Summary: The Council is at fault for failing to be clear about whether the services it provided were chargeable. The Council is also at fault for delays in invoicing and complaint handling. These faults have caused Mrs C frustration and uncertainty. The Council has agreed to remind officers about the importance of clearly explaining whether services are chargeable especially when leaving hospital. It will also review how it deals with complaints to avoid delay.

The complaint

1. For anonymity I refer to the complainant as Mrs C, and her late mother as Mrs D.
2. Mrs C complains the Council inappropriately charged Mrs D for services after an officer had told her she would receive free intermediate care. It also delayed in sending a bill for the charges and in responding to her complaint.
3. Mrs C says that she has had time, trouble, and frustration in dealing with the complaint; and her mother’s estate has suffered a financial loss.

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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 an injustice, we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
5. We may investigate a complaint on behalf of someone who has died or who cannot authorise someone to act for them. The complaint may be made by:

• their personal representative (if they have one), or
• someone we consider to be suitable.

(Local Government Act 1974, section 26A(2), as amended)

6. If we are satisfied with a council’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

7. I read Mrs C’s complaint and written information she provided. I spoke with Mrs C and discussed her complaint. I asked the Council questions and for documentary evidence.
8. In addition I considered:-
• the Council’s response to my enquiries;
• Care Act 2014 and the associated Care and Support Statutory Guidance (CASS).
9. Mrs C and the Council have had an opportunity to comment on a draft decision. I have considered any comments made before making a final decision.

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What I found

What happened

10. Mrs D had several health problems. She went into hospital. The Council supported her to look at options on leaving hospital which included returning home or going into a care home.
11. On 2 March 2018 the Council held a meeting. The collective view was for Mrs D to have short-term care. The care records say,

“Family feel STP is appropriate at this time, but agreed that this would be with the provision of rehab services to monitor/assess progress and ongoing need”.

12. Mrs C and the Council are in dispute about what was said at the meeting. Mrs C says the social worker told three relatives, including a clergyman and a retired health professional, that the Council would provide free residential reablement services. This was to facilitate improved mobility so Mrs D could return home. Mrs C says this is what happened, and all the relatives can corroborate what the social worker said.
13. The Council records say,

“Age UK referral completed, explained that placements and services provided by ASC are means tested and chargeable – I did not have any brochures to give them”. (ASC – Adult Social Care)

14. Mrs D entered a care home on 5 April. In Mrs C’s view this was to receive free residential intermediate care for six weeks. Following a referral a community physiotherapist supported Mrs D. On the same day the Council records it sent out a financial assessment form. Soon after, the Council sent Mrs D an invoice setting out the charges. It billed Mrs D the full amount of the care costs. On receipt of the invoice Mrs C spoke with the Council disputing the charge as the Council had told her the care would be provided for free.
15. Mrs C says she received information from Age UK which included information about assessed charges and free intermediate care.
16. Mrs D received another invoice dated 18 April 2018. On the same day Mrs C wrote a formal complaint reiterating her concerns. Mrs C also disputed the amount charged. The Council’s letter based Mrs D’s charge on the assumption that she had more than £23,250 in savings and that she had failed to complete a financial assessment. Mrs C says she did not receive a financial assessment as the Council had sent it to Mrs D’s empty home address. The Council also failed to update the financial assessment when it was aware Mrs D had less than £23,250 in savings.
17. The Council acknowledged Mrs C’s complaint on 1 May 2018.
18. On 15 May 2018 Mrs D returned home with a care package. There was no charge for this care as it was part of a reablement package known as the “Reach Service”.
19. Some time later Mrs D was readmitted to hospital and went into permanent residential care in September 2018.
20. The Council responded to Mrs C’s complaint on 17 October 2019. It accepted there were faults in the invoices that it sent. It said it would review the standard letters it sent out and apologise.
21. The Council said the social worker told the family services were chargeable and following a referral, Age UK provided Mrs C with an information pack which also included information about paying for care. The Council said this was further evidence the family were aware the care was chargeable. Mrs C says this was a general leaflet and included both chargeable and non-chargeable services.
22. Mrs C and her three siblings were upset by the response as they received it six days after their mother had died, and 18 months after the original complaint.

What should have happened

23. CASS says where a local authority arranges care and support to meet a person’s needs, it may charge the adult, except where it is required to arrange care and support free of charge. The local authority must not charge for certain types of care and support which must be arranged free. This includes reablement, which must be provided free of charge for up to six weeks.
24. Paragraph 2.14 of the guidance says “‘Intermediate care’ services are provided to people, usually older people, after they have left hospital or when they are at risk of being sent to hospital. Intermediate care is a programme of care provided for a limited period of time to assist a person to maintain or regain the ability to live independently – as such they provide a link between places such as hospitals and people’s homes, and between different areas of the health and care and support system – community services, hospitals, GPs and care and support.”

Was there fault causing injustice?

Information provided about charges

25. The social worker records he told those at the meeting that Council services were chargeable. This is at odds with what Mrs C, and others present, recall. They say the social worker told them there would be no charge for the services. I cannot say that either record is untrue. It is likely there was discussion about different types of care available some chargeable, others not.
26. The Council says the short-term stay was chargeable. However it is unclear whether the Council provided enough information and explanation to Mrs C. The Council relies on information provided by Age UK. However the information from Age UK included information about chargeable and non-chargeable services. It was not specifically aimed at Mrs D. So Mrs C would have been none the wiser.
27. I consider the failure to provide Mrs D and her family with clear information that services would be chargeable is fault. As a result Mrs D lost an opportunity to challenge whether she should receive free intermediate care.
28. The Council says Mrs D was not entitled to intermediate care as she had no reablement needs. However it is unclear how the Council made this decision. From the information I have available it appears that Mrs D needed a short term placement, where she could receive reablement and to assess whether she could return home or needed to enter a care home permanently.

Invoicing

29. The Council has accepted that it delayed in completing a financial assessment. It also accepts standard letters sent to Mrs C saying Mrs D would have to pay the full cost of her care were wrong. It agreed to review the wording of these letters and to apologise.
30. I consider these actions are appropriate to remedy this element of the complaint.
31. Mrs C says she did not receive a financial assessment and invoice as they were sent to Mrs D’s home address, some 15 miles from where she lives. To avoid this from happening to others, I suggest the Council asks people at the point of assessment about a correspondence address.

Complaint handling

32. The Council took 18 months to respond to Mrs C’s complaint. During this time it did not update her or provide any information about the reason for the delay. This is fault. As a result Mrs C has had the frustration, time, and trouble in pursuing the complaint.
33. The Council’s response reached Mrs C a few days after the death of Mrs D which caused her and her siblings distress. I do not consider the Council acted out of malice, and it has apologised for the timing of the letter. I consider this is appropriate to remedy this part of the complaint. I would however suggest that in future officers are sensitive to the timing of letters especially when there has been a bereavement.

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Agreed actions

34. I have found fault causing an injustice. The Council has agreed to take the following actions to remedy the complaint:-
1. to apologise to Mrs C for the failures I have identified within this statement and for the errors made in invoicing;
2. pay Mrs C £150 for the frustration caused by the delay in complaint handling;
3. review Mrs D’s care records to assess whether she should have received intermediate care for a six week period following her hospital discharge. An officer with no previous involvement with the case, and preferably from another Council, should complete the review. If the review concludes Mrs D would have been eligible for intermediate care to waive the charges for the according six week period;
4. provide the Ombudsman with evidence of the revised letters/processes to ensure those chargeable are not provided with incorrect or conflicting information;
5. review how information about charging is provided to avoid misunderstanding about care fees;
6. review how the Council dealt with this complaint to avoid long response delays in future;
35. The Council should complete (a) to (c) within a month of the final decision and (c) to (f) within three months of the final decision.

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Final decision

36. I have found fault causing injustice. I consider the agreed actions are suitable to remedy the complaint. I have now completed my investigation and closed the complaint.

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Investigator's decision on behalf of the Ombudsman