Summary: Mrs Y complained about the reablement service the Council provided for her and her late husband, and the care charges they were asked to pay. We have found fault by the Council, in failing to provide clear information about the review of their reablement care, causing injustice. The Council has agreed to remedy this by apologising, waiving some initial charges, and making a payment to Mrs Y to reflect her upset and service improvements.

The complaint

1. The complainant, who I am calling Mrs Y, complains about the reablement service the Council provided for her and her late husband, who I am calling Mr Y, and the care charges they were asked to pay. Mr Y sadly passed away in July 2021.
2. Mrs Y says the Council failed to:

• provide them with six weeks of reablement service, free of charge, to which they were entitled.
• tell them their reablement service had been reviewed and the ongoing care they had been assessed as needing would now be chargeable.
• give them any other options to consider. They were only told their care would now be provided by another agency.

3. Mrs Y says they could not afford the care package once it became chargeable. She wants the Council to revise the start date and apply affordable rates.

Back to top

The Ombudsman’s role and powers

4. 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)
5. 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)

Back to top

How I considered this complaint

6. I spoke to Mrs Y, made enquiries of the Council and read the information Mrs Y and the Council provided about the complaint
7. I invited Mrs Y and the Council to comment on a draft version of this decision. I considered their responses before making a final decision.

Back to top

What I found

What should have happened

Adult Social Care

8. Under the Care Act 2014, councils have a duty to assess adults who have a need for care and support and provide a plan setting out the services required to meet any eligible needs. And, if asked to do so, councils must arrange a care package.to meet these needs.
9. Councils can make charges for care and support services they provide or arrange. Charges may only cover the cost the council incurs (Care Act 2014, section 14). Councils must assess a person’s finances to decide what contribution, if any, they should make to the cost of their care.
10. Councils should ensure the information supplied about care and support is clear. Information should only be judged as clear if it is understood and able to be acted upon by the individual receiving it. (Care and Support Statutory Guidance 2014 (Care Act 2014) Chapter 3)).

Reablement

11. Councils have a duty to prevent, reduce or delay needs for care and support for all adults (Care Act 2014 section 2).
12. Providing a reablement service is one of the ways a council can fulfil this duty. Reablement helps people learn to manage again after, for example, a period of illness. It may be provided in a person’s own home by a team of social care workers.
13. Where a council provides reablement it must be provided free for the first six weeks, or if the timescale agreed is less than six weeks, for that period. (The Care and Support (Charging and Assessment of Resources) Regulations 2014 regulation 3 (2) (b))

The Council’s reablement service

14. The Council’s Home Assessment and Reablement Team (HART) offers a reablement service. In its published information about the service the Council said:

• Reablement was a free, short-term, time limited service.
• Care and support needs would be reviewed before the end of the service
• The user may need to contribute to the cost of any ongoing support needed after the end of the service.
• There would be a financial assessment to determine how much they would be expected to pay for ongoing support.

15. The Council also issues a Reablement Service User Guide for service users. This included the following information:

• It would go through the guide with users at the introductory visit at the start of the service.
• Care needs would be continually assessed. A review would be arranged as soon as it was felt full potential for independence had been reached.
• If ongoing support was needed when the HART service was coming to an end, the team would help users decide how they wanted to be supported.
• The HART service was a short-term service, free for the duration of the reablement care. Care and support needs would be reviewed before the end of reablement care. An assessment would be completed to determine care needs if ongoing support was required. Ongoing care may be chargeable.

What happened

Background

16. Mr and Mrs Y both had significant health issues in 2020. Mrs Y’s condition affected her mobility. They were still able to meet their care and support needs at this stage.
17. In October 2020 Mrs Y called emergency medical help for Mr Y for a possible heart attack. Paramedics confirmed Mr Y had severe muscle strain from supporting Mrs Y with her mobility issues. The Council’s Adult Social Care (ASC) team was asked to assess Mr and Mrs Y’s care and support needs.

HART’s involvement – October and November 2020

18. On 26 October, a member of the ASC team visited Mrs Y and assessed her care and support needs. It was decided HART would provide Mrs Y with reablement care to help her recover mobility. And it was decided Mr Y also had reablement potential.
19. A HART team member made introductory visits to Mrs Y on 28 October, and Mr Y on 31 October. The Council’s records say Mr and Mrs Y were told on these visits:

• HART was an assessment and reablement service. It was not a mandatory six week programme. As needs are assessed accordingly, the service could be for less than six weeks.
• Its service would be chargeable if ongoing need was identified, based on the outcome of the financial assessment.
• Charges would start from the day after the review.

20. HART provided Mr and Mrs Y with reablement care visits twice a day.

Review

21. The Council says it completed an assessment and review of Mr and Mrs Y’s reablement care by telephone on 17 November. It had decided they had reached their full reablement potential but needed an ongoing care package which would be chargeable from the day following the review.

Telephone calls on 17 and 18 November

22. There is a dispute between the Council and Mrs Y about these phone calls on 17 and 18 November.
23. The Council says its case records for Mrs Y and Mr Y, completed by officer A on 17 November, confirm:

• Officer A completed Mrs Y’s assessment and telephone review, based on evidence from HART, case notes and talking to Mrs Y.
• Mrs Y still needed a care package. The options were discussed. It was explained care services would become chargeable from 18 November, at an hourly rate of £18.03 with a weekly administration charge of £5.40 if they were assessed as full cost payers.
• Two care visits a day were put in place for Mrs Y, to run alongside Mr Y’s care package.
• Officer A completed Mr Y’s assessment and telephone review, based on evidence from HART, case notes and talking to Mr Y.
• Mr Y still needed a care package. The options were discussed. It was explained care services would become chargeable from 18 November, at an hourly rate of £18.03, with a weekly administration charge of £5.40 if they were assessed as full cost payers.
• Two care visits a day were put in place for Mr Y, to run alongside Mrs Y’s care package.

24. The Council says its case records, completed by Officer A on 18 November, confirm a care agency was commissioned to provide Mr and Mrs Y’s care package going forward, and she telephoned Mr and Mrs Y to arrange their daily call times.
25. Mrs Y says:

• Neither she nor Mr Y had any recollection of a call from Officer A on 17 November about a review. The only calls they had with the Council on 17 November were from Officer B. She told them their carers would be changing but nothing else was mentioned and there was no reference to charges.
• Officer B phoned again on 18 November. She confirmed the new carers would start on 23 November, but no reference was made to charges.

Care from 18 November

26. The Council began charging Mr and Mrs Y for their care package from 18 November. HART continued to provide their care until 22 November.
27. The commissioned care agency took over Mr and Mrs Y’s care package from 23 November.

Financial assessment

28. The Council sent Mr and Mrs Y financial assessment forms to complete so it could determine the amount of their contribution, if any, towards the cost of their care package.
29. Mrs Y had difficulty completing the forms. Mr Y was now in hospital and Mrs Y had had a medical procedure from which she was still recovering and in pain. Mrs Y contacted the Council about this on 30 November. It agreed to extend the time for the return of the forms until 29 December.

January 2021

30. Mrs Y completed an online assessment for Mr Y on 20 December but had not yet returned her form. On 16 January Mrs Y received the Council’s notification their weekly contributions had been assessed as £297 (Mrs Y) and £117 (Mr Y) starting from 18 November.
31. Mrs Y contacted the Council’s financial assessment team. They advised she had been assessed as paying the full cost of her care because her forms had not been returned. And Mr Y’s online assessment had been incorrectly completed.
32. Mrs Y said she could not afford to pay the care costs and disputed the start date for the charges. They had only received reablement care for four weeks instead of the six weeks to which they were entitled. They had not been assessed at the end of the reablement care. Mrs Y wanted to stop her care temporarily because she could not afford it.
33. The Council supported Mrs Y with the financial assessment and completed this with her by phone on 25 January.
34. Mrs Y also said she wasn’t told when the care would become chargeable and had understood their care was free for the first six weeks. She asked to cancel her care completely and said she would complain.
35. The Council contacted the care agency on 28 January. It told the agency Mrs Y wanted to end her care package and the last call should be that evening.
36. Mr Y’s evening care calls were cancelled from 4 February.

Mrs Y’s complaint

37. In her complaint to the Council, Mrs Y said:

• She understood reablement care was free for six weeks.
• Her reablement care started on 26 October and should have been free until 6 December.
• The only written information given to them was the Reablement User Guide.
• There should have been a review to determine whether they needed care going forward. This didn’t happen.
• They should have been given information to allow them to make an informed decision about their care and its affordability going forward. They weren’t given this.
• Officer A did not phone them on 17 November. The only call was from Officer B who told them about the change in carers. She said nothing about charging for their care.

38. Mrs Y asked about other care agencies’ charges so she could compare the cost, had they been given other options. She also asked the Council to revise the charges based on what they could afford.

The Council’s response

39. In response to the complaint, the Council said:

• Its reablement service could be provided free of charge for up to six weeks. There was no guarantee it would be provided for the full six weeks.
• Reviews were carried out once a service user met their reablement goals or it was decided no further progress would be made.
• Its records confirmed their reviews were completed on 17 November by phone. Mrs Y was told the review outcome. This was they both had longer term support needs, care would be chargeable from 18 November at £18.03 an hour with a weekly administration fee. Mrs Y had accepted the care offer.
• It could not confirm it had provided them with a copy of the review. It should have done so, and it apologised for this. The start date for charges would be amended to 23 November.
• There was no record of discussion about other types of support available. But this did not make any difference. Their free reablement care ended with the review, and their care package would have been transferred to a council commissioned care agency in the short term in any event. All care agencies commissioned by the Council charged the same hourly rate.

My findings – was there fault by the Council causing injustice?

Information about the reablement service

40. HART made introductory visits to both Mr and Mrs Y. The Council’s records say they were told on these visits, reablement care could be provided for less than six weeks and care services provided after the review would be chargeable.
41. Mrs Y says the only written information she was given about the service or charges was the Reablement User Guide. In my view this guide clearly explained this was a short-term service and free for the duration of the reablement care. And that care needs would be reviewed and assessed before the end of the service, and if ongoing support was needed, this may be chargeable.
42. On the basis of the evidence seen so far, I consider the Council provided Mr and Mrs Y with sufficient information, at the start of the reablement service, about the way it worked, that free care would end when a review was completed, and care provided after the review could be chargeable.
43. I have not found fault by the Council regarding the information it provided to Mr and Mrs Y about the reablement service.

The review

44. The information Mr and Mrs Y were given at the start of the service confirmed charges would not be made until after a review had been completed. I understand the purpose of the review was to decide whether to end reablement care, either because the goals had been achieved or no further progress could be made. The effect of this decision, where a continuing need for care had been assessed, was that the user would be charged for care provided from the day after the review.
45. On this basis, I consider it should be made clear to users a review has taken place and why it had been decided to end the reablement care.
46. In my view, the Council’s records do not confirm Mrs Y was clearly told on 17 November a review had been completed and why the decision had been made to end her reablement care. And there does not appear to have been a separate phone call or conversation with Mr Y about his review and assessment.
47. And according to the Council’s record of what was said on 17 November, which I appreciate Mrs Y disputes, she was given a lot of information over the phone which she had not been expecting, at a stressful time for her. And without it being made clear the Council had completed a review of their reablement care, triggering charges. Neither the outcome of the review or details of costs were confirmed in writing.
48. I do not consider the Council provided Mr and Mrs Y with clear information about their review on 17 November, in a way they could understand and act on, in accordance with the statutory guidance. In my view, this was fault by the Council.

The impact on Mr and Mrs Y

49. I consider, because of the failure to provide clear information about the review, Mrs Y continued to believe reablement care was free until the end of the six week period, and they incurred charges they had not been expecting.
50. My view is the Council should remedy this by waiving Mr and Mrs Y’s charges for the period from 18 November 2020 until the end of the six weeks from the start of their reablement care.
51. I also consider the failure to clearly explain and confirm in writing the completion of the review and care costs going forward caused Mr and Mrs Y distress, time and trouble. Sadly, we cannot put this right for Mr Y now.

Information about other options

52. The Council has accepted there is no record it discussed options for ongoing support with Mrs Y, other than continuing their existing care package. There is no evidence it confirmed the weekly cost of their current package or provided written information about costs. In my view, the Council failed to provide Mr and Mrs Y with the information they needed to make an informed decision about their care package, in accordance with the statutory guidance, and this was fault.
53. I accept the Council’s evidence any care agency it commissioned charged the same hourly rate. My understanding is Mr and Mrs Y still needed care and support from 18 November. I do not consider Mr and Mrs Y were caused injustice by not being given details of other care agencies at this stage.

Charges from the end of the six week period

54. As explained above, in my view the Council made it clear at the outset charges would be made for ongoing support provided after reablement care ended. Care was still being provided after the six week period during which Mrs Y understood care was free. I do not consider it was fault by the Council to charge Mr and Mrs Y for the care provided to them from the end of the six week period.
55. The Council could not determine the amount of Mr and Mrs Y’s contribution towards the charges until their financial assessments had been properly completed. I appreciate Mr and Mrs Y’s upset and concern about the amount they were asked to pay. But I have not seen any indication this has been incorrectly assessed.

Back to top

Agreed action

56. To remedy the injustice caused by the above faults and, within four weeks from the date of our final decision, the Council has agreed to:

• apologise to Mrs Y for its failure to clearly explain and confirm in writing the completion of the review and care costs going forward.
• pay Mrs Y £150 to acknowledge the distress, time and trouble this failure caused her. This is a symbolic amount based on our published remedies guidance.
• waive Mr and Mrs Y’s care charges for the period from 18 November 2020 until the end of six weeks from the start of their reablement service. It should also check charges have not been made for care visits cancelled by Mrs Y in January 2021
• discuss an arrangement with Mrs Y for payment of the remaining charges.

57. And within three months from the date of our final decision the Council has agreed to:

• review its procedures and guidance to its ASC team for informing service users about the outcome of reviews and costs of ongoing care, and:
• confirming this information in writing.

58. The Council should provide us with evidence it has completed the above actions.

Back to top

Final decision

59. I have found fault by the Council causing injustice. I have completed my investigation on the basis the Council will carry out the above actions as a suitable way to remedy the injustice.

Back to top

Investigator's decision on behalf of the Ombudsman