Summary: Mrs X complained about the charges made by the Council for her mothers care home place. There was fault. The Council took too long to resolve a situation in which the care home was paid twice. It has now reached an agreement to get a refund from the care home and cancel the invoices to Mrs M. To remedy the distress and inconvenience Mrs M was put to and to remedy the Council’s poor communication the Council apologised and made a payment to Mrs X. There was no fault in the Council’s decision there was no reablement care. Or its decision that Mrs M should contribute financially during the 12 week period when the value of her property was disregarded.

The complaint

1. Mrs X complains for her mother, Mrs M. Mrs X says the Council told them a 6 week placement after hospital discharge would be free of charge but they were later charged for it.
2. Mrs X says the Council’s communication over care fees has been inadequate and resulted in the care home being paid twice. And, the Council has not contributed the amount it said it would towards care home fee in a letter dated February 2024.
3. Mrs X says receiving repeated invoices from the Council when they have already paid the care home has caused her huge distress. And the delay in sorting the complaint out has caused her more distress.

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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 significant injustice, or that could cause injustice to others in the future we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
5. 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

6. I considered evidence provided by Mrs X and the Council as well as relevant law, policy and guidance.
7. Mrs X and the Council had an opportunity to comment on my draft decision. I considered any comments before making a final decision.

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What I found

Payment of care fees

8. During the investigation of this complaint, Mrs X met with the Council about her complaint that both Mrs M and the Council had paid the fees for care to the home. Mrs X reached an agreement with the Council, in that the care home would refund the fees paid by the Council and the Council would cancel the invoices to Mrs M.
9. There was fault by the Council. It failed to respond promptly to Mrs X’s complaints about the care home fees being paid twice. This caused injustice to Mrs X as she has had to attend meetings to explain to the Council exactly what had happened and reach a resolution. In order to remedy the injustice the Council should make a payment to Mrs X towards her distress and frustration. I recommend a payment of £500, along with an apology from the Council and a letter which clearly sets out the agreement reached.

Six weeks care after hospital discharge

10. Mrs M received one, 30 minute, care visit a day at home which she was charged for. Mrs M went into hospital for two nights after a fall.
11. Mrs X says the family were told by the hospital that Mrs M would be discharged that day. Mrs X says she telephoned the Council to ask for an additional 30 minute visit per day and a male employee told her that her mother should not be discharged without a safeguard package for her to return home and this was the hospital’s responsibility to organise. There is no record of this call in the Council records but the Council believes Mrs X may have spoken to an initial response worker who answers the phones at lunchtime.
12. Mrs M was discharged from hospital on 13 April 2023. Mrs X said the hospital put in place a ‘safeguard’ package of three 45 minute visits per day. Mrs X said she was told from the start of the ‘safeguard’ package there would be no care charges for 6 weeks. Mrs X says that the additional 30 minutes care she requested would have cost an extra £74 per week, but the increase to 3, 45 minute visits cost an extra £196 per week.
13. The Council social worker visited Mrs M on 23 May. Mrs X and her brother were also there. Mrs X says the social worker told her that the three visits a day would remain but that Mrs M may be responsible for the increased costs if they continued past the 6 weeks. Mrs M had previously been paying towards 1 care visit per day.
14. Mrs X says she became aware on 22 June that her mother had been charged for the 6 week period. She says she telephoned the Council and was told that ‘the code for removing the charge for safeguard package had not been used’.
15. Intermediate care is free for up to 6 weeks after hospital discharge. The Council has said that as Mrs M had a care package already in place before she went into hospital, she did not receive intermediate care. Instead, her care package was increased. This would not be free of charge. Unfortunately, the Council has said that no written information was sent to Mrs M or Mrs X so they were not informed in writing that the care package would be chargeable for the 6 week period.
16. It is difficult for me to determine what happened during the telephone calls as I was not there. It is clear the family were given no information in writing to confirm what was happening and what the costs would be. This was fault.
17. I now have to decide if the fault caused injustice to Mrs M. i.e. would the situation have been different if the family were aware the 6 weeks care would not be free of charge.
18. Intermediate care is not a period of free care that people are always entitled to following a hospital stay. It is short term care offered if staff believe that people will rehabilitate and live more independently. Generally, there will goals set for people to achieve towards independent living and reviews of progress.
19. From the information I have, Mrs M had 1 care visit per day before the hospital admission and 3 afterwards. There were no goals set for her rehabilitation or reviews of progress. In fact, Mrs M went into respite care after a few months. So, on the balance of probabilities I think it was unlikely that she was discharged for intermediate care, it was more likely that her existing care package was increased. This would not be free of charge and so I do consider the Council is entitled to charge for the 6 weeks of care.
20. However, the communication with the family was poor and the response to the complaint slow so they were obviously left with the impression the care would be free. So, I do consider the Council should apologise and make a payment of £500 in recognition of the distress it has caused.

Residential care charging

21. After a hospital stay it was decided that Mrs X needed to go into a residential care home. The social workers notes of a telephone call of 18 October 2023 said that the family were going to transfer Mrs M to a care home privately as they did not like the one the hospital intended to discharge Mrs M to. The social worker’s notes say she ‘advised Mrs X of the dangers of doing this as Mrs M was under the savings threshold’.
22. There is an email on 19 October from the hospital to Mrs X’s brother telling him the families’ choice of care home was well above the Council’s weekly rate and the family would need to fund this or choose a care home at the Council rate.
23. Mrs X’s brother replied they were moving Mrs M from hospital the next day as her care was their immediate priority.
24. Mrs M went into a residential care home on 20 October 2023 with the family paying for her care privately. The Council sent the family a financial assessment form on 20 October.
25. The case was allocated to a social worker on 1 November. A care assessment was carried out on 9 November.
26. The Council agreed a placement in residential care on 30 November. Mrs X was told on 19 December 2023.
27. After a financial assessment, the family were told the value of Mrs X’s property would be disregarded for 12 weeks. This would start from 5 December 2023. For the 12 weeks the total cost of the placement per week would be £1435. The Council would pay £737 (minus the assessed financial contribution) and the family would pay a third party top up of £698 per week. From 27 February 2024 Mrs M paid the full cost of the fees.
28. Mrs X has said the Council has not paid £737 per week for the 12 weeks, it has paid £273 per week for the 12 weeks. The Council has sent a copy of the financial assessment which assessed Mrs M as needing to make a financial contribution of £463 per week due to her income. Mrs X complains that she was told the Council would pay £737, not £737 minus the assessed financial contribution from Mrs M.
29. In response to my enquiries, the Council has said a letter sent to Mrs X as the third party paying the top up would not have needed to include the details of the financial contribution made by Mrs M. However, it has now changed the letter template to make it clear.
30. I can see there was a separate letter to Mrs X dated 14 February 2024. This says that ‘any assessment of financial contribution from your relative (Mrs M) will be used to make up the total care home fee of £737, with the Council paying the balance’.
31. I find no fault by the Council on this point. The Council carried out a financial assessment and calculated the financial contribution Mrs M should pay. Mrs X and Mrs M were informed of this, although I appreciate the third party top up letter was not as clear as it could be. This has now been remedied. I do note the second financial assessment was not carried out until after the end of the 12 week financial disregard period. However, as the family had chosen the care home and placed Mrs M there, I do not believe the time taken affected the charges for Mrs M, who got care throughout.

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Action

32. Within one month of the date of the decision on this complaint the Council should:
• Apologise to Mrs X and set out clearly in writing the agreement reached after the meeting.
• Pay Mrs X £1000.
33. The Council should provide us with evidence it has complied with the above actions.

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Decision

34. I have completed the investigation of this complaint and I find fault causing injustice. This complaint is upheld. The Council has agreed actions to remedy injustice.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman