Summary: Mrs X complained the care home told her that her late mother Mrs Y could not leave until she was authorised to do so by the Council. There is no evidence the care home prevented Mrs Y from leaving. It delayed billing Mrs X for Mrs Y’s care but this delay was not due to fault by the care home.

The complaint

1. Mrs X complained the care home told her that her late mother Mrs Y could not leave until she was authorised to do so by the Council. She said this meant Mrs Y was prevented from leaving and was charged for care she did not want. Mrs X also complained the care home did not bill Mrs Y for the care until five months after she left the care home and did not issue her with a contract, so they lost the opportunity to dispute the charges at the time.

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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. 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

3. I considered evidence provided by Mrs X and the care provider as well as relevant law, policy and guidance.
4. I gave Mrs X and the care provider an opportunity to comment on a draft of this decision. I considered any comments before making a final decision.

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What I found

Relevant law and guidance

Continuing healthcare funding

5. Continuing healthcare funding (CHC) is a package of ongoing care that is arranged and funded by the NHS where a person has been assessed as having a ‘primary health need’. Fast track CHC is an assessment of eligibility for funding when someone’s health is deteriorating rapidly. A person may receive fast-tracked CHC is they have a rapidly deteriorating condition that may be terminal.

Funded nursing care

6. NHS-Funded Nursing Care (FNC) is the funding provided by the NHS to care homes providing nursing, to support the cost of nursing care delivered by registered nurses. This is over and above the cost of the residential care provided within the care home.

Paying for care

7. When a council arranges a care home placement it must follow the charging rules for residential care are set out in the Care and Support (Charging and Assessment of Resources) Regulations 2014 to decide how much a person must pay towards their care costs. Those who have over the upper capital limit of £23,250 must pay the full cost of their residential care. If care is not arranged by the council and is paid for direct by the resident the resident is known as a self-funder.

What happened

8. Mrs Y was unwell and in hospital. She wanted to go home and in late August 2023 was discharged home under a CHC fast track end of life care package. Mrs X lived in a different council’s area but moved in with Mrs Y to care for her. Mrs X says Mrs Y was discharged from hospital with a pressure sore. Mrs X says during her time at home Mrs Y’s health improved and she started to eat and drink more.
9. In September 2023 Mrs Y’s electrics blew during the night. Mrs Y used an airflow mattress which deflated as a result. The NHS arranged an urgent respite care home placement.
10. The palliative (end of life) care nurse visited Mrs Y in early October. When asked about the care the notes record Mrs Y said she ‘likes to stay here’.
11. In November 2023 an NHS multi-disciplinary team meeting reviewed Mrs Y’s placement at the care home and funding. The outcome of the meeting was that fast track CHC funding would end in late November and Mrs Y was eligible for funded nursing care. A council social worker completed a needs assessment which recommended Mrs Y receive 24 hour nursing care.
12. Following the meeting a social worker spoke to Mrs X and told her Mrs Y would need to self-fund her care because of her savings. They noted Mrs X wanted Mrs Y to move in with her and was not happy that Mrs Y would have to pay for the care. Mrs X says she did not say she was not happy to pay for the care but that she would not pay as Mrs Y did not want or need to be there.
13. The care home says it received no documentation to confirm the fast track funding had ended. It said any documentation sent to Mrs Y was not opened by the care home but given to Mrs X. It said Mrs X did not tell it that Mrs Y’s CHC funding had ended and that she needed to self-fund the care. It said if Mrs X had told it, it would have issued Mrs Y with a contract.
14. In early December 2023 a nurse reviewed Mrs Y at the care home due to an unresponsive episode and her low mood. Within the nurse’s record they noted Mrs Y liked her room but wanted to go and live with her daughter. They noted they were waiting for a further plan for the move and to ensure a care package was arranged.
15. In mid December 2023 a nurse carried out a tissue viability assessment. They noted Mrs Y’s wound was healing. They also noted Mrs Y and her daughter wanted her to move back home ‘at present this was taking a long time to arrange due to obstacles and delay – nursing team assisting with this’. Around this time Mrs X told the care home manager she felt like just taking Mrs Y home in a taxi. The care home manager says they told Mrs X if she did they would have to report a safeguarding concern due to Mrs Y care and medical needs. Mrs X disagrees. She says she was told they would be prevented from leaving and that both she and the care home manager would be in big trouble if Mrs Y left.
16. In late January a social worker visited Mrs Y and was satisfied Mrs Y was able to make her own decisions and she wanted to go and live with her daughter. In early February 2024, Mrs Y left the care home and moved in with Mrs X. She died later that year.
17. In June 2024 the care provider contacted the NHS to enquire about Mrs Y’s funding. It said it had received full funding up to the end of November 2023 but then only the funded nursing care element. It asked who was responsible for her funding from November 2023 to February 2024. The NHS referred the care provider to the Council who confirmed Mrs Y was self-funding following the ending of her CHC funding.
18. In July 2024 the care provider sent Mrs X an invoice for Mrs Y’s stay at the care home. Mrs X emailed the care home and said the contract was between the Council and care home. She said they were not told the cost or terms and conditions and did not accept that Mrs Y was responsible for paying the debt. In a further email she said the care home had detained Mrs Y against her wishes and there was no agreement she would cover the cost.
19. The care home responded in September 2024. It said it had not detained Mrs Y against her will. It said Mrs Y received residential and nursing services which were agreed with all parties and the money remained owed.

Findings

20. The records show Mrs Y received appropriate care at the care home. The records show she was generally calm and settled and did not object to being there. There is no evidence Mrs Y was detained by the care home against her will. Mrs Y wanted to leave and go to live with her daughter but any delay in Mrs Y leaving the care home was not due to fault by the care provider.
21. The records show the Council told Mrs X that Mrs Y was responsible for self-funding her care. However, the care provider was not aware of this until June 2024 when it contacted the Council. It therefore could not have issued a contract or invoices any sooner. It was not at fault for the delay in issuing the invoices.

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Decision

22. I have completed my investigation. There is no evidence of fault causing injustice by the care provider.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman