Summary: Mr X complained Healthcare Homes Limited is pursuing him for care home fees even though he never signed a contract, it provided verbal assurances that he did not owe any money and it did not bill him for five months. Mr X says the actions taken to pursue the debt have caused distress and will lead to financial hardship. Healthcare Homes limited showed a lack of professional curiosity in respect of how Mr X’s placement was funded and wrongly assumed a local authority was paying. A suitable remedy is agreed for the injustice caused by this fault.

The complaint

1. Ms Z, on behalf of Mr X, complained Healthcare Homes Limited (the Care Provider) is pursuing him for a debt related to care home fees even though he never signed a contract and it did not bill him for five months and providing assurances from managers that there was no cost to him for his stay.
2. Mr X says the actions taken to pursue the debt have caused distress and will lead to financial hardship.

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The Ombudsman’s role and powers

3. The Ombudsman investigates complaints about adult social care providers and decides whether their actions have caused an injustice, or could have caused injustice, to the person making the complaint. I have used the term fault to describe such actions. (Local Government Act 1974, sections 34B and 34C)
4. 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

5. As part of the investigation, I have:
• considered the complaint and the documents provided by the complainant;
• made enquiries of the Care Provider and considered the comments and documents it provided;
• discussed the issues with the complainant;
• sent my draft decision to both the Care Provider and the complainant and taken account of their comments in reaching my final decision.

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What I found

Discharge to assess funding

6. Discharge to assess is funding is provided to people who cannot go home straight from hospital. It supports people to leave hospital and into a residential setting where their care and assessment can continue out of hospital. This is NHS funding and is time limited, normally a period of two to six weeks.

Key facts

7. Mr X was admitted to hospital in August 2021 due to a fall causing a fracture. Other health concerns required him to stay in hospital for a period of time for tests and observations. While in hospital, Mr X was informed he would have to leave the accommodation he had been living in as the property owner needed to sell it to pay for their own residential care. Mr X was medically fit for hospital discharge on 12 August but there were concerns about his fluctuating mental capacity.
8. A mental capacity assessment was completed which found Mr X was unable to demonstrate insight into his care needs. It was decided he needed a short term interim residential care placement with a long term plan to move to sheltered accommodation. It was agreed to fund the placement using NHS Discharge to Assess funding.
9. Mr X moved into Hillcroft House Care Home on 2 September 2021. The funding was to end on 30 September and so an assessment was carried out by a social worker on 29 September. The assessment found that Mr X did not require a residential care home placement but he agreed to remain there until his family was able to arrange suitable accommodation for him. The social work case notes state it notified Mr X’s family that he would be a self-funder after 30 September and they would need to discuss payment with the care home.
10. On 3 December 2021, the Care Provider emailed the Council about payments for Mr X’s placement. They detailed the two payments received and asked the Council to confirm payment from 2 October at the rate of £800 per week. It says it did not receive any response from the Council.
11. On 3 February 2022, the Care Provider emailed the social worker asking for an update regarding Mr X’s placement saying he had been there a long time and he should not be in a dementia setting. The Council responded the same day updating the situation regarding housing for Mr X and also stated that as the placement was not funded by the Council, the family could consider placements elsewhere if that was their choice.
12. The Care Provider emailed back asking about current funding for Mr X’s placement. The Council said that he was privately funded following the expiration of the NHS Discharge to Assess funding on 30 September 2021. The social worker confirmed that when she visited Mr X on 24 September at the care home that she advised staff that Mr X’s placement would be privately funded from that date and to liaise with the family. The Council said it did not know who would be responsible for sending a “cessation letter” because this was NHS funding.
13. The Care Provider accepts that managers within the home told Mr X, when he asked about the cost of his placement, that he did not owe Healthcare Homes any money. However, on 17 February, following the above communications with the Council, it wrote to Mr X saying it had received notification from Suffolk County Council that he was not entitled to be local authority funded from 30 September 2021. It included an invoice requesting payment of £21,571.42.
14. Mr X immediately gave notice to leave the care home as he was unable to pay the £800 per week the home was expecting him to pay. Mr X left the care home in March. Mr X has paid for the period from 17 February, when he was notified his stay was chargeable, until he left in March.
15. Mr X sought assistance from Ms Z, a CAB advisor. She acted on his behalf to make a formal complaint to the Care Provider about the charges. She said that Mr X had not signed a contract for the care, that the home had not only never notified him of the charges from 1 October until 17 February but that when asked directly, staff had told him he did not owe anything.
16. The Care Provider responded to Mr X’s complaint on 18 July 2022. It said that when admitted to Hillcroft House, his placement was funded by Suffolk County Council at a weekly rate of £800. It said that the Council had informed Mr X and his daughter that funding would cease on 30 September. It apologised that managers had told him he did not owe any money saying they mistakenly believed that the Council was still providing funding. It suggested Mr X was aware he ought to be paying privately for his care after 30 September. It said that no-one had paid for the care provided to him and that under the Consumer Rights Act 2015, a recipient of services and goods should pay a reasonable price for the services and goods received. It asked Mr X to pay the outstanding amount of £15,885.71.
17. Dissatisfied with the situation, Ms Z complained on behalf of Mr X to the Ombudsman.

Analysis

18. The information provided in this case shows that the Care Provider did not make any agreement with Mr X regarding the cost of his placement following the cessation of the NHS Discharge to Assess funding on 30 September. It seems to have assumed the Council was paying the full cost. It says it received notification from the Council which did not include any end date or indicate this was NHS funding.
19. I consider there was a lack of professional curiosity by the Care Provider in this case. The emails dated 1 September 2021 between it and the Council are very informal and limited to only confirming a rate of £800 per week. It was known that this was a temporary placement and that Mr X did not require the level of care provided. While the Care Provider contacted the Council in December about the funding, it did not follow this up until February and there is nothing to suggest it ever discussed finance with Mr X or his family directly. I consider the Care Provider allowed the situation to drift. As a care business, it should have mechanisms in place to ensure it receives payments for the care it is providing whether from the resident or the Council.
20. The Care Provider says staff have no recollection of the social worker relaying information about funding during her visit on 24 September. However, it suggests that the social worker advised Mr X on the same date that he was to be a self-funder and Mr X did not mention this to the care provider. It is clear that Mr X did ask managers about the cost of his placement on more than one occasion and was told he did not owe anything. I therefore consider that Mr X, an elderly man with unclear mental capacity, did raise this with the Care Provider and it answered based on incorrect assumptions and without making any enquiries to clarify the true situation. This is fault.
21. As a result, Mr X continued to incur charges of £800 per week for a level of care which is agreed by all parties, he did not require. When he found out on 17 February that he was expected to pay £800 per week, he immediately gave notice to leave the care home. I note that Mr X has accepted the charges from 17 February until the date he left and has paid the care home in full. Based on these actions, I am satisfied that if Mr X had known sooner of the charges, he would have looked to make alternative, more affordable living arrangements. However, I also accept the Care Provider’s argument that it has provided accommodation, heating, food, laundry and care for Mr X that it has not received any payment for. I consider Mr X should make a payment for the services he received but not the full cost of £800 per week.

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Agreed action

22. To remedy the injustice caused to Mr X as a result of the fault identified in this case, Healthcare Homes Limited will, within one month of my final decision, take the following action:
• Reduce the amount owed by Mr X for the period from 1 October 2021 to 16 February 2022 by 50% and send Mr X an invoice for this new amount. If Mr X is not able to pay the amount in full, the Care Provider should agree a repayment scheduled based on what is an affordable monthly payment; and
• Review its procedures to ensure that both it and residents are clear about charges when they enter the care home and that this is properly recorded.
23. The Care Provider should provide us with evidence it has complied with the above actions.

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Final decision

24. I have completed my investigation with a finding of fault for the reasons explained in this statement. The Care Provider has agreed to implement the actions I have recommended. These appropriately remedy any injustice caused by fault.

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Investigator's decision on behalf of the Ombudsman