Summary: Ms X complained that a delay in carrying out a financial assessment meant that her mother was not aware she would be charged for care in her home. And that no free reablement care was received after two hospital stays. There is no evidence of fault. The delay in the financial assessment was not the fault of the Council and there is no evidence Ms X’s mother was eligible for reablement care.

The complaint

1. The complainant, who I shall call Ms X, complains the delay in carrying out a financial assessment meant that her mother (Mrs M) was not aware there would be charges for the care she received.
2. Ms X also complains the Council did not provide free reablement care for Mrs M when she was discharged from hospital. Ms X says that the family has been caused distress and financial stress. Ms X wants all charges before the week of 7 April 2024 to be waived.

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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 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)
4. 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)
5. When considering complaints we make findings based on the balance of probabilities. This means that we look at the available relevant evidence and decide what was more likely to have happened.

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How I considered this complaint

6. I considered evidence provided by Ms X and the Council as well as relevant law, policy and guidance.
7. Ms 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

Law and guidance

8. A council has a duty to arrange care and support for those with eligible needs, and a power to meet both eligible and non-eligible needs in places other than care homes. A council can choose to charge for non-residential care following a person’s needs assessment. Where it decides to charge, the council must follow the Care and Support (Charging and Assessment of Resources) Regulations 2014 and have regard to the Care Act statutory guidance. (Care Act 2014, section 14 and 17)
9. Where a council has decided to charge for care, it must carry out a financial assessment to decide what a person can afford to pay. It must then give the person a written record of the completed assessment. Councils have no power to assess couples according to their joint financial resources. A council must treat each person individually. A council must not charge more than the cost it incurs to meet a person’s assessed eligible needs.
10. People receiving care and support other than in a care home need to keep a certain level of income to cover their living costs. Councils’ financial assessments can take a person’s income and capital into consideration, but not the value of their home. After charging, a person’s income must not reduce below a weekly amount known as the minimum income guarantee (MIG). This is set by national government and reviewed each year. A council can allow people to keep more than the MIG. (Care Act 2014)
11. Intermediate care and reablement support services are for people usually after they have left hospital or when they are at risk of having to go into hospital. They are time-limited and aim to help a person to preserve or regain the ability to live independently. The National Audit of Intermediate Care lists four types of intermediate care:

• crisis response – services providing short-term care (up to 48 hours);
• home-based intermediate care – services provided to people in their own homes by a team with different specialties but mainly health professionals such as nurses and therapists;
• bed-based intermediate care – services delivered away from home, for example in a community hospital; and
• reablement – services to help people live independently which are provided in the person’s own home by a team of mainly care and support professionals.

12. Regulations require intermediate care and reablement to be provided without charge for up to six weeks. This is for all adults, whether or not they have eligible needs for ongoing care and support. Councils may charge where services are provided beyond the first six weeks but should consider continuing providing them without charge because of the preventive benefits. (Reg 4, Care and Support (Preventing Needs for Care and Support) Regulations 2014)

Key facts

13. The Council carried out a care assessment of Mrs M on 8 September 2023. The Council proposed 4 care calls a day for 30 minutes each. The file notes says that ‘Mrs M is aware of the fairer charging policy and financial assessment process’. Ms X says she was not made aware there would be a charge for care and would not have agreed to 4 calls a day if she had been.
14. The package of care started on 25 October 2023. The Council sent the financial assessment forms on 25 October 2023. The Council also sent the support plan to the family. This included the statement ‘your plan provides details of your personal budget, which is the cost of meeting your eligible needs and outcomes. The amount that you must pay towards theses costs is determined by your financial assessment’.
15. Mrs M went into hospital from 2 to 7 November 2023. She did not receive any care on discharge from hospital and the Council was told of this at the 6 week review on 30 November. Ms X explained she was not happy with the care company and asked for direct payments. The Council sent Ms X an information pack about direct payments on 4 December 2023. The package of care restarted.
16. The Council said the financial assessment forms were returned by the family on 22 December 2023 but were incomplete. The Council asked for the complete information on 27 December. After further communication, the Council received all the information on 11 February 2024 and sent out the completed financial assessment on 28 February 2024. The letter of 29 February 2024 clearly informed Ms X that the cost of her care would be £342 per week.
17. There was a review of the care package on 25 January 2024. The morning care call length was increased.
18. The Council carried out a home visit on 13 March 2024. Notes of this visit record that Ms X said that she was not told that the service provision might be charging following the financial assessment outcome and that she had recently received a £4000 care bill. Mrs M said she no longer required the care provision as she could not afford to pay for care.
19. The notes of an email dated 2 April 2024 show that Ms X was clearly informed on that date that care was no longer free of charge after the financial assessment. The Council said ‘a counter fraud team verification report confirmed Mrs M owned another property in addition to the one she lived in. This was not disclosed by the family on the financial assessment and resulted in a decision that Mrs M was eligible to pay the full cost of her care’.
20. The Council emailed Ms X to say that as Mrs M had been identified as having long term care needs she would not be eligible for free, reablement care so her long term package of care would continue.
21. Mrs M’s care was reduced to one 30 minute call and one 15 minute call daily from 20 May 2024.

My analysis

Reablement care

22. Ms X complains the Council did not provide free reablement care for Mrs M when she was discharged from hospital.
23. In response to my enquiries, the Council said ‘Mrs M had on-going care needs and a long term package of care in place she would not be eligible for reablement. Reablement is a service that is provided to support individuals to return back to their independent baseline- meaning no longer requiring formal care. In your mothers case she has on-going formal care so therefore, does not meet the criteria for reablement’.
24. I cannot see any evidence of fault in the Council’s decision that Mrs M was not eligible for free reablement care. Reablement care is not automatic following every hospital stay, it is for specific circumstances and Mrs M did not fit those. She has a long term package of care and was unlikely to return to independence. This is supported by the fact that Mrs M has continued to require a care package. If reablement care had been put in place, there would be documentation to support this which could include short term targets towards independence including mobility and self-care. I have seen no evidence that the period of care after the hospital stays was reablement care.

Care charges

25. Ms X complains that she was not told there would be a charge for care and asks for the Council to cancel the invoices before 7 April 2024.
26. I have looked carefully at all the evidence. The Council’s file notes record that the family were informed there would be a charge for care and this is also included on the support plan sent to Mrs M. The family also received the financial assessment forms quickly.
27. I have found no delay in the Council carrying out the financial assessment. The information I have shows the delay occurred because it took the family some time to return the complete forms to the Council. The family also did not include on the form that Mrs M owned a second property and so the initial calculations did not reflect this, they showed Mrs M did not have to contribute financially towards her care which was later corrected.
28. I was not present at the care and support assessment, so I cannot know for sure that the Council told Ms X and Mrs M that they would have to contribute towards the cost of care. However, on the balance of probabilities I think that it was likely they were given the information. It is recorded on the Council’s file notes and written on the support plan which was given to the family. If the family had returned the financial assessment form promptly, with the second property included on it, they would have been informed of the correct charges from the start. I do not consider the Council was at fault.

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Decision

29. I propose to complete my investigation. I find no fault and this complaint is not upheld.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman