Summary: Mr X complained the Council failed to tell his father about charges for a short term residential care placement when he was discharged from hospital. We found the Council failed to provide clear and timely information which caused the family distress as they received an unexpected charge. The Council has agreed to apologise and, due to the particular circumstances involved in this case, waive the fees.

The complaint

1. The complainant, Mr X, complains about short-term residential care charges the Council is asking his father, Mr Z, to pay. Mr X says the Council failed to tell his father and family about charges when he was discharged from hospital in July 2024 under discharge to assess arrangements. Mr X says this caused the family distress as they were led to believe there would be no charge.

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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. 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. 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.
5. We may investigate complaints made on behalf of someone else if they have given their consent. (Local Government Act 1974, section 26A(1), as amended)
6. 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

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

Background

Hospital discharge

9. Schedule 3 to the Care Act 2014 and the Care and Support (Discharge of Hospital Patients) Regulations 2014 set out arrangements for the discharge of hospital patients with care and support needs. The NHS can claim money back from councils that have caused delays transferring patients. The NHS must issue a notice to the council where it considers an NHS hospital patient receiving acute care may need care and support as part of a transfer from an acute setting regardless of whether it intends to claim repayment.
10. The NHS should try to give the council as much notice as possible of a patient’s impending discharge. This is so the council has as much notice as possible of its duty to start a needs assessment. The Care and Support Statutory Guidance says local agreements should be in place between NHS bodies, councils and other relevant partners to set out each organisation’s responsibilities to achieve timely and safe hospital discharge.
11. On receiving an assessment notice, the council must assess the person’s care and support needs and (where applicable) those of a carer to determine whether it considers the patient and carer have needs. The council must then decide whether any of these identified needs meet the eligibility criteria. If so, it should confirm how it proposes to meet any of those needs. The council must inform the NHS of the outcome of its assessment and decisions.
12. To avoid any risk of having to pay back money, the council must start a needs assessment and put in place any care arrangements for meeting eligible needs before the ‘relevant day’. The relevant day is either the date when the NHS proposes to discharge the patient or the minimum period (two days after the council has received the assessment notice), whichever is the later.
13. The NHS body should tell patients and carers the discharge date at the same time as, or before the council does. Hospital staff may give the council early warning of when discharge is likely, to help their planning.

Discharge to Assess

14. Discharge to Assess (D2A) is a model whereby people with new or additional health and/or social care needs on discharge from hospital receive post-discharge recovery support, and where assessments of longer-term or ongoing needs (if required) are fully completed only once a person has reached a point of recovery and stability. As discharge to assess is underpinned by simple principles rather than rigid criteria, there is no fixed delivery model.

Intermediate Care and Reablement

15. 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.

16. 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)

Charging

17. The Care Act 2014 (section 14 and 17) provides a legal framework for charging for care and support. It enables a council to decide whether to charge a person when it is arranging to meet their care and support needs, or a carer’s support needs. The charging rules are set out in the Care and Support (Charging and Assessment of Resources) Regulations 2014 and councils should also have regard to the Care and Support Statutory Guidance.

Key events

18. The following is a summary of key events. It does not include everything that happened.
19. Mr Z had previously received support at a reablement hub between 17 April and 2 June 2024 following a hospital admission. This discharge was on a reablement pathway and not a discharge to assess (D2A) pathway. Therefore, there was no charge incurred for the support at this placement.
20. Mr Z was subsequently admitted again to hospital in June 2024 following a fall at home. The hospital recommended Mr Z required a D2A residential placement to support his discharge for up to 28 days or until the completion of a needs assessment.
21. Mr Z was discharged to a care home placement on 24 July.
22. The Council met with Mr Z on 20 August to complete a needs assessment. It is recorded that his named daughter and son had a Lasting Power of Attorney but Mr Z confirmed he was happy to update his three children with information. It was noted Mr Z had been admitted to hospital on a significant number of occasions during the previous 12 months. It is also recorded that Mr Z had been given a charging leaflet. The Council says the charging leaflet referred to here was one provided to Mr Z on 16 November 2023. The Council has a record dated 17 November 2023 that the leaflet was discussed with Mr Z. There is no record that this assessment document was shared with Mr Z’s family.
23. The Council contacted Mr Z’s family on 21 August following the above assessment and explained the outcome was that he no longer met the criteria for residential care. It was agreed Mr Z would require a package of care and some community support such as a day centre to meet his eligible care needs to support his return home.
24. There are two notes dated 2 September of contact with Mr Z’s daughter. The first is timed at 10.20am and sets out her concern about her father following a visit that he was likely to fall and end up back in hospital if he returned home. A further note timed at 12.11pm says the social worker advised Mr Z’s daughter that a financial assessment would be carried out from the date of the assessment to determine any costs towards Mr Z’s care while he was still residing at the care home. Mr Z’s daughter disputes that she was advised that any charges would apply for the short term placement.
25. The Council says it identified a package of care to support Mr Z’s return home on 11 September.
26. There is a note recorded on 12 September that Mr Z’s daughter had spoken to him about returning home and was arranging a visit on the Saturday with the move home to take place on Sunday. She asked for the care package to start on Sunday afternoon. The Council explained care packages did not start at the weekend and so the care package would be put in place from Monday 16 September.
27. The Council contacted the home on 16 September to check Mr Z had returned home but the home advised this had not happened as he had been overwhelmed following a visit home on Saturday with his daughter. Mr Z’s daughter discussed the possibility of Mr Z staying longer at the care home for some rehabilitation towards going home as she was worried about how he would cope. There is a record that the Council left a message the same morning stating it would not be able to fund Mr Z’s bed at the residential home as no 24 hour care needs had been identified. There was the option to self- fund the placement if that is what Mr Z wanted.
28. Mr Z returned home on 16 September.
29. The Council wrote to Mr Z care of Mr X on 8 October. The letter enclosed a financial assessment form for completion within one month of the date of the letter. The letter highlighted that if no financial information was provided it would consider Mr Z was agreeing to pay the full cost of the placement.
30. The Council completed a Care and Support Plan dated 21 October for Mr Z. This records that the charging policy was discussed with Mr Z’s daughter on that date.
31. The Council sent a reminder on 29 October for the financial assessment form to be returned within 14 days. Mr X contacted the Council on 5 November to say he had received a financial assessment form to complete for a bill he had not been told about at the time.
32. The Council wrote to Mr Z care of Mr X on 14 November. This confirmed Mr Z would be responsible for the full cost of his care for the period 20 August to 15 September 2024. This was because no financial details had been provided. The cost was currently £687.91 per week.
33. Mr X complained to the Council on 14 November 2024. The Council responded to Mr X’s complaint on 26 February 2025. It concluded that Mr Z and his family were properly informed of his discharge to a care home and that Mr Z had capacity and had consented to the discharge plan. However, the Council also accepted it had not provided appropriate information about the D2A care home placement ie that it was non-chargeable for up to 28 days or to the date of the completion of a needs assessment. The Council acknowledged this had caused the family uncertainty and apologised. However, the Council did not consider this caused a financial loss as the D2A placement was non-chargeable and no charges were incurred during that period. The Council noted the needs assessment was completed within 28 days but there was a delay of 13 days from the date of the assessment until it advised the family that Mr Z may need to pay a contribution towards the cost of his care. The Council apologised for this delay. The Council also offered a £50 time and trouble payment for the delay in receiving a complaint response. The Council confirmed it had issued a reminder to the relevant team about the need to provide clear communication to patients and their families including about the D2A pathway and any financial implications.

My analysis

34. The Council has highlighted that Mr Z had been previously informed that care services may incur a charge, subject to a financial assessment, and charges could apply to services either in the community or in a care home. Therefore, the Council’s position is that Mr Z was aware he would potentially need to contribute towards any support arranged by the Council and this would be dependent on the outcome of a financial assessment. The Council considers any injustice caused to Mr Z and his family by its accepted fault was uncertainty about the specific charge payable. However, I note the charging information had been provided in 2023 under different circumstances.
35. The Council accepts in the complaint correspondence that the D2A process and financial implications (ie that it was non-chargeable for up to 28 days or until completion of a longer term needs assessment) were not fully explained to Mr Z or his family at the relevant time. The Council’s position is that the family were told in a telephone call on 2 September there would be a charge from 20 August although the family disputes this.
36. In any event, this information would be 13 days after the D2A non-chargeable period ended. It is also unlikely the family would have been able to move Mr Z on 2 September as the Council did not finalise the care package until 11 September.
37. The fact that the family sought a short delay to 16 September for Mr Z to return home would also suggest they did not understand the stay was now chargeable. Such a belief would have been compounded by the previous placement following a hospital discharge being non-chargeable as it was made on a reablement basis. This is not a distinction I would expect the family to understand unless they were properly advised at the relevant time which they were not.
38. We do not normally consider it to be appropriate to recommend a council ‘waive’ or reimburse payments for care that has been received. This is because, the person received the care and should be assumed to have expected to make some contribution, unless there is evidence of misleading advice. We would instead usually recommend a symbolic payment. However, in the particular circumstances of this case, I consider the waiver of fees (or reimbursement if paid) is a proportionate and reasonable remedy.
39. I note the Council has already issued a reminder to relevant staff about the need to provide clear communication to patients and their families including about the D2A pathway and any financial implications. Therefore, I have not made any additional service improvement recommendations.

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Action

40. The Council will take the following action within one month of the date of my final decision:
1. apologise to Mr X and Mr Z for the failure to provide clear and timely information about Mr Z’s discharge to assess placement and that this would only be non-chargeable for up to 28 days or the date of the completion of a needs assessment;
2. waive the fees charged for the period 20 August to 15 September 2024; and
3. make the £50 time and trouble payment for the delay in its complaint handling offered in the complaint correspondence if this has not already been paid.
41. We publish guidance on remedies which sets out our expectations for how organisations should apologise effectively to remedy injustice. The organisation should consider this guidance in making the apology I have recommended in my findings.
42. The Council should provide us with evidence it has complied with the above actions.

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Decision

43. I find fault causing injustice. The Council has agreed actions to remedy injustice.

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Investigator's decision on behalf of the Ombudsman