Summary: Mrs J, Mrs K and Ms L complain the Council wrongly charged their mother, Mrs M fees for short stay in a care home. The Ombudsman has found no evidence of fault in the way the Council considered these matters and has completed his investigation.

The complaint

1. The complainants whom I shall refer to as Mrs J, Mrs K and Ms L complain on behalf of their mother Mrs M about the Council’s charges for Mrs M’s stay in a care home. Mrs K is the lead representative and complains:
• There was poor communication around Mrs M’s move to a care home on her discharge from hospital, so it was unclear about what the various assessments meant. And what the involvement of the Council’s Intermediate Care Service was.
• The Council failed to explain there would be charges for Mrs M to stay at the care home. Mrs K said they were told Mrs M could stay there free of charge for a six-week trial period.
• Mrs K disagrees with the Council’s view the family transferred Mrs M to the care home themselves.
• The Council delayed carrying out a Financial Assessment until Mrs M passed away and did not tell the family it was being carried out. So, it caused distress to the family to receive an invoice for her care home fees. Mrs K considers the Financial Assessment incorrect and Mrs M should not have to pay as she had limited funds.
• Mrs M should have been receiving Continuing Health Care (CHC) Funding because of her ill health. Mrs K says Mrs M was being considered for CHC Funding when she passed away. Mrs K considers it likely Mrs M would have qualified for funding from the NHS and had her care home fees paid anyway.

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The Ombudsman’s role and powers

2. We may investigate a complaint on behalf of someone who has died or who cannot authorise someone to act for them. The complaint may be made by:

• their personal representative (if they have one), or
• someone we consider to be suitable.

(Local Government Act 1974, section 26A(2), 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 read the papers submitted by Mrs J, Mrs K and Ms L. I considered the Council’s comments on the complaint and the supporting documents it provided. I have explained my draft decision to Mrs J, Mrs K and Ms L and the Council and invited comments.

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What I found

The Council’s Intermediate Care Plus service

5. The Council’s Intermediate Care Plus service (IC+) is an integrated health and social care service that provides short term support to patients to prevent hospital admissions and to help people leave hospital. It can provide services in the person’s home or in a specified care home for a short stay. The IC+ service has a team of social care, therapy and nursing staff, and staff with mental health and pharmacy skills staff.
6. The Council’s web site document on Adult Care and Support explains a resident needs to be referred to the service by their doctor, a social worker or other professional. They then have an assessment to see if the service is suitable for them.
7. The document explains care and support is not free to everyone at the point of delivery. Many people have to pay for their own care and support. If a person has eligible needs for care and support arranged by the Council, they can apply for financial help. The Council carries out a Financial Assessment to work how much the person can afford to pay towards the cost of the care and support.
8. The document says if a person goes into residential care and cannot fund their own care then they will need an assessment by a social worker.

Events leading to the complaint

9. Mrs M lived on her own in a property. She had three daughters Mrs J, Mrs K and Ms L who provided support when needed. Mrs M was diagnosed with medical conditions needing hospital treatment. Following treatment Mrs M received care services at home from the Council’s IC+ service on several separate occasion after each hospital discharge from 2017 onwards. Each period of rehabilitation provided by the IC+ service lasting up to a maximum of 6 weeks, to support her living at home.
10. Mrs M went into hospital for treatment in April 2018. The Council’s IC+ service received a referral for a needs assessment to facilitate Mrs M’s discharge from hospital. An IC+ social worker competed the assessment with Mrs M and Mrs J the same day. They planned for Mrs M to return home with the IC+ service providing a short-term package of care to support her recovery and independence.
11. Mrs M returned home but quickly became unwell again so was readmitted to hospital. The IC+ social worker advised Mrs J the hospital would refer Mrs M again for another needs assessment. Mrs J discussed with the social worker the possibility of Mrs M moving temporarily into a care home after discharge from hospital. The social worker advised Mrs J of the procedure for securing a temporary care placement and answered Mrs J’s queries about CHC Funding. CHC funding is provided by the NHS to people with long term complex health needs who qualify for free social care. It can be provided for a stay in a care home.
12. The Council apologised to Mrs J if the IC+ social worker did not clearly explain the IC+ service to her and her role in Mrs M’s case. The Council said it would address this through its supervision procedure.
13. The IC+ service received a referral to complete a needs assessment on Mrs M to help her discharge from hospital on 14 May 2018. The social worker contacted the hospital staff who advised Mrs M was not well enough to be discharged. The hospital staff said they would contact the social worker once Mrs M’s situation changed.
14. The IC+ service was told on 25 May 2018 by hospital staff Mrs M had been moved to a care home.
15. The Council says hospital staff discharged Mrs M to the care home before the social worker could carry out a needs assessment. The social worker did not have the opportunity to discuss with Mrs M and her daughters about any issues with the placement or the associated contribution Mrs M would have to make. The Council says it could not do a full needs assessment on Mrs M as she had already moved to the care home
16. The Council says Mrs M’s move occurred outside of the Council’s service procedures and contract with the care home. So, it considered it a private arrangement and Mrs M would be funding the placement. The social worker noted hospital staff advised her Mrs J and the matron arranged the move to the care home.
17. The social worker spoke to Mrs J on 29 May 2018 to ask if Mrs M was self-funding her placement in the care home. Council documents record Mrs J said Mrs M was receiving CHC Funding. The social worker noted hospital staff left Mrs J with this impression about CHC Funding and that Mrs M need not contribute to her care home fees. The Council says the IC+ service did not provide Mrs J with the information she had about assessments and impression about fees.
18. The social worker explained to Mrs J that Mrs M did not have CHC Funding as she had contacted the CHC team to check this. The team advised Mrs M was not receiving CHC Funding as the checklist supplied by the hospital for Mrs M had not triggered a Decision Support Tool meeting (DST). The DST is a health led assessment process that decides if a patient is eligible for CHC Funding.
19. Once the social worker was aware of the placement and found out it was not CHC funded she took necessary steps to have the placement approved. This allowed Mrs M to access the Council’s contract with the care home and agreement for the Council to contribute to funding the placement. The Council says the social worker sought management approval for the temporary placement and agreement to backdate it to the date of admission on 26 May 2018.
20. Health services carried out a further CHC checklist on Mrs M and sent it to the CHC team on 5 June 2018. The checklist did meet the criteria for a DST meeting.
21. The Council says Mrs M was receiving a chargeable service at the care home, so the social worker completed the documentation needed to request a Financial Assessment. The Finance team received this on 4 June 2018. Mrs M was readmitted to hospital on 26 June 2018 and permanently discharged from the care home. A DST meeting could not be arranged before Mrs M was readmitted to hospital and before she sadly passed away on 17 July 2018.
22. The Council says it has no records of either Mrs J or Mrs K being given information about Mrs M staying at the care home for a six-week free trial period. It says the social worker would not advise this as the Council does not offer such a service. It can offer to support rehabilitation with health services from one day to a maximum of 6 weeks. Although this can include residential provision the Council says Mrs M was not eligible for such a service due to her long-term needs. Mrs M’s placement was not being provided as an IC+ placement so it was a chargeable service.
23. The Finance team carried out a ‘light touch’ financial assessment as it was done retrospectively after Mrs M passed away. This involved contact with the Department of Works and Pensions to gain information to compete the assessment and calculate the service users’ contribution. The relevant regulations allow the Council to carry out such an assessment. The Council’s documents show it calculated Mrs M’s contributions based on her income and benefits.
24. The Council sent an invoice to Ms L for Mrs M’s contribution towards her care home fees of £1,128. The Council later adjusted this to £889.40 as a goodwill gesture to reflect the date of Mrs M’s permanent discharge from the care home rather than the date she passed away.
25. The Council accepts there was no record of any discussion with Mrs J or other family members about the financial assessment. Nor the contribution Mrs M would need to make towards her care home fees by the IC+ social worker on 29 May 2018. However, the services Mrs M received from the Council while at the care home were chargeable. The Council says it must be consistent when applying its charging policy and so it has correctly charged Mrs M for the services provided. Because of this the Council cannot waive the fees.

My assessment

26. The Council has apologised to Mrs J if the social worker did not clearly explain the role of the IC+ service in Mrs M’s care. However, the documents show Mrs M was previously receiving services from the IC+ team so I consider the family were aware of the service. The records show the social worker explained to Mrs J the process for moving Mrs M to a care home and answered queries about CHC Funding. So, it is clear Mrs J had discussions about the procedures involved about Mrs M’s care with the IC+ service. Because of this I do not consider there are any grounds to warrant the Ombudsman pursuing this issue any further.
27. Records show the social worker was waiting to hear from hospital staff when Mrs M was fit to be discharged. The notes show the Council was only made aware she had been discharged when notified she had moved into the care home. Although Mrs K disputes it was not the case the documents record that it was arranged by the hospital and Mrs J.
28. While there appears to have been a misunderstanding by the family about arrangements made for Mrs M’s move to the care home, I cannot say it was due to any fault by the Council. This is because the social worker could not carry out a needs assessment of Mrs M. And so, had no opportunity to explain the placement and any associated costs to the family before Mrs M’s move. The documents I have seen show the Council was unaware of Mrs M’s move to the care home and so, did not arrange the placement.
29. Once the Council became aware of the placement it agreed to approve it and take it over. The Council was under no obligation to do so at this point. However, this was subject to a Financial Assessment to calculate Mrs M’s contribution.
30. The Council acknowledges it has no record of the social worker discussing on 29 May 2018 the Financial Assessment and contribution Mrs M would need to make once it took over the placement. This is unfortunate but I do not consider it has caused a significant injustice to Mrs M’s family. Once Mrs X moved into the care home without a care needs assessment from the Council, she was in private arrangement with the care home and receiving a chargeable service. If the Council had not agreed to take over the placement Mrs M may have remained as self-funding for some time and be liable for the whole cost of her stay.
31. The Council has apologised for the fact that the family were not informed of the likely costs for Mrs M in May 2018 once it had agreed to the placement. It has also reduced the amount as a gesture of goodwill. I consider this suitable action for the Council to take. I do not consider I can achieve anything further for Mrs M’s family. This is because Mrs M was receiving a chargeable service from the Council and this was subject to a Financial Assessment to decide her contribution.
32. The Council has explained Mrs M was the registered contact for the Financial Assessment and therefore it did not contact any of the named family members about it. I consider it would have been good practice for the Council to have told the family at some point so they were aware there may be some charges likely. However, I consider the Council’s apology and reduction in fees suitable action for it to take.
33. The relevant regulations allow the Council to carry out a light touch financial assessment retrospectively after Mrs M passed away. The Council sent Mrs J a copy of the assessment to show how it was calculated. The Council has calculated Mrs M’s contribution based on her income and benefits as required by the regulations. Because of this there is no evidence of fault in the way the Council has calculated Mrs M’s contribution.
34. Mrs M’s entitlement to CHC Funding is determined by health services and the local CCG. So, this is an issue Mrs K will need to pursue with her relevant authority. It was also open to Mrs M and her family to appeal against the decision not to award CHC Funding and apply retrospectively for the funding.

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Decision

35. I have completed my investigation. I have found no evidence of fault by the Council in the way it dealt with charges for Mrs M’s stay in a care home.

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Investigator's decision on behalf of the Ombudsman