Summary: Mr X complained about the way the Council dealt with his mother’s care and support following a stay in hospital. We found the Council at fault for delay in deciding a financial assessment and Disabled Facilities Grant application for Mr X’s mother. The Council agreed to apologise and to make a payment in recognition of the injustice caused. We did not find any evidence of fault by the Council in the other matters raised in the complaint.

The complaint

1. Mr X complained on behalf of his mother, Mrs Y about the way the Council dealt with her care and support needs following a stay in hospital. He complained the Council:

• made his mother leave hospital too soon;
• did not provide her with enough physiotherapy;
• did not refer his mother to the Falls Clinic or the Wheelchair Clinic;
• took too long to complete his mother’s financial assessment and did not tell her she would need to pay for her care before it began;
• took too long to consider his mother’s application for a Disabled Facilities Grant (DFG); and
• made the wrong decision that his mother is not eligible for a DFG.

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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 an injustice, 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 have:

• discussed the complaint with Mr X and considered information he provided;
• made enquiries of the Council and considered its response and documents its provided;
• considered the relevant government guidance and legislation and the Ombudsman’s guidance on remedies; and
• set out my initial thoughts on the complaint in a draft decision statement and considered Mr X’s comments in response.

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What I found

5. 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.
6. 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. On receiving an assessment notice, the council must assess the person’s care and support 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.
7. 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.
8. 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 for non-residential care

9. 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)
10. 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. A council must not charge more than the cost it incurs to meet a person’s assessed eligible needs.
11. 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)

Disabled Facilities Grants

12. Disabled Facilities Grants (DFG) are provided under the terms of the Housing Grants, Construction and Regeneration Act 1996 (the Act). There is also detailed guidance on good practice.
13. The Council will need to check the proposed works are:
• necessary and appropriate to meet the disabled person’s needs.
• reasonable and practicable depending on the age and condition of the property.
14. Councils will often consult an occupational therapist (OT) from the social services department to determine what is necessary and appropriate.
15. The maximum grant payable by the council is £30,000. A council can award other discretionary help if it thinks it is necessary. The council grant amount is subject to a means test.
16. The means test has three parts. The first is the Applicable Amount. This is how much it is assumed the applicant needs to live on each week based on their circumstances. The second part is the applicant’s income, which is the amount they receive every week from work, pensions and benefits plus any savings they have. The third part is the applicant’s contribution. An applicant will need to contribute if their income is greater than their Applicable Amount. If the applicant’s contribution would be more than the cost of the work the Council will not pay a grant.
17. The Act says housing authorities should approve or refuse a grant application as soon as reasonably practicable and no later than six months after the date of the application.

What happened

18. Mrs Y lives with her son in a house. She has type 2 diabetes, hypertension and glaucoma. She previously fractured her back in a fall.
19. In February 2021 Mrs Y was hospitalised following a fall which fractured her left femur.
20. Mrs Y was discharged in March 2021. Before leaving hospital, the Council assessed Mrs Y’s needs and a reablement care package was in place before she returned home. This consisted of help with her with personal care, meal preparation and transfers as she had restricted mobility.
21. A hospital bed, rotunda to help her with transfers and a commode were provided to Mrs Y as she could not use her bedroom or bathroom on the first floor of her home.
22. In April 2021 the reablement team assessed Mrs Y’s progress and found she would still need help when the reablement package ended. The assessment said a referral for a financial assessment, to see if Mrs Y would need to contribute to the cost of her care, would be requested and that her daughter should be contacted to arrange her ongoing care.
23. The assessment also said Mrs Y could not leave her home because she could not negotiate steps at both the front and back entrance and this was negatively impacting her wellbeing.
24. In May the Council assessed Mrs Y’s needs and issued a care and support plan. Her care transferred to a private provider later that month. A referral was requested for an Occupational Therapy (OT) assessment to provide a ramp to the front of Mrs Y’s home and for adaptations to provide bathing and toileting facilities.
25. In June a referral was made for a financial assessment for Mrs Y.
26. In July an OT assessment took place. It recommended installing a stairlift and adapting the first floor bathroom to provide a level access shower. It also said Mrs Y’s family would contact her doctor to make referrals to the Wheelchair Clinic and Falls Clinic.
27. Mr X was unhappy with the recommendation because when Mrs Y returned home an OT told him it was not safe for his mother to go upstairs. He said his mother had experienced falls since returning home and a stairlift would be unsafe. The Council made a referral for an assessment of Mrs Y’s case by an Advanced Practitioner. It gave the referral a high-risk score because Mrs Y could not access suitable bathing facilities.
28. Also, in July the Council completed Mrs Y’s financial assessment and found she had enough income to pay for her care. The Council sent her backdated invoices for the cost of her care following the end of the reablement package.
29. In October a further OT assessment was carried out. During the assessment Mr X raised concerns that his mother was not receiving enough physiotherapy and that he had not heard back from the Falls Clinic.
30. Following the assessment, a means test letter was sent to Mrs Y to see if she would meet the criteria for a Disabled Facilities Grant. The OT also made referrals to the Falls Clinic and the physiotherapy service.
31. In October Mr X complained to the Council about delays in considering the adaptations for his mother’s home. The Council responding saying it was considering the request.
32. In January 2022 another OT assessment took place. It recommended a ground floor level access shower room and a ramp for the front entrance of Mrs Y’s home.
33. In February the Adaptations Panel agreed the recommendations.
34. Also, in February the Council began a means test assessment to see if Mrs Y meet the criteria for a DFG.
35. In March the Council completed the means test, following receipt of the necessary information, and it found that Mrs Y did not meet the criteria for a DFG.
36. Mr X was unhappy with the Council’s decision on the DFG, the result of her financial assessment and delay by the Council in these matters. It responded saying it had assessed Mrs Y’s financial contribution for her care costs in line with relevant legislation. It denied that it had taken too long to handle matters and said the DFG took longer because Mr X disputed the first recommendation for a stairlift.
37. Mr X remained unhappy and approached the Ombudsman. He also contacted a charity to see if it could help his mother with the cost of adaptations for her home.

Analysis

38. Mr X says his mother was discharged from hospital too soon. The hospital decided Mrs Y was fit for discharge from hospital, not the Council. The Council completed the required assessment and put in place a reablement package to meet her needs from the date she left hospital and for the maximum six weeks thereafter.
39. The NHS provides Mrs Y’s physiotherapy and so the Council is not responsible for its delivery. The Council told the physiotherapy service about Mr X’s concerns after he raised them as part of the OT assessment.
40. Mr X says the Council did not act to prevent his mother missing medical appointments. I have not found any reference in Mrs Y’s care records suggesting that Mr X asked the Council for help with this matter. Moreover, it is not the Council’s role to provide hospital transport. The NHS provides patient transport.
41. Mrs Y’s care records show that Mr X said he would speak to his mother’s doctor to arrange referrals to both the Wheelchair and Falls Clinics. When Mr X told the Council, as part of the October 2021 OT assessment, that he had not heard from either the Council followed up his concerns with the relevant services. I am satisfied the Council took the suitable action.
42. Mr X says his mother was unaware she would need to pay for care once her reablement package ended. The Council did not complete the financial assessment for Mrs Y until July. I therefore agree that Mrs Y was unaware of the contribution she would need to make for her care when it began.
43. However, Mrs Y needs the care provided and has continued with the care package since learning she would need to pay the full cost of her care. Therefore, I cannot say that Mrs Y would have chosen not to have the care had she known the cost before it began and so I do not see the delay caused her a significant injustice.
44. I have found no evidence of fault in how the Council considered Mrs Y’s financial assessment. Its calculations show that it applied the correct disregards, as set by the government, to her weekly income including the Minimum Income Guarantee.
45. A referral to the OT was made in May 2021. The first OT recommendation was made in July. The guidance says councils should aim to take 20 working days to do this. The Council took longer. This is fault.
46. The OT completed its recommendation in February 2022, nine months after receiving the referral. I recognise the process took longer because Mr X challenged the first assessment and so more information was needed. However, I do not see why this took six months especially as Mrs Y’s case was given a high-risk score when referred to the service and there was no significant change to her mobility during this period.
47. The law says councils must approve or refuse a DFG grant within six months of receiving it. Mrs Y’s referral was made in May 2021 and so her application should have been decided by November 2021. A decision was made in March 2022, four months after the six-month deadline.
48. The delay caused Mrs Y an injustice even though the Council decided Mrs Y was not eligible for a DFG. She was left waiting to know the result of her application in accommodation which, as identified in the Council’s own assessments, was having a negative impact on her physical and mental wellbeing. If the Council had completed the DFG process sooner, then Mrs Y would have been able to consider alternative funding options such as the charity Mr X contacted after the Council’s decision.
49. Mr X says the Council made the wrong decision that his mother is not eligible for a DFG. He says it has not considered the amount Mrs Y is paying towards her care costs. However, this expense is not something the Council can consider. It can only disregard the Applicable Amount from an applicant’s income, which the Council did.

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Agreed action

50. Within four weeks of my final decision the Council will:

• Apologise to Mrs Y in writing for the failings identified; and
• Pay her £800 in recognition of the injustice caused to her by the delay in deciding the DFG application. This comprises of £200 per month for the period December 2021-March 2022.

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Final decision

51. I have completed my investigation and uphold Mr X’s complaint. There was fault by the Council which caused injustice to Mrs Y. Although Mr X does not agree with my decision, I am satisfied the action the Council will take is sufficient remedy for the injustice caused to Mrs Y.

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Investigator's decision on behalf of the Ombudsman