resulted in a build up of fluids and sepsis, and a lengthy stay in hospital.
58. Mrs X told me Miss Y missed hospital appointments due to problems with ambulance bookings, being too poorly, and due to poor phone signal in the care home making it difficult to make arrangements. Mrs X also said Miss Y’s poor eyesight contributed to her not filling in forms.
59. Mrs X said Miss Y could not return to Oak Grange after a hospital admission in 2023. She said the Council placed Miss Y in an unsuitable care home for dementia patients (Manor Park). Miss Y struggled at the new care home and was admitted to hospital shortly after with fever, sepsis, a chest infection and a urinary tract infection. She spent three months in hospital before passing away from sepsis. Mrs X feels the Council did not properly assess Miss Y’s health before admission.
60. Mrs X acknowledged Miss Y agreed to go to Manor Park care home, but probably because it had been good many years ago. The reality was different, however. The room was not large, was dark, and was not the right shape to accommodate Miss Y’s needs. It also lacked a private bathroom.
61. The Council told me it considered Oak Grange care home was suitable for Miss Y’s needs. Health colleagues consulted 15 care homes before Oak Grange accepted it could meet Miss Y’s care needs.
62. The Council said relevant equipment was rented and in place, with the express understanding Miss Y would need to buy her own chair.
63. The Council said it gave Miss Y suitable advice and information about care charges and the financial assessment process.

Analysis

64. I found Oak Grange was the only care home able to meet Miss Y’s needs and with availability when she first left hospital. The NHS consulted several other care homes, but they could not offer Miss Y a place.
65. I found the Council gave Miss Y suitable and consistent information and advice about the financial situation and assessment process, and about her housing options.
66. The Council told Miss Y several times that her care was not free of charge, and it needed to complete a financial assessment to determine how much she needed to contribute. The Council sent Miss Y the relevant financial assessment forms to complete, but she did not complete them, so the Council sent invoices for the full charges. The Council encouraged Miss Y to complete the forms to bring the charges down and officers were due to help Miss Y with this when unfortunately, she was hospitalised.
67. I found Miss Y expressed unhappiness about having to pay towards the costs of her care on several occasions. I am therefore satisfied she understood her care was chargeable.
68. Miss Y told the Council she wanted to join the housing register so she could get a Council home. Miss Y did not qualify to join the housing register while she owned a house, even though she did not live in it. There was therefore no fault by the Council when it advised Miss Y she would need to sell her home in order to make a successful housing application. I also found the Council spoke to another council and helped Miss Y make an application to join the housing register in their area.
69. I found the NHS only agreed to fund Miss Y’s chair for a limited time. Miss Y was then informed she would need to take over payment of the chair if she wished to keep it. The Council spoke to Miss Y about this and was not at fault. Miss Y was also warned the chair would be removed if she did not pay for it.
70. Once Miss Y’s chair was removed, she used a bariatric bed for a short time. While I appreciate Miss Y did not like the bed, and was more comfortable in her chair, the bed was assessed as being suitable for Miss Y’s needs. I cannot comment on the reasons for, or cause of, Miss Y's subsequent hospital admission. That is for healthcare professionals.
71. After another spell in hospital, Miss Y resided at Manor Park care home. I found Manor Park were aware of Miss Y’s needs and confirmed they could meet them. That was after consultation with the Council, and also after regularly speaking to Miss Y. Miss Y was aware Manor Park did not normally accept residents her age, but it was her preference due to its location. I did not see evidence suggesting Manor Park was unsuitable or could not meet Miss Y’s needs. Again, it is for healthcare professionals to comment on the reasons for Miss Y’s further hospital admission.
72. The Council has acknowledged it took longer than normal to allocate a social care assessor when Miss Y moved into Oak Grange, and it apologised for this. While this was frustrating for Miss Y, I found the Council’s apology and the subsequent help and advice it provided was enough to remedy any injustice suffered. I do not consider the Council needs to provide any further remedy.

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Final Decision

73. I found I found the Council was not at fault in sourcing residential care placements, or in the charging information it gave. The Council accepted it took too long to allocate a social care assessor and apologised.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman