London Borough of Islington (19 018 941)

Category : Adult care services > Charging

Decision : Upheld

Decision date : 18 Feb 2021

The Ombudsman's final decision:

Summary: The Council acknowledges it failed to provide the proper information about charging when Mrs Y was admitted to a care home for a period of assessment. The Council agrees to waive the charges for the relevant six-week period.

The complaint

  1. Mrs X (as I shall call the complainant) complains the Council incorrectly charged her elderly mother (Mrs Y) when she was admitted to a care home for assessment. Mrs X says she was never told there would be a charge. She says the way her mother’s care was described by the Council fits the definition of intermediate care (for which no charge is made).

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The Ombudsman’s role and powers

  1. We investigate complaints about ‘maladministration’ and ‘service failure’. In this statement, I have used the word ‘fault’ to refer to these. 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

  1. I considered the information provided by the Council and the complainant. I spoke to Mrs X. Both the Council and Mrs X had an opportunity to comment on an earlier version of this statement and I considered their comments before I reached a final decision.

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What I found

Relevant law and guidance

  1. A temporary resident is someone admitted to a care or nursing home where the agreed plan is for it to last for a limited period, such as respite care, or there is doubt that permanent admission is required. The Care and Support (Charging and Assessment of Resources) Regulations 2014 and the Care and Support Statutory Guidance 2014 set out charging rules for temporary residential care. When the Council arranges a temporary care home placement, it has to follow these rules when undertaking a financial assessment to determine how much a person has to pay towards the costs of this stay.
  2. The guidance says (2.14) “Intermediate care’ services are provided to people, usually older people, after they have left hospital or when they are at risk of being sent to hospital. Intermediate care is a programme of care provided for a limited period of time to assist a person to maintain or regain the ability to live independently – as such they provide a link between places such as hospitals and people’s homes, and between different areas of the health and care and support system – community services, hospitals, GPs and care and support”.
  3. The Council’s “Charges for Care” brochure says

“Intermediate care: The aim of this service is to help someone to regain the ability to carry out everyday tasks of daily living that may have become lost during a period of ill health. Intermediate care may also be provided where a period of assessment is needed to establish someone’s longer-term needs.

Intermediate care may be provided in your own home, in a sheltered housing scheme or in a care home, with or without nursing care, for a maximum of six weeks.

There is no charge for intermediate care, although at the end of the period of intermediate care you may need to have other care services for which there is a charge.

Short Term placement: Short term care may be provided in extra-sheltered or supported housing schemes or in a care home, with or without nursing care.

• It includes all placements where a clear exit plan is in place for the service user to return home or be rehoused in more suitable accommodation.

• It includes unplanned events e.g. emergencies due to housing issues / safeguarding issues.

• It may be needed where an unpaid carer is unavailable for a period due to hospital admission for example.

• There is a financial charge for short term placements and you will have your assessed contribution worked out in the same way as anyone else that gets care in the community or in a care home.”

What happened

  1. Mrs Y was admitted to hospital after a stroke in April 2019.
  2. There was considerable discussion about Mrs Y’s long-term needs, between the social work team and her daughter Mrs X, and between the social work team and NHS professionals. Mrs Y was assessed as lacking capacity to make her own decisions about her care and Mrs X acted as her advocate.
  3. Mrs X first complained to the Council in May 2019 when she discovered a ‘desktop’ assessment of Mrs Y’s needs had been undertaken and a social worker had notified the hospital Mrs Y would be returning home. Mrs Y met the social worker who then said she believed a residential placement would be better. Mrs X says the social worker telephoned her on 3 June and said she thought residential care was appropriate and she would apply for funding.
  4. On 27 June the team leader emailed Mrs X about the next steps. She said the social worker was still compiling an assessment of need. She said “The allocated social worker will complete a Quality Assurance Form which will explain (Mrs Y’s) assessed needs and reason for the interim placement…. If the review of (Mrs Y)’s Needs is she requires a long-term placement, then at this stage; next of kin (if (Mrs Y) lacks capacity) will need to make the necessary arrangements of returning the flat to housing. If (Mrs Y’s)’s needs are reviewed as being able to be met at home with a package of care, then arrangements will be made for (Mrs Y) to return to her home address.”
  5. In July the social work team noted Mrs Y moved to a residential placement “on a short-term basis pending a six week review”. There was a delay in undertaking the assessment of Mrs Y’s needs which did not take place until September. The assessment concluded she required permanent residential care.
  6. On 11 September Mrs X received a letter from the Council requesting payment for her mother’s stay in the care home.

The complaint

  1. On 30 September Mrs X emailed the Council for clarification about the placement and charges. She said “When my mother was first admitted to (the care home), I was informed in an email ….that my mother was on an interim placement and would be assessed for 6 weeks to establish her longer-term needs. The Charges for Care homes brochure, indicates on page 11, that there is no charge for interim/intermediate care where people are being assessed. However, I received a letter from the Income Recovery team on 11th September requesting payment of a pending charge of £254.22 a week from 17th July 2019, subject to financial review.”
  2. The Council replied “There seems to be some misunderstanding in the wording “interim” with regards your mother’s placement. When someone is placed in a home it is for a period of 6 weeks pending a review to agree as to whether or not the placement would be made permanent. Service users still have to pay for this service pending a financial assessment. Usually benefits are not stopped during this period. As I explained above there was a mistake which has been passed to our finance team to rectify. This was not explained to you properly and should have and for this I apologise”.
  3. Mrs X requested a review of the response. The Council wrote to her again in January 2020. It said there was a clear difference between “intermediate care”, for which no charge was made, and interim/short-term care for which a charge was payable. It said “Your mother however was receiving a short-term placement in a care home pending a social care review to assess whether the care home placement would be permanent and not intermediate care”.
  4. Mrs X complained to the Ombudsman. She said the emails she had received from the Council in June 2019 met the Council’s own definition of intermediate care and therefore her mother should not be charged for the six-week placement while her needs were being assessed.
  5. The Council acknowledges there is no evidence to show it followed the correct procedure at the start of the placement, when it should have given proper information to Mrs X to explain the financial procedures. It says ‘When a care package is agreed the service user or next of kin should be provided with a financial circumstances form and information booklet from the care manager and sign a letter to advise they have received it. We have no evidence to show this was completed in this case’.
  6. The Council says it will waive the care charges for the six-week period from 17 July 2019.
  1. Mrs X says in addition to the problems she faced with the Council’s charging system, there was poor communication, she had to supply numerous copies of her power of attorney documents, and it was not until a local councillor became involved in her case that officers began to return her calls.

Analysis

  1. The Council acknowledges it failed to provide the proper information about the charges. That was fault, which caused injustice to Mrs X.
  2. The Council acknowledges there was poor communication between departments.
  3. The Council’s description of the purpose of Mrs Y’s placement in its emails to Mrs X fit its own description of intermediate care, not interim or short-term care.

Agreed action

  1. Within one month of my final decision the Council will write to Mrs X with an apology for its failure to provide proper information, and confirmation that it will waive the outstanding charges;
  2. Within three months of my final decision the Council will review the way in which it describes intermediate care to ensure that the placements for which it charges are not at odds with its own definition and the law.

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Final decision

  1. There was fault on part of the Council which caused injustice to Mrs X: completion of the actions recommended at paragraph 20 will remedy the injustice to Mrs X.

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Investigator's decision on behalf of the Ombudsman

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