Summary: Mr C complained that the Care Provider failed to provide accurate information to him or his family about Funded Nursing Care contributions when his father, Mr D moved into a nursing home. We did not find fault in the actions of the Care Provider.

The complaint

1. Mr C complained that Gibsons Lodge Ltd (the Care Provider) failed to give him or the family accurate information about the Funded Nursing Care (FNC) contributions when his father (Mr D) moved into the nursing home. It also failed to provide Mr C with a copy of the contract until several months after Mr D had moved in or obtain a signature from him indicating agreement with the terms. This has caused distress to the family on discovering that the FNC contributions are not deducted from the fees of £1400 per week.

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The Ombudsman’s role and powers

2. 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)
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 considered evidence provided by Mr C and the Care Provider as well as relevant law, policy and guidance.
5. Mr C and the Care Provider 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

Funded Nursing Care

6. FNC is when the NHS pays for the nursing care component of nursing home fees. The NHS pays a flat rate directly to the care home towards the cost of this nursing care.

What happened

7. Mr C’s father Mr D was discharged from hospital to a nursing home (the Home) in March 2024. He had dementia and Mr C had lasting power of attorney for him (the authority to make decisions on behalf of Mr D in respect of his finances).
8. Mr C said the hospital had been pressurising the family to find a suitable nursing home and a family member had taken Mr D’s wife, Mrs D to look at some. She selected the Home. They recollected that the Home had said the fees would be around £1400 per week. They received nothing in writing. Mrs D recollects saying to the Home that the fees were very high, and the manager replied that she would see what she could do.
9. Shortly afterwards Mr C and Mrs D were invited by the NHS to attend an assessment of Mr D at the Home for continuing healthcare funding (where the NHS pays the whole cost of care for a person with complex health needs) and FNC (which may be payable where a person is not eligible for continuing healthcare funding).
10. Following the assessment Mr C was notified in June 2024 that Mr D was eligible for FNC. Mr C wrote to the Care Provider asking it to refund the FNC payments back to the date Mr D moved into the Home. He said he understood the FNC was deductible from the £1400 a week fees.
11. The Care Provider replied explaining that FNC contributions were a flat rate paid directly to the Home in addition to the weekly fees and were not deductible from them.
12. Mr C replied saying that his mother had been told the fees were £200 a day and there was no suggestion that the fees were in addition to payment of the FNC. He also said Mrs D had never received a copy of the contract and asked for a copy. He also questioned why he and his mother were asked to attend the assessment if the FNC was not going to be deducted from the fees.
13. The Care Provider sent a copy of the contract which is said it had posted out to Mrs D in March. It was dated 18 March 2024 and confirmed that FNC was always payable in addition to the fees quoted to the residents. The contract included a breakdown of the fees and showed the FNC at the 2023/24 rate paid directly to the Home in addition to the £1400 a week fees.
14. Mr D continued to query the charge. He said the family were verbally quoted the fees and were not told that FNC was payable in addition. He said his natural understanding was that the fees would be reduced once FNC was paid. He said they did not receive the contract, and the Care Provider should have sent a copy to him.
15. The Care Provider replied saying Mrs D’s address was the only address on its records, invited Mr C to provide his address and said Mr C should contact the Home directly about the fees.
16. Mr C complained to the Home in September 2024. He said his understanding was the FNC would be deducted from the fees, and this had been reinforced by the timing of the FNC assessment invite following Mrs D’s query that the fees were very high. He also cast doubt on whether the Care Provider had ever posted out the contract.
17. The Care Provider responded saying it had spoken to the manager of the Home and she had assured it that the fees had been fully explained to Mr D’s family and that they did not include the FNC element. It said the manager had been aware from her assessment of Mr D that he would have been entitled to the FNC payments, so these had been included in the contract. The Care Provider confirmed a copy of the contract was posted to Mrs D on 20 March 2024. It agreed the contract had not been signed by Mr C but said that the family had continued to accept the care for Mr D which was evidence that the contract had been accepted. It apologised for the misunderstanding.
18. Mr C complained to us. In response to my enquiries the Care Provider said it had received a referral from the hospital social worker regarding Mr D’s case and it provided evidence that it had told the social worker that the fees were £1400 a week excluding FNC. It also said the failure to obtain a signature on the contract was due to miscommunication.
19. After I started my investigation Mr C informed me that sadly Mr D had passed away.

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Analysis

20. I understand Mr C was aggrieved to find out that the FNC was not deductible from the nursing home fees. However, I have not identified fault by the Care Provider in the way it dealt with the matter.
21. The Care Provider informed the hospital social worker and Mrs D that the fees would be £1400 a week. It sent a copy of the contract to Mrs D setting out that the FNC would be payable directly to the Home and would be in addition to the fees of £1400 a week payable by Mr D. I accept that Mrs D did not receive this document, but I cannot safely conclude that it was not sent because the non-receipt could have been due to a postal issue. So, it was reasonable for the Care Provider to assume that Mrs D and the family were aware of the amount of fees for Mr D’s care.
22. Neither Mr C nor Mrs D asked the Care Provider to clarify the fees or whether the FNC would be deductible from the £1400. They rather assumed that it would be. This understanding was not due to any act or omission by the Care Provider and so I have not concluded the Care Provider was at fault. Mr C could have checked his understanding at any time with the Care Provider or the NHS.
23. It would have been good practice for the Care Provider to obtain a signed copy of the contract but as Mr D received the care, it implies the family accepted the terms of the contract and there are no grounds to reduce the bill.

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Decision

24. I find no fault.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman