Summary: Mrs X complains about the Council’s decision to charge Mrs Y for her care following discharge from hospital, which she believes should be free. Also, that it did not tell her a charge would apply. She says this caused Mrs Y a financial loss as she was still paying for her flat and the Council should waive the charge. The Ombudsman finds the Council was not at fault in the way it dealt with Mrs X.

The complaint

1. The complainants, whom I shall refer to as Mrs X, and her brother Mr Z, complain that the Council:
• charged their mother, Mrs Y, for care in an assessment unit which should be free.
• did not tell them that Mrs Y would have to pay for her stay.
2. Mrs X says she understood the NHS would pay for the assessment unit as it was a continuation of hospital care. She says Mrs Y also had to pay rent and utility bills and should not be expected to pay for two homes.

Back to top

The Ombudsman’s role and powers

3. We investigate complaints of injustice caused by ‘maladministration’ and ‘service failure’. I have used the word ‘fault’ to refer to these. 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)
5. We may investigate complaints made on behalf of someone else if they have given their consent. (Local Government Act 1974, section 26A(1), as amended). Mrs Y has given her consent for Mrs X to bring this complaint on her behalf.

Back to top

How I considered this complaint

6. I considered information from the Complainant and from the Council.
7. I sent both parties a copy of my draft decision for comment and took account of the comments I received in response.

Back to top

What I found

Background

Assessment

8. Sections 9 and 10 of the Care Act 2014 (the Act) require local authorities to carry out an assessment for any adult with an appearance of need for care and support. They must provide an assessment to all people regardless of their finances or whether the local authority thinks an individual has eligible needs. The assessment must be of the adult’s needs and how they impact on their wellbeing and the results they want to achieve. It must also involve the individual and where suitable their carer or any other person they might want involved.

Charging for residential care

9. The charging rules for residential care are set out in the “Care and Support (Charging and Assessment of Resources) Regulations 2014”, and the “Care and Support Statutory Guidance 2014”. When the Council arranges a care home placement, it has to follow these rules when undertaking a financial assessment to decide how much a person has to pay towards the costs of their residential care.
10. The rules state that people who have over the upper capital limit are expected to pay for the full cost of their residential care home fees. However, once their capital has reduced to less than the upper capital limit, they only have to pay an assessed contribution towards their fees.
11. The council must assess the means of people who have less than the upper capital limit, to decide how much they can contribute towards the cost of the care home fees.

What happened

12. Mrs Y had health conditions which caused her difficulty with mobility and understanding. In September 2019, Mrs Y was admitted to hospital following a fall. Mrs Y was found to have no potential for reablement or rehabilitation and was not eligible for nursing care or continuing health care which is paid for by the NHS. Mrs X believed Mrs Y was discharged before she was medically fit.
13. In early October 2019, Mrs X and her husband, Mr X, attended a discharge planning meeting for Mrs Y. The Council gave Mrs X a pack which included information about charging and a financial assessment form. Mrs X completed the form for Mrs Y, and signed the agreement to pay the contribution of £199.77, the same day. Mrs Y was discharged into an “access to home” bed. This is a short term arrangement to allow for a thorough assessment of a person’s long term needs. It saves the person staying in hospital unnecessarily at risk, while the Council completes an assessment. For someone with health conditions like Mrs Y, the hospital environment can be disorientating and frightening.
14. The Council calculated the charge from the information Mrs X provided and allowed for costs relating to Mrs Y’s home including rent and council tax. Mrs X thought the charge would only apply if Mrs Y had to stay in residential care permanently. Mr and Mrs X both said the social worker took them to a small cupboard like room to sign the form and they felt pressured. The Council says the discharge meeting, where it discussed charges with Mrs X, was held in a meeting room able to hold at least 15 people comfortably.
15. Mrs X withheld payment of invoices covering the time when Mrs Y was in the care home for assessment, because she believed Mrs Y should not pay for this. Mrs X confirms the Council did not tell her the care would be free.

Was there fault which caused injustice?

16. If Mrs X had concerns that Mrs Y was discharged before she was medically fit for discharge, this would be a complaint for the NHS to consider. Having discussed this with Mrs X, I believe her complaint arose from a misunderstanding about the purpose of Mrs Y’s move to the assessment unit. It was not for a continuation of NHS care as she believed. The Council understood Mrs Y to be fit for discharge. It arranged a suitable placement so it could assess Mrs Y’s needs and decide where her needs would best be met in the longer term.
17. Mrs Y was not eligible for NHS funding for her care after discharge. The Council was responsible for her care and it was right to charge. She did not have to pay for two homes as the Council reduced her contribution to her care by the amount of costs she still had to pay for her previous home. I found no fault here.
18. The Council gave Mrs X the information she needed, and she signed the form agreeing to the charge. Mrs X does not complain the placement was unsuitable. Had the Council had given Mrs X longer to consider the information, it is almost certain Mrs Y would still have gone to a care home and had to pay a contribution.
19. The Council was not at fault.

Back to top

Final decision

20. I have completed my investigation and do not uphold Mrs X’s complaints that the Council:
• charged her mother, Mrs Y, for care in an assessment unit which should be free.
• did not tell her that Mrs Y would have to pay for her stay.
21. As I have not identified any fault or injustice, I have not made recommendations.

Back to top

Investigator's decision on behalf of the Ombudsman