Summary: Mrs X complained the Council refused to fund Mr Y’s care because he chose to move into a care home with his wife rather than staying on the planned rehabilitation pathway after fracturing his hip. This caused distress and impacted Mr Y financially. There was no fault in the Council’s decision not to fund Mr Y’s care when he chose not to stay on the rehabilitation pathway.

The complaint

1. Mrs X complained the Council refused to fund Mr Y’s care because he chose to move into a care home with his wife rather than staying on the planned rehabilitation pathway after fracturing his hip.
2. Mrs X said the care home for the planned rehabilitation pathway was oversubscribed, meaning a long wait at a temporary placement, and Mr Y wanted to be reunited with his wife of 57 years, who he had been carer for.
3. Mrs X said the Council’s decision impacted Mr Y’s wellbeing and finances, and was distressing for the family.

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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(1), as amended)

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How I considered this complaint

6. As part of the investigation, I considered the complaint and the information Mrs X provided.
7. I made written enquiries of the Council and considered its response along with relevant law and guidance.
8. Mrs X and the Council had an opportunity to comment on my draft decision. I considered any comments received before making a final decision.

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What I found

Discharge to assess

National guidance

9. Government guidance states most people are expected to go home after discharge from hospital. Other than in exceptional circumstances, people should not be discharged directly into a permanent care home placement for the first time without first having the chance to recover in a temporary placement before assessing their long-term needs.
10. During discharge planning, people with new or additional needs may be offered short-term health and/or social care and support in the community to aid their post-discharge recovery. The choices offered will depend on what has been put in place locally and should be suitable for a person’s short-term recovery needs and available at the time of discharge.
11. People should be supported to participate actively in making informed choices about their care, including, for people who fund their own care, the potential longer-term financial impact of different care options after discharge.
12. If a person does not accept a short-term package or temporary placement from the options offered, they should be discharged to an alternative that is appropriate for their short-term recovery needs. Those on the discharge to assess pathway should be discharged to a temporary care home placement for an assessment of long-term or ongoing needs, after which the decision about their permanent care home placement should be made.

North Lincolnshire provision

13. People on the NHS discharge to assess pathway 1 are those able to return straight home from hospital with immediate reablement and rehabilitation.
14. The purpose of the service is to ensure people are assessed for their long-term needs in their own home wherever possible. This will reduce their length of time in hospital and avoid further deconditioning and low mood.
15. People on the NHS discharge to assess pathway 2 need a community bed-based setting which has dedicated recovery support offering short-term input to help the person recover, enabling them to live more independently. People discharged from hospital on pathway 2 require rehabilitation and reablement, some require specialist input at Sir John Mason House Intermediate Care Centre.
16. The service provides residential care as part of short-term intermediate care rehabilitation packages, known as 'step-down care', for people aged over 30 years, who are transitioning from hospital to their own homes or to more permanent residential care.

What happened

17. I have summarised below some key events leading to Mrs X’s complaint. This is not intended to be a detailed account of what took place.
18. Mr Y lived at home with his wife, who had a package of care. Mr Y also supported his wife with personal care, dressing, nutrition, managing the home, and medication.
19. Mr Y had a fall in December 2024, fracturing his hip. He needed an operation in hospital. Afterwards, Mr Y needed support with all transfers, personal care, dressing, managing the home, and accessing the community while he recovered. This meant Mr Y could no longer care for his wife.
20. Mrs X telephoned the Council on 31 December 2024. She said the family were looking for a care home for Mr Y’s wife due to her dementia. Mr Y wished to be in the same care home as his wife on discharge as he would not manage at home without support. The Council said it would arrange an assessment to consider the support Mr Y needed on discharge from hospital. It said if the assessment found Mr Y’s needs can be met at home, he would not be eligible for funding for a care home placement.
21. The family found a temporary placement for Mr Y’s wife at the Manor care home.
22. Mr Y was assessed while in hospital. The assessor considered Mr Y would benefit from further therapy in residential rehabilitation with a long-term goal of eventually returning home.
23. Mr Y wanted to go to a rehabilitation placement to improve his mobility. However, he wanted to be discharged to the Manor care home to be with his wife while awaiting rehabilitation.
24. Mr Y was instead discharged from hospital to the Grange care home, on a rehabilitation pathway awaiting a bed at Sir John Mason House.
25. The Council discussed the case on 6 February 2025. It asked staff at the Grange to speak to Mr Y’s family and advise them that if they chose to place Mr Y at the Manor care home this will be self-funded.
26. The Grange updated the Council that Mr Y’s family still planned to move him to the Manor care home to be with his wife. They were buying two beds for Mr Y and his wife to have at the care home and wanted to move Mr Y as soon as they had the equipment needed. The Council reiterated this would be the family’s choice and self-funded.
27. Mrs X asked the Council for a needs assessment on 14 February as Mr Y was due to move into the Manor care home later that week.
28. A social worker visited Mr Y at the Grange care home on 18 February. Mrs X and Mr Y’s son were also present. They noted Mr Y needed support with all transfers and with personal care, nutrition, managing the home and accessing the community. He wanted to join his wife full time at the Manor care home. The social worker explained the financial threshold. Mr Y’s son believed Mr Y was above the threshold. The social worker explained the current recommended pathway for Mr Y was to go to Sir John Mason House to build back mobility and independence, then hopefully return home with his wife. Mr Y wanted to be with his wife immediately as he spent several weeks in hospital before the Grange and must now wait for a bed at Sir John Mason House. He asked how long it would take. The social worker was unsure of the waiting list but said they could find out. They said Mr Y’s time at Sir John Mason House depends on his progress. Mr Y still wanted to move to the Manor care home. The social worker explained this would be self-financed if Mr Y is above the threshold and, even below the threshold, the Council may not support him as he made a capacitated decision to give up his pathway. The social worker recorded that Mrs X and Mr Y were aware and understood this.
29. Mrs X complained to the Council on 2 April 2025 about its inefficiency and lack of communication. She said the Council was stalling on Mr Y’s care funding. She said the family faced care bills for both their parents and were told the Council would fund this, but the Council was now saying it disputed Mr Y’s pathway to the Manor care home, because he chose to join his wife there. The Council was now questioning this decision and potentially not going to fund Mr Y.
30. The Council responded to the complaint on 9 April. It confirmed it would fund Mr Y’s wife’s placement from 8 January 2025, subject to any contributions she may be assessed to make. It said it backdated the funding to the date Mr Y’s wife went into the care, in recognition of its delay assessing her. It said if both Mrs X’s parents remain in the care home and sell their home, they will self-fund their care.
31. The Council said its assessment determined Mr Y needed a rehabilitation facility, not a care home such as the Manor. Since Mr Y voluntarily moved to the Manor on 20 February, with the intention of selling his home to fund his stay, the Council will not fund his placement.
32. The Council understood from speaking to Mrs X that her parents wished to explore the option of returning home. It said an officer will visit to assess them and explain the available support options.
33. A social worker assessed Mr Y at the Manor care home on 10 April 2025. Mr Y had finished private therapy and an NHS outreach programme. Unfortunately, he had not been able to regain his previous mobility. He was not independent with daily needs. His needs were met by carers. Mrs X raised concerns the Manor was not the right placement for Mr Y, and he was not stimulated enough socially.
34. The social worker’s professional opinion was that Mr Y could not be supported if he returned home, as he would receive no support between care calls. This would pose a significant risk. They recommended Mr Y remain in 24-hour care. They considered he would benefit from a more stimulating environment, but Mr Y had declined this at the time as he wished to remain with his wife.
35. The Council wrote to Mrs X on 3 June 2025 following Mr Y’s financial assessment. It assessed Mr Y had to pay £414.98 a week for his care at the Manor. This was backdated to 10 April 2025, meaning Mr Y owed £3,082.71.

My investigation

36. Mrs X told me Mr Y was placed at the Grange after a stay in hospital because Sir John Mason House was oversubscribed. The family did not know how long Mr Y would have to wait at the Grange before a bed became available at Sir John Mason House. Because Mr Y missed his wife so much the family thought it would be better to place him with her at The Manor care home.
37. Mrs X said the family consulted the Council before the move, which happened on 18 February 2025.
38. Mrs X said staff at The Manor were not properly trained. Mr Y had physiotherapy through the NHS for six weeks, but they considered he would not make more progress. Mrs X felt Mr Y deteriorated at The Manor because his needs were not being met.
39. The Council assessed Mr Y’s needs while at The Manor and said it did not suit him. It suggested other care homes, including Edmund House. Mr Y moved to Edmund House on 24 May 2025. The Council told the family Edmund House only charged minimal top-up fees. However, since Mr Y and his wife moved there the fees the family must pay are more than anticipated. Mr Y is self-funding after selling his home to pay the fees.
40. The Council said Mr Y’s discharge from hospital was arranged by co-ordinators in the North Lincolnshire Integrated Discharge Team. Council social workers are part of the Integrated Discharge Team but did not have any involvement in Mr Y’s discharge and did not speak to his family.
41. The Council told me an assessment determined Mr Y’s needs were best met within a rehabilitation setting rather than a care home environment.
42. The Council said Sir John Mason House is North Lincolnshire’s short stay rehabilitation facility. When a placement at Sir John Mason House is not immediately available, the usual pathway is a temporary stay at the Grange with therapy and reablement. Mrs X visited the Grange and consented to Mr Y’s discharge there while waiting for availability at Sir John Mason House. Mr Y was on a health-funded residential rehabilitation pathway. During a management meeting on 18 February 2025, a social worker told Mrs X and Mr Y that any deviation from the recommended pathway needed to be self-funded.
43. The Council explained to Mrs X and Mr Y that the level of therapy support at the Manor care home would not match the intensity at Sir John Mason House or the Grange. Mr Y decided to decline rehabilitation at the Grange and chose to move to the Manor care home on a self-funded basis to be with his wife.
44. The Council said it assessed Mr Y on 10 April 2025 at the Manor care home. It decided he could not be supported at home due to the absence of care between visits, posing significant risks. The recommendation was for Mr Y to remain in 24-hour care, subject to financial assessment.

Analysis

45. Before going into hospital, Mr Y did not have a package of care or any assessed care and support needs. Following surgery, the Council did not initially assess Mr Y as needing permanent residential care. It was determined Mr Y needed rehabilitation to help him regain mobility and independence, with the aim of returning home. The rehabilitation pathway was for Mr Y to stay at Sir John Mason House, which is a centre providing time-limited rehabilitation and reablement support for people recovering from illness or injury, helping them regain independence and confidence before returning home.
46. Unfortunately, Sir John Mason House had a waiting list. Mr Y was therefore discharged to the Grange, which is a reablement centre, temporarily.
47. Mr Y did not know how long he would have to wait at the Grange. He has been married for many years and acts as carer for his wife, who suffers from dementia. Mr Y’s wife went into respite care at the Manor care home while Mr Y was in recovering from surgery. Mr Y was understandably anxious to be reunited with his wife and was concerned by the time he would be apart from her while he waited for a bed to become available at Sir John Mason House. He wanted to move in with his wife at the Manor care home.
48. The Manor care home specialises in supporting people with dementia, mental health conditions, physical disabilities, and sensory impairments. The Council did not consider this was suitable for Mr Y’s recovery as it could not provide the focused rehabilitation he needed.
49. The Council told Mr Y and Mrs X that Mr Y would have to self-fund his care at the Manor care home if he were above the financial threshold. The Council also said it may not support him even if he were below the threshold, as he chose to give up his rehabilitation pathway.
50. I did not see any evidence the Council told Mr Y or Mrs X that it would fund Mr Y’s move to the Manor care home.
51. Mrs X told me Mr Y deteriorated at the Manor care home because his needs were not being met and staff were not properly trained. This is why the Council wanted Mr Y to go to Sir John Mason House for his rehabilitation.
52. I appreciate the reason why Mr Y wanted to move to the Manor care home, but this was not like for like care. Mr Y does not have dementia, and the Manor was unable to provide the level of physiotherapy or rehabilitation support he needed.
53. The Council assessed Mr Y needed 24-hour residential care in April, after a report from Mrs X that his needs had changed. Mr Y’s care at the Manor was Council commissioned from that point and subject to financial assessment. The Council then assessed the amount Mr Y must contribute towards the cost of his care and invoiced him for this.
54. I did not find fault in the Council’s actions. Mr Y’s rehabilitation was due to be funded by the NHS, not the Council. When Mr Y chose to give up the rehabilitation pathway the Council warned him he would have to self-fund. I have seen no basis on which I could say the Council should or must fund Mr Y’s care at the Manor when he chose not to follow the NHS funded rehabilitation pathway, particularly in circumstances where Mr Y went into a care home which was not suitable to meet his rehabilitation needs at the time.

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Final Decision

55. I found the Council was not at fault for refusing to fund Mr Y’s care when he chose not to stay on the rehabilitation pathway.

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Investigator's decision on behalf of the Ombudsman