Summary: The Council is at fault for applying residential care fees for a five-day period Mr X was in hospital and awaiting a reassessment of his care needs.

The complaint

1. Mrs X complains the Council invoiced her for six weeks care home fees when her late husband was in hospital and then in a short-term NHS funded nursing placement, and not resident in the care home.

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The Ombudsman’s role and powers

2. We investigate complaints of injustice caused by ‘maladministration’ and ‘service failure’. I have used the word fault to refer to these. We consider whether there was fault in the way an organisation made its decision. If there was no fault in how the organisation made its decision, we cannot question the outcome. (Local Government Act 1974, section 34(3), as amended)
3. If we are satisfied with an organisation’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:

• considered the complaint submitted by Mrs X:
• considered the correspondence between Mrs X and the Council, including the Council’s response to the complaint;
• made enquiries of the Council and considered the responses;
• taken account of relevant legislation;
• offered Mrs X and the Council an opportunity to comment on a draft of this document.

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What I found

Relevant legislation

5. 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)
6. Councils must assess a person’s finances to decide what contribution he or she should make to a personal budget for care. (Care Act 2014 Department for Health, ‘Fairer Charging Guidance’ 2013, and ‘Fairer Contributions Guidance’ 2010).

What happened

7. Mr X moved into a residential care home in March 2022. The placement was arranged and funded by the Council.
8. Mr X was admitted to hospital on 30 June 2022. I have sight of the hospital discharge notes, which record the intended discharge date as 3 August 2022.
9. A social worker contacted the hospital on 4 August 2022 to enquire about Mr X’s progress. The social worker was told Mr X was medically fit for discharge and that the ward were waiting for a staff member from the care home to visit to assess him for return to the care home.
10. The care home’s usual procedure for assessments is for two managers to visit together to ensure they are fully informed of residents’ needs before a return to the care home. The Council says at the time there was only a part-time manager in post and this manager was also covering another care home. A full-time manager was not in post until October 2022.
11. The part-time manager was not able to visit Mr X and complete an reassessment of his needs until 8 August 2022, which was five days after he had been declared medically fit for discharge. The assessment concluded Mr X’s needs had increased and the care home could no longer meet his needs. The placement at the care home was ended on 8 August 2022.
12. The Council’s records show the social worker informed Mrs X that Mr X could not return to the care home and the ‘discharge to assess process’ was explained.
13. When a patient in hospital is fit enough to leave hospital but not well enough to return to their previous place of residence, they can be discharged to a nursing home under the ‘discharge to assess’ pathway to receive additional support and further assessment of their long-term needs.
14. Mr X was transferred into a different care home funded by the NHS under ‘discharge to assess’.
15. Mr X sadly passed away in October 2022.
16. Mrs X received an invoice (£448.96) for Mr X’s contribution towards his care at the care home for the period Mr X was in hospital. She believed the fee should be reduced because the care home did not incur the full cost of caring for Mr X.
17. Mrs X complained to the Council. It responded in writing in April 2023. The author of the letter explained Mr X’s placement was kept open and available to him until it became evident he was unable to return, and as such the usual charges apply. She (the author) said there had been no indication prior to the reassessment of Mr X’s needs completed on 8 August 2022, that he would not return to the placement. She confirmed the placement had been terminated the same day. The author said, had the placement been terminated prior to this, Mr X could have been left homeless on discharge from hospital.
18. Mrs X remined of the view the full charges should not apply.

Analysis

19. When Mr X was first admitted to hospital it was not known for certain that he would not return to the care home. The Council was right to ensure his placement remained available so that he could return if required.
20. When a care home placement remains available to a resident, whether they are present or not, the usual charges apply, so there is no fault by the Council for charging during the period Mr X was in hospital. However, there was a short delay of five days in the reassessment of Mr X’s needs. Had it not been for the delay, Mr X’s placement would have ended five days earlier, which would have reduced the charge slightly.
21. Given the delay was not through any fault of Mr/Mrs X, the Council should not charge for the five-day period Mr X was awaiting assessment.

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Agreed action

22. The Council should, within four weeks of the final decision, reduce the outstanding charges for Mr X’s care by five days.
23. The Council provide us with evidence it has complied with the above actions.

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Final decision

24. The Council is at fault for charging Mr X residential care charges for five-days when a reassessment of his needs was delayed.
25. The recommendation above is a suitable way to settle the complaint.
26. It is on this basis; the complaint will be closed.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman