Summary: Mr and Mrs C complaint the Council failed to tell them there would be a charge for the homecare Mrs M would receive. The Ombudsman found that, while there was some fault in the actions of the Council, it did tell Mr C there would be a charge. The Council has already taken appropriate action to address any faults and remedy any injustice.

The complaint

1. The complainants, whom I shall call Mr and Mrs C, complain on behalf of Mrs C’s mother, whom I shall call Mrs M. Mrs M complains the Council failed to properly explain there would be a charge for her home care. If the Council had told them, they would not have gone ahead with the chargeable service.

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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, section 30(1B) and 34H(i), as amended)

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How I considered this complaint

4. I considered the information I received from the complainants and the Council. I shared a copy of my draft decision statement with the complainants and the Council and considered any comments I received, before I made my final decision.

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What I found

What happened

5. According to the Council’s records, Mrs M was independent and managed well before she went into hospital. Mrs M ended in hospital following pneumonia. She returned home with reablement care. Mr C told me that, before the care support started, he was advised there could be a charge. Mr C said:
• He had made it clear to the Council, that: if there would be a charge, they would not want to use the carers, because they would be able to manage without them.
• It was only when he received an invoice from the Council on 14 September 2018 (£1,142.46 for six weeks’ care from 27 February 2018 to 5 April 2018), that he found out there had been a charge.
6. An NHS Occupational Therapist (OT) considers in hospital if there are any reablement goals for a patient, which could be addressed through a short-term intervention of up to six weeks. If so, the OT will tell the hospital social work team. The OT will point out the need for reablement in the hospital discharge notes. Reablement support is free of charge and will be provided for as long as needed, up to a maximum of six weeks.
7. The Council says that, once an OT has recommended reablement support, a social worker will explain the “Charges for Reablement Service Agreement” to the client. The social worker will check they understand it and will then ask them to sign their consent to the Agreement. The form says, among others, that:
• The support you receive will be free for up to six weeks. This is the maximum period and your actual stay may be much shorter as it will be dependent upon your progress towards planned goals.
• Following the free period there may be a customer charge for any further social care support/service that you receive. To work out whether you need to pay anything towards the cost of any support/service you receive after the free period, we will need to assess your financial circumstances during your stay.
• A Welfare Benefit Advisor will visit you and calculate your contribution.
• I understand that any reablement service I receive is free of charge for up to a maximum of 6 weeks.
• If I continue to receive any support/service after this free period, I understand that this will be chargeable and the actual contribution payable by me is subject to a financial assessment.
8. Mrs C signed this form on her mother’s behalf on 15 February 2018. Therefore, by signing the form she said she understood the information provided.
9. The Council has said it also provided information about reablement support, by providing a pack of leaflets to the family, while Mrs M was in hospital in anticipation of her discharge. It included information about:
• The Council’s approach to non-residential care services such as home care and/or reablement services (information booklet ‘Your Life, Your Choice’).
• The leaflet “Choosing and paying for non-residential care”. Nothing about reablement.
• A practice guidance on the Regaining Independence Service (Community Reablement Service).
• The ‘Supporting you to manage at home again’ leaflet, which sets out the Council’s approach to supporting people at home through community-based reablement.
10. I have not seen evidence in the records the social worker explained things to Mr and Mrs C (as suggested in paragraph 7), or the social worker provided any leaflets to them in hospital (as suggested in paragraph 9). The Council has told me that staff does often not record this. However, staff routinely provide these leaflets to customers and/or their representatives.
11. As such, the Council will include the following reminders in its next “Best Practice Groups’ Briefing”, which will be disseminated to all staff and practitioners:
• Always provide a printed copy to customers and their representatives of the ‘Your Life, Your Choice’ booklet.
• Show greater clarity in individual case records of which public information leaflets and booklets have been supplied in print format to the customer and /or representatives, and whether any particular discussion on aspects covered in those information leaflets and booklets has taken place. This is particularly relevant where a person – or their representative - is signing confirmation to agree to pay any assessed charges.
12. The Council has told me it will also review the “Community Reablement Service Agreement” to ensure it more clearly references, amongst others, to the ‘Supporting you to manage at home again’ leaflet.
13. The records state that:
• As of 19 February 2018, the plan was: CRS (Community Reablement Support) twice a day. Maximum end date 3 April.
• On 20 February, CRS advised that Mrs M would need to be re-referred for a long-term package of care as reablement wasn't appropriate. Mrs M has Alzheimer’s and finds it difficult to follow and remember routines or instructions. As such, the social worker agreed that Mrs M would not be suitable for enablement and would need on-going care instead. However, as the support package had already started, it would be up to the OT's to refer on for on-going support after completing their assessment.
14. An OT completed an assessment on 21 February 2018 at Mrs M’s home. Following the assessment, the OT concluded that Mrs M would not benefit from reablement but would need to have longer term help at home to sustain her independence. The OT noted that: ‘Mrs M needs to move on to a more settled care package as she needs stability. She has no memory to set goals - reablement is not the best service at this time.’ This meant the free-of-charge reablement service (provided by Essex Care) would transfer to another longer-term provider.
15. Mr and Mrs C were not present during this assessment. However, according to the records made at the time, the OT contacted Mr C by telephone afterwards. The OT recorded that they discussed the situation and Mr C agreed that reablement was not appropriate for his mother-in-law. ‘Talked about charging and explained that support is not for six weeks as Mr C said was stated in the hospital. Explained that goals need to be sent for reablement support and a free period of support. Mrs M has savings under £23,250 so explained that I will ask for ongoing support twice a day and will request for a WBA [Welfare Benefits Adviser] to check on what Mrs M will be charged. Agreed that I will complete the paperwork by Monday 26 February and Mrs M will be charged from this date.’
16. The OT had another conversation with Mr C on 27 February 2018. The OT ‘explained TOC (transfer of care arrangements at the end of a period of free-of-charge reablement) and charging for this that was effective from today…Agreed with family that TOC should be applied from today’.
17. Mr C confirmed to me that he had a conversation with the OT. However, Mr C said the OT did not tell him they would be charged from the date they said.
18. The Council posted the “Charging for Care” form to Mr C on 6 March 2018 to complete, as part of Mrs M’s financial assessment. The Council advised Mr C it would contact him once a long-term care provider had been found, but Essex Care would continue until an alternative provider was in place.
19. Mr C contacted the Council on 5 April 2018, which was six weeks after Mrs M left hospital. The records state that Mr C said he: ‘Would like to cancel CRS as he did not want to be charged in the interim whilst waiting for a new provider. Mr C said they could manage without support in the interim, as Mrs M was mostly independent with personal domestic activities of daily living.’ (…) Mr C wanted to find out how much Mrs M would need to financially contribute towards ongoing care and then as a family they would make the decision. Mr C said on 1 May that it would be more beneficial for them as a family to continue supporting Mrs M, rather than having care workers coming in.
20. The Council acknowledges that it took an unreasonable amount of time, before it could produce an invoice and tell Mr and Mrs C how much Mrs M would have to contribute towards the cost of her care. Mrs M only received her invoice of £1,142.46 on 14 September 2018. Mr C called the Council on 1 October 2018. The record states that he asked: Title: “Why have they been charged as they thought it was free.’
21. The Council says it has since improved its internal processes to ensure these delays no longer occur. In the Council’s complaint response letter to Mr C in November 2018, the Council accepted its failure to produce an invoice in a timely manner. Furthermore, it agreed to reduce the final invoice to £571.23, as “a gesture of goodwill, and in acknowledgement of the delay with the original invoice being issued”.

Assessment

22. When the support changed from reablement to a normal care package on 27 February 2018, Mr C was aware there could be a charge for Mrs M’s care support, going forward.
23. The Council has acknowledged it failed to record, that it provided information and leaflets to Mrs M and her family about the cost of care, while she was in hospital. This is fault. However, the Council is confident that this was provided in this case. Mr C told me that, before the care support started, he was advised there could be a charge. Furthermore, Mrs C read and signed the “Charges for Reablement Service Agreement”, which contain information about reablement and charging.
24. The Council’s records also state that Mr C agreed on 21 February 2018, that Mrs M would not benefit from further reablement support. The OT spoke to him about charging and agreed with the family on 27 February that the care package should transfer from reablement to a normal package.
25. The Council has acknowledged it subsequently took too long before it could tell Mr C what the charge would be. It has apologised for this and offered to reduce the outstanding invoice by half.
26. The Council has also set out the actions it will undertake to ensure that lessons learned will be used to improve its practice

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Final decision

27. For reasons explained above, I found that while there was fault by the Council, it has already identified appropriate action to remedy this.
28. I am satisfied with the actions the Council has carried out in response to the faults, and have therefore decided to complete my investigation and close the case.

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Investigator's decision on behalf of the Ombudsman