Kirklees Metropolitan Borough Council (18 012 402)

Category : Adult care services > Charging

Decision : Not upheld

Decision date : 25 Jun 2019

The Ombudsman's final decision:

Summary: There is no evidence that shows Council told Mr X that Mrs Y would receive a period of free reablement care. Mrs Y was not a suitable candidate for such care and Mr X was informed Mrs Y would have a financial assessment and depending on the outcome, would have to contribute towards her care.

The complaint

  1. Mr X complains the Council charged his late sister-in-law Mrs Y for a period of reablement care in a residential care home, that they were told would be free.

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The Ombudsman’s role and powers

  1. 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)
  2. 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

  1. I have:
  • considered the complaint and discussed it with Mr X;
  • considered correspondence between Mr X and the Council, including the Council’s response to the complaint
  • made enquiries of the Council and considered the responses;
  • taken account of relevant legislation;
  • offered Mr X and the Council an opportunity to comment on a draft of this document, and considered the comments made.

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What I found

Relevant legislation

  1. Under the Care Act 2014 local authorities must carry out an assessment for any adult who appears to need care and support. If a council decides the person is eligible for care and support it may charge for care and support services it provides or arranges. To decide how much to charge the council carries out a financial assessment of the service user’s means.
  2. Kirklees Council offers reablement care and rehabilitation care. Reablement care is short-term care provided in a service user’s home for up to six weeks, to aid recovery after discharge from hospital. The aim is to provide support to enable people to regain the ability to look after themselves following an illness or injury, by learning or re-learning the skills necessary for daily living.
  3. Rehabilitation can be part of a reablement service and is also time limited for up to six weeks, with the aim of maintaining or increasing a person’s independence. People assessed as being eligible within the Council’s area, are admitted to Westmore Rehabilitation Unit, which offers temporary 24-hour support.

Background

  1. Mrs Y was admitted to hospital on 30 April 2018. During her stay, it became apparent she would not be able to manage stairs when she returned home. The hospital made a referral to the Council. Mr X says a social worker visited Mrs Y in hospital and all parties agreed Mrs Y should go into residential care for a short stay until decisions could made about her future care. Mr X says he was told the care would be free for up to six weeks. He expected Mrs Y would receive at least four weeks free care. Mr X says he was not given any written information about reablement or about charging.
  2. Eighteen days after Mrs Y went into the care home she fell and broke her hip. Following this it was decided she needed permanent residential care.
  3. During Mrs Y’s stay in the care home the Council fitted a handrail to Mr X’s’ home. Mr X says this is evidence Mrs Y was expected to return home.
  4. Mr X says the first he knew about the charges was when he received a bill from the Council. He contacted the Council on 1 October 2018 to query it. He received a response on 8 & 23 October 2018. The Council said Mrs Y had not received either reablement care or rehabilitation, and that the short stay was chargeable.
  5. After contacting the Ombudsman for advice Mr X wrote to the Council again on 9 November 2018 to make a formal complaint about the charges. He said when Mrs Y went into the care home from hospital, the intention was she would return to live with him and Mrs X. This did not happen because she fell and broke her hip at the care home and was re-admitted to hospital. He accepted that Mrs Y needed permanent residential care but he was under the impression that 4 - 6 weeks of the short stay would be free of charge, and that the Council’s website said, “up to six weeks free care can be available after a hospital stay to allow a person to recuperate”. He believed the Council should not have begun charging Mrs Y until 10 July 2018, when it was decided she would not return home.
  6. Mr X received a final response to his complaint on 18 December 2018 to say the Council had not upheld the complaint.

The evidence

  1. Following Mrs Y’s admission to hospital on 30 April 2018, a social worker telephoned Mr & Mrs X on 3 May 2018. Mrs X told the assessor that Mrs Y’s memory and mobility had declined and she was unsure if she could continue to care for her at home. She said Mr X was also experiencing some health problems. The social worker agreed to meet Mr & Mrs X at the hospital the following day to discuss a forward plan.
  2. Prior to meeting with Mr & Mrs X, the social worker spoke with the hospital physiotherapist on 4 May 2018. The notes show the physiotherapist said Mrs Y was not suitable for rehabilitation because of cognitive impairment.
  3. Mr & Mrs X met with the social worker at the hospital on 4 May 2018. I have seen the notes of this meeting. Mr & Mrs X explained they had cared for Mrs Y for two and half years, and recently her mobility had declined and they were concerned they could not continue to care for her. The social worker agreed to speak to Mrs Y to ascertain her capacity to decide where she wanted to live. Following which, “we would then move forward with a short stay bed”. The social worker provided Mr & Mrs X with a list of care homes. Mr & Mrs X expressed a preference for two homes because they were close to their home. The social worker told Mr & Mrs X that one of the care homes had a £20 top-up and that this would have to be paid by them, not by Mrs Y, and that Mr & Mrs X understood this. The social worker explained Mrs Y would need a financial assessment to establish her contribution towards the short stay. Mr & Mrs X told the social worker Mrs Y was under the capital threshold and received state benefits. The social worker said she would complete her assessment of Mrs Y and update them later that day.
  4. The social worker completed her assessment the same day. She requested and received authorisation for funding for Mrs Y a four-week residential short stay “to support discharge from hospital and to allow time for an assessment of Mrs Y’s long term care and accommodation needs”. The social telephoned Mr & Mrs X to inform them. Mrs X said they had chosen one of their preferred care homes.
  5. The care home visited Mrs Y in hospital on 8 May 2018 to assess her needs, and agreed to accept her.
  6. Mrs Y was discharged from hospital to the care home on 9 May 2018.
  7. The social worker maintained contact with the care home to check on Mrs Y’s progress.
  8. The social worker telephoned Mrs X on 17 May 2018 to arrange to meet and complete an assessment of Mrs Ys’ long-term needs on 5 June 2018.
  9. On 31 May 2018, Mrs X telephoned the social worker to say Mrs Y had been re-admitted to hospital on 28 May 2018 after a fall at the care home. She had broken her hip. The assessment planned for 17 May 2018 was cancelled.
  10. The social worker spoke with Mrs X and the hospital on 1 June 2018 for an update on Mr Ys’ progress. She contacted the hospital again on 5 June 2018 and was told Mrs Y would be ready for discharge later that week
  11. After discussion with the hospital, and the care home Mrs Y had previously stayed, the care home agreed to visit Mrs Y in hospital and assess if it could meet her needs. After doing so on 7 June 2018, it agreed Mrs Y could return to the care home. The social worker telephoned Mrs X to update her. The social worker requested, and received authorisation to extend Mrs Y’s short stay for a further two weeks.
  12. Mrs Y was discharged from hospital back to the care home on 8 June 2018.
  13. The social worker contacted Mrs X and arranged to meet her at the care home on 19 June 2018 to complete an assessment of Mrs Y. I have seen the notes of this meeting. Mrs X told the social worker she and Mr X were unable to provide the care Mrs Y needed. The social worker agreed to submit a request to the Council’s finding panel for a permanent placement.
  14. Mr and Mrs X completed an online financial assessment on 9 July 2018, which calculated Mrs Y needed to make a weekly contribution £132.35 for respite care services.
  15. The Council’s funding panel agreed the placement on 10 July 2018. The social worker informed Mr & Mrs X.
  16. The Council’s financial assessment team reviewed the information submitted online by Mr & Mrs X. It discovered an error by them. After correction and recalculation, the outcome concluded Mrs Y needed to contribute £138.10 per week towards her all her care. The Council informed Mr & Mrs X in writing on 15 August.
  17. The Council’s records show grab rails were ordered 14 February 2018 and that they were fitted by 16 May 2018.

Analysis

  1. When someone has been in hospital, or had an illness they may be entitled to free reablement care for up to six weeks. There is no automatic entitlement to this service, it depends on individual circumstances.
  2. Mr X believes Mrs Y was entitled to reablement for the first six weeks after her discharge from hospital. He refers to the Council’s information sheet to support this. Having reviewed the Council’s information sheet, it says people ‘may’ be entitled. It does not say all people in these circumstances receive this service.
  3. There is no evidence to show the Council told Mr & Mrs X at any time that Mrs Y would receive reablement / rehabilitation support. Mrs Y was not eligible for this type of support due to her cognitive impairment and mobility issues. This decision was made by a health professional and communicated to the social worker on 4 May 2018, before the social worker met with Mr & Mrs X. The records I have seen refer consistently to a ‘short stay’.
  4. Mrs Y had a short stay in care home to allow time for decisions to be made about her future. Short stays are different to reablement care. People in a short stay placements receive only residential care. This can allow them time to recuperate and/or time to allow longer term decisions to be made. This does not qualify for free care. This was the care Mrs Y received.
  5. People receiving reablement care have a specific agreed care plan before discharge from hospital, and receive intensive input from physiotherapy/and/or occupational during their residential stay. This type of care can be free for up to six weeks. Mrs Y did not receive this type of care.
  6. Having reviewed the Council’s records on this case. The contemporaneous notes detail the conversation the social worker had with Mr & Mrs X on 4 May 2018 This makes clear that Mrs Y would have a short stay in care home and would be financially assessed, and depending on the outcome, she would have to pay towards her care.

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Final decision

  1. There is no evidence of fault by the Council in this complaint.
  2. It is on this basis; the complaint will be closed.

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Investigator's decision on behalf of the Ombudsman

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