Summary: Mr C complained to us about the way in which the Council dealt with his uncle’s contribution to this homecare support. The Ombudsman found fault with the actions of the Council. It failed to provide enough information about charging, before the care package started, and failed to properly deal with questions Mr C raised about this, as well as his complaint. The Council has agreed to apologise and remind its staff about the importance of providing comprehensive information about charging and properly recording discussions about this.

The complaint

1. The complainant, whom I shall call Mr C, complained to us on behalf of his uncle, whom I shall call Mr U. Mr C complains about the way in which the Council dealt with the contribution Mr U has had to pay for his homecare support. He said:
• The Council failed to provide timely and accurate information (verbally and in writing) about the contribution they were expecting Mr U to pay towards his homecare.
• The Council charged Mr U for the care he received at home, even though he should have received free reablement / intermediate care.
• When the family challenged the contribution, the Council took a long time to deal with the complaint. However, it kept on sending invoice reminders (and ‘threats’ of actions) in the interim and the Council failed to respond to his comments.

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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. We cannot question whether a council’s decision is right or wrong simply because the complainant disagrees with it. We must consider whether there was fault in the way the decision was reached. (Local Government Act 1974, section 34(3), as amended)
4. 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

5. I considered the information I received from Mr U and the Council. I also contacted the care agency that was involved at the time. I shared a copy of my draft decision statement with Mr C and the Council and considered any comments I received, before I made my final decision.

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What I found

Relevant law and guidance

Intermediate Care

6. The Care and Support Act Guidance says:
• There are four types of intermediate care, including “home-based intermediate care” (provided to a person in their own home by a team with different specialities but mainly health professionals such as nurses and therapists) and “reablement” (services to help people live independently that are provided in the person’s own home by a team of mainly care and support professionals).
• Intermediate care and reablement must be provided free of charge for up to 6 weeks.
7. Guidance from the National Institute for Health and Care Excellence (NICE) says that:
• People should be assessed for intermediate care if it is likely that specific support and rehabilitation would result in faster recovery and improve their ability to live independently.
• One should not exclude people from intermediate care, based only on whether they have a particular condition such as dementia.
• Reablement should be offered if a person can be supported to recover or re-learn specific skills that they may have lost, to maximise their independence. It is a program of specific support, identifying specific goals (i.e. teach how to do specific tasks independently again) and how to achieve them.
• Intermediate care differs from a normal package of care support, because the client will need and receive intensive support usually provided by a mix of health and social care professionals with a range of different skills, such as OTs, Physiotherapists, Speech and Language Therapists etc.

Charging

8. The Care and Support Act Guidance says that:
• Financial information and advice are fundamental to enable people to make well-informed choices about how they pay for their care. It is integral to a person’s consideration of how best to meet care and support needs, immediately or in the future.
• A council should be clear and transparent, so people know what they will be charged. The Council should provide enough information and advice, at the right time, to ensure that a client can understand any contributions they may, or will be, asked to make so they can make an informed decision.
• A council should normally complete a financial assessment once it has decided a person’s needs are eligible for council support or involvement, and before creating a personal budget and care and support plan.
9. The Care Act 2014 and its Statutory Guidance say that a Council should complete a financial assessment before arranging care services. It also indicates that, in cases when this is not possible, for instance in an emergency, a council should give the client a reasonable estimate of likely charges before they have to decide what support they want the Council to arrange. Furthermore, the Council is still required to complete the formal financial assessment as quickly as possible after that.

Reablement, and the way the Council dealt with charging

10. Mr U had been in hospital following a fall. Mr C says that:
• His uncle was very ill on discharge. He needed more care than his wife could provide and was in no position to do anything himself.
• His cousin is adamant that, when she called the hospital, the hospital staff told her that the first six weeks of support after discharge would be free. The Council never told the family otherwise.
• Before Mr U was discharged, Mrs U declined the offer for Mr U to receive support at home.
11. The Council told me the hospital did not notify the Council of Mr U’s discharge from hospital. As such, it was not involved in his discharge.
12. It soon became clear that Mrs U could not cope with the support her husband needed. Mrs U’s GP contacted the Council and the short term / recovery hospital avoidance team attended on 15 June 2018.
13. The Council says it immediately deployed its Hilton Nursing Team, which is a five-day free of charge short term / recovery hospital avoidance service, which was subject to a review on day three.
14. The Council carried out a care needs assessment on 17 June 2018. The record states that Mrs U had always been her husband’s carer and found it very difficult to accept support. Mr U needed a lot of prompting to complete his personal care and was able to mobilise with a Zimmer frame and use the stairs. The social worker concluded that Mr U would need a 30 minutes visit in the morning and evening, every day. However, Mrs U only accepted the morning visit.
15. The Council says:
• The assessment showed that Mr U needed ongoing care and support, which started on 21 June 2018.
• Hilton colleagues and the social worker recommended that Mr U needed ongoing care and support. The records show that reablement support was not suitable for him:
1. Mr U was formally diagnosed with Dementia in 2015. His Dementia made him more forgetful and confused. He also had Narcolepsy. When combined with his age and Dementia, this caused a persistently tired state of mind, which in turn propagated his symptoms of confusion. Mr U’s daughter said her father was “less responsive by the day” and experienced consistent confusion and disorientation. This meant Mr U would likely forget any specific advice and skills that support workers would try and teach him on how to independently complete specific tasks.
2. Mr U showed he was unable to complete any daily living tasks without support and constant prompting. Mr U also lacked physical strength to take part in practising physical tasks with staff. He was described by the Respiratory Support and Sleep Centre in May 2018 as frail spending most of the day sleeping.
3. The hospital did not make a referral for community therapy support, when Mr U went home. The social worker’s decision that he needed a standard support package was based on his presentation.
16. Mr C says the note by the Respiratory Support and Sleep Centre in May 2018 is misleading. He often did not sleep well at night so caught up with naps during the day. Mr U was alert for extended periods once he received his medication (four times a day). He also says the social worker should have discussed reablement with the family on 17 June 2018. He believes that, with targeted help, Mr U could have regained his strength and awareness. Furthermore, Mr U still had capacity at the time to make decisions.
17. The Council says the social worker discussed finances and the need for a financial assessment with Mr U’s daughter. However, the social worker failed to make a not in the records of what she discussed. The social worker later declared that: “At the time of my visit we did discuss finance and I informed them they would be contacted about the financial assessment. The daughter who was visiting from abroad, informed me she did not know about her parents’ finances and that her cousin would be more likely to know more. I informed her that all information needed re finance would be dealt with by the finance team”. As Mr U’s family still assumed the first six weeks would be free, the family believed the financial assessment would be to assess what Mr U may have to pay for the support he would receive thereafter.
18. Mr C says the Council should have drawn up a written document, to be signed by both parties, that included relevant information about what support would be provided and what charging would apply. He says that, this way, the family would have been aware there could be a charge.
19. After Mr U’s needs assessment, the Council sent a copy to the care agency. The form said the support was not ‘in lieu of reablement service’. This told the care agency the support was not reablement support.
20. Mr C says that Mrs U had a meeting subsequently with two staff members of the care agency that would provide Mr U’s support. A note she made of that meeting said: “six weeks free…21 June .. 2 August”. I have contacted the care agency to ask about this. The agency has told me the package was to be a normal open-ended support package; it was not meant to be a reablement package. The provider also said it is against company policy for care workers to discuss financial matters with clients.
21. Mr U’s condition deteriorated, and he went into a care home in mid-July 2018.
22. It took two months before the Council completed the Financial Assessment. It concluded that Mr U’s capital was above £23,250 and he would therefore have to pay for the total cost of his care (£153). The Council has told me it does not know why it took two months to complete the assessment but is sorry for this delay.
23. Mr C said his aunt first became aware the first weeks would not be free, when she received the first invoice in August 2018.

Analysis:

24. There is no requirement for the Council to always have a discussion with a client / family about reablement. The Council was unaware at the time that the family had allegedly been told about reablement by the hospital. The Council concluded, following an assessment, that Mr C needed an ongoing care package. The Council has explained why it believes this was the correct conclusion. I have not seen evidence there was fault in the process through which the Council reached a conclusion about how Mr U needed to be supported. Therefore, without fault, I will not question the merits of the Council’s decision (see paragraph 3 above).
25. There is no requirement to draw up and sign an agreement / contract that sets out how a homecare support package will be paid for, before it starts. However, the Council is required to explain the charging process in a clear manner and give the client a reasonable estimate of likely charges. The Council told Mr U and his family that there would be a financial assessment to determine how much he would have to contribute towards his support. However, it failed to ensure there was a proper record of what it explained. This is fault. As a result, there is insufficient evidence to enable me to conclude the Council provided enough information about charging, including a reasonable estimate of likely charges.
26. Under normal circumstances, it should have been clear that any assessed charge would start on day one. I have no reason to believe that, if the Council had known that the family believed that the first six weeks would be free, the Council would have specified at the meeting that the charge would start on day one.
27. Furthermore, on the balance of probabilities, the family would still have chosen to go ahead with the support, if they had known there would be a charge from day one.

The way the Council dealt with Mr C’s complaint

28. Mr C says he started to challenge Mr U’s contribution from September 2018 onwards, by sending emails to the Council. The Council told him it would refer his email to the Adult Social Care department to confirm if the period was chargeable.
29. The Council contacted the social worker the same day, who confirmed she had told the family that there would be a charge for the support. I have not seen evidence that the Council’s Customer Services team fed back this information to Mr C. It took until 11 October (five weeks) before it contacted the social worker again to ask if this information could be disclosed to Mr C. It was confirmed shortly after that it could.
30. Mr C said that, instead of providing a response, the Council continued to send invoice and payment reminders to Mrs U. According to the records, the Council had still not provided a response to Mr C by 29 November 2018, with regards to the above. However, it did send a letter that day to Mrs U, which said: “If you have a valid reason as to why payment has not been made, please contact us within seven days (…) to prevent further action being initiated in the recovery of this debt”.
31. In response, Mr C sent another email to the Council on 12 December 2018, asking it to write off the debt, explaining his reasons for this request, and to stop sending threatening letters to his aunt. Again, instead of providing a response to this, the Council sent another letter to his aunt in February 2019 to chase the outstanding amount.
32. As such, Mr C made a complaint to the Council in March 2019. The Council provided a response to this within three weeks, which said the care was chargeable.
33. Mr C says he was unhappy with the response and wrote an email to the Chief Executive on 30 April 2019. In the email, Mr C asked the Council to reconsider its decision and explained why he believed this should be the case. Mr C told me he did not chase a response to this email and believed it had been forwarded on for review, action and response. Mr C says he did not receive a response. However, the Council continued to send an invoice for the outstanding amount to his aunt, every month.
34. When the Council became aware in January 2020 that he had referred his complaint to the Ombudsman, the Council decided to stop sending further letters with regards to the outstanding amount, while awaiting the outcome of the investigation.

Analysis

35. The Council failed to respond to the emails Mr C sent in September and later on in December 2018. It also failed to answer the email he sent to the Chief Executive in April 2019, either by providing a response to the issues he raised or telling him the complaint process had come to a close and he should go to the Ombudsman if he remained unhappy. This caused Mr C distress and frustration. It also resulted in a delay in the issue being progressed, during which time his aunt continued to receive letters about the outstanding amount of £153.

Agreed action

36. I recommended that, within four weeks of my decision, the Council should:
• Apologise for the delays above and the distress it caused him and Mrs U. It should also pay Mr C and Mrs U each £100.
• Remind its adult social care staff of the importance to provide sufficient clear and comprehensive information about charging and the financial assessment before the care package starts, including a reasonable estimate of likely costs if a financial assessment has not taken place yet, and sufficiently record this conversation.
37. The Council has told me it has accepted my recommendations.

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Final decision

38. For reasons explained above, I found there was fault with the actions of the Council. I am satisfied with the actions the Council will carry out to remedy this and have therefore decided to complete my investigation and close the case

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Investigator's decision on behalf of the Ombudsman