Summary: Miss J complained the Council should not have charged a contribution for her stay in a care home. The Ombudsman has not found fault by the Council.

The complaint

1. The complainant whom I shall refer to as Miss J, complains that the Council unfairly charged her £629 for a stay in a care home following her discharge from hospital. She says she believed there would be no charge as it was a reablement placement and she was told her capital was below the threshold.

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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 have discussed the complaint with the complainant and considered the complaint and the copy correspondence provided by the complainant. I have made enquiries of the Council and considered the comments and documents it provided. I have also invited the complaint to comment on my draft decision.

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What I found

Intermediate Care and Reablement

5. Intermediate care and reablement support services are for people 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. Regulations say local authorities must not charge for the first six weeks of intermediate care or reablement services. They may make a 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).
6. Miss J was due to be discharged from hospital in March 2018 after a fall led to a hip fracture. However, as she is an amputee and wore a prosthetic leg, she could not return home immediately.
7. The Council’s assessment reablement team carried out an initial assessment of Miss J’s needs. It noted that Miss J did not feel she would manage at home as she was only able to pivot transfer when moving from one point to another. The Council assessed that Miss J required assistance with all transfers and to mobilise until her hip had healed. The Council’s assessment form stated Miss J’s rehabilitation goals or therapy needs were “patient aware of exercises and completed these. Awaiting short stay chargeable bed. Community therapy on discharge.”
8. The Council also noted under additional notes “Miss J agrees that she would not be able to manage at home and has agreed for a short stay chargeable bed until she is back to her base line using her prosthetic leg”. Miss J signed the assessment agreeing the details in the assessment form were true and accurate.
9. The Council’s social worker also completed a Care Act assessment of Miss J’s needs before she was discharged. Before carrying out the assessment, the Council’s case notes on its system show the social worker questioned why the assessment reablement team had not suggested a reablement placement. She contacted the therapy team and it advised “rehabilitation not possible as client has met potential to progress at this time, while she is unable to wear her prosthetic leg due to swelling.”
10. The social worker also noted Miss J “is willing to contribute towards short stay fees- signature obtained, client states not self funding and does not have savings near thresh[hold] so would need financial assessment.”
11. The Council identified Miss J had a number of needs including, maintaining nutrition, maintaining personal hygiene, managing toileting needs and being appropriately clothed. The Council’s assessment form stated in general notes that the person requiring care may need to make a contribution towards the cost of their care and support depending on the support received and their financial circumstances. Miss J signed the form confirming it was a true and accurate statement.
12. Miss J’s care and support plan stated the agreed outcome of the plan was “24 hour residential care short stay care until clients hip heals”. The Council also referred Miss J to community physiotherapy by the health service.
13. The Council agreed a personal budget of £496 per week. The personal budget is the amount of money allocated to meet the needs identified in the assessment and recorded in the plan. The Council must carry out a financial assessment to work out the amount that a person must contribute towards their care.
14. Miss J says before she was discharged the care home manager visited her and told her that there would be no charge for the short stay in the home because her capital was below the limit. Miss J also says that she told the manager that if here was a charge, she would not go into the care home.
15. Miss J stayed in the short stay care home for 31 days. She says she did not receive any physiotherapy, as the Council’s assessment stated she would. She also says she was not satisfied with the home itself.
16. The Council attempted to carry out a financial assessment of Miss J while she was in the short stay home to assess her financial contribution. It wrote on 5 April 2019 making an appointment to visit her in the home on 19 April. However, Miss J had already left the home by the time of the visit.
17. The Council attempted to visit Miss J at home. It eventually did so on 2 May 2018. The Council then sent a financial assessment letter on 17 May 2018 confirming that Miss J’s contribution was £142 per week for her care while she was in the short stay home. The Council sent Miss J an invoice for £629. Miss J says she received an invoice for a lower amount, but the Council denied sending a different invoice.
18. Miss J complained to the Council disputing the invoice as she thought there was no charge based on the care home manager’s response. In addition, she thought that as it was reablement should be no charge. She said she did not receive physiotherapy as the Council’s needs assessment stated.
19. The Council replied that it had advised her twice before her hospital discharge that he short stay home was chargeable. The first was when the assessment reablement team carried out its assessment and the second was when the social worker carried out a Care Act assessment. She advised Miss J that the council would carry out a financial assessment. The Council said that Miss J confirmed to the social worker that she was willing to contribute to the short stay care home fees and said that did not have savings in excess of the capital threshold. The Council stated that the care home fees remained payable.
20. Mr J complained further. She repeated that the care home manager told her she would not have to make any payment. She said she did not have any clear memory of discussions about payments but was under the influence of strong medication including painkillers. She asked for a breakdown of the charges and repeated that she was dissatisfied with the home. She said she did not receive any physiotherapy and was in the care home longer than necessary.
21. The Council replied upholding its earlier response.
22. In its response to my enquiries the Council confirms that it considered a reablement placement, as its case notes show. However, after discussing the matter with the therapy staff it was felt inappropriate as Miss J had been received physiotherapy in the hospital and the therapists advised that she had reached her potential during this time.
23. The Council also responded regarding Miss J’s complaint that she received no physiotherapy at the home until the last day despite the Council agreeing that physiotherapy was agreed for her rehabilitation. The Council states that it referred Miss J for community therapy when she was discharged. Community Therapy services are provided by health services. As Community Therapy considered Miss J had reached her full potential at the time of discharge it deemed she was a low priority.

Analysis

24. Based on information I have seen, it appears that the Council advised Miss J that the short stay care home would be chargeable. It also advised that it would carry out a financial assessment. There was a short delay in carrying out financial assessment, but the Council had already notified Miss J that the service was chargeable and that a financial assessment would confirm the amounts due.
25. The Council has provided evidence that reablement care was considered but was not appropriate for Miss J. I have not found fault here.
26. The Council has not been able to provide the care home manager’s comments as she is no longer employed by the home. We do not have sufficient evidence of what was said. But in any case, I do not consider the Council is responsible for comments that may have been made by the home’s manager. In addition, as set out above, the Council’s evidence shows it advised Miss J twice that the short stay home was chargeable. I have not found fault here.
27. The Council has confirmed that it referred Miss J to community therapy. As this service is provided by the health service, it was for the health service to respond to Miss J’s concerns regarding the physiotherapy she received not the Council. I have not investigated this matter, as it is not within the Ombudsman’s jurisdiction.

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Final decision

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

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Investigator's decision on behalf of the Ombudsman