Summary: Mr X complained the Council wrongly charged his mother, Mrs Y, for a period of reablement care which should have been free for up to six weeks. We found fault by the Council for charging Mrs Y for this care. The Council agreed to remove the charges for this period, apologise to Mr X and Mrs Y and make them a symbolic payment in recognition of the avoidable worry and time and trouble caused to them.

The complaint

1. Mr X complained on behalf of his mother, Mrs Y. He complained the Council wrongly charged Mrs Y for reablement care which should have been free for up to six weeks. He also stated the Council continued to invoice Mrs Y for care after she cancelled her home care service.
2. Mr X says this matter has caused him and Mrs Y worry, stress and put them to the avoidable time and trouble of complaining.

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The Ombudsman’s role and powers

3. 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)
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 my investigation I have:
• Discussed the complaint with Mr X and considered information he provided;
• Considered information provided by the Council in response to our enquiries;
• Considered the relevant legislation and guidance and;
• Set out my initial view on the complaint in a draft decision statement and considered Mr X and the Council comments in response.

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What I found

Intermediate Care and Reablement

6. 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.

7. 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)

What happened

8. Mrs Y lives alone in her own home.
9. In August 2022 Mrs Y sought help from her doctor for acute back pain which made it difficult for her to carry out daily tasks.
10. Mrs Y’s doctor referred her to the Rapid Response Team (RRT) who assessed her needs. It found Mrs Y needed a twice daily care package to help with daily tasks and personal care. The Community Reablement Service (CRS) provided the package for two days in August before Mrs Y went to stay with her son, Mr X.
11. Mrs Y returned to her home in September. The RRT assessed her again. The assessment reinstated Mrs Y’s twice daily care package. CRS provided the care package from 1 September 2022 -22 September 2022.
12. On 23 September 2022 the Council outsourced Mrs Y’s care package to a Care Provider as she needed ongoing support.
13. In December 2022 the Council completed a Strength Based Assessment for Mrs Y to identify her needs and plan for her care. It found Mrs Y needed long-term care and the Council began to put together a care and support plan for her.
14. In March 2023 Mrs Y had a stroke and was admitted to hospital. As Mrs Y was in hospital her care package stopped and the Council’s reablement team closed her case.
15. On 18 April 2023 an Occupational Therapist spoke with Mr X and told him Mrs Y required long term care and she would be financially assessed for her financial contribution towards the cost.
16. The hospital discharged Mrs Y on 19 April 2023. A care package consisting of one 45-minute morning visit and 30 minutes visits at lunch and teatime was commissioned. Documents for the care package state it was not a reablement service.
17. On 20 April 2023 an email was sent to Mr X stating that Mrs Y would receive a reablement package.
18. The Council charged Mrs Y for her care package from the date she left hospital until 14 September when she ended the service.
19. In October Mr X complained to the Council. He said Mrs Y’s care should have been free for the first six weeks after she left hospital because she was eligible for a reablement package. He also said the Council continued to charge Mrs Y for care despite her ending the care package in September.
20. The Council replied to Mr X’s complaint. It said:
• Mr X was told on 18 April that Mrs Y needed longer term care and so a six-week reablement package was not suitable for her needs. He was told Mrs Y would be financially assessed to find out her contribution to her care costs.
• Mrs Y’s long-term care package was in place from 19 April 2023 and the financial assessment became effective from that date.
• It accepted there had been miscommunication with Mr X about whether the first six weeks of Mrs Y’s care would be treated as free reablement care. It apologised for this.
• It should have stopped invoicing Mrs Y for care after she ended her care package on 14 September. It said it would do stop doing so and issue a revised invoice for the period after the service ended.
21. Mr X disagreed with the Council’s response and complained to the Ombudsman. He told us the email sent to him by the Council on 20 April clearly stated that Mrs Y would receive a free reablement service. He also said the Council’s financial assessment team told him Mrs Y would be charged for her care from 5 June 2023, six weeks after she left hospital.
22. We made enquiries of the Council. It told us:
• Mrs Y needed long-term support before her stroke. She had received a care package from the Council between September 2022-March 2023. This had been funded, wrongly, as a reablement package.
• Following her stroke Mrs Y continued to need long-term support and so a reablement package was not suitable for her care.
• It disagrees the email sent to Mr X clearly states Mrs Y would receive a free period of reablement. It said the email says “in receipt of reablement” and so it is an overstatement to say it clearly states Mrs Y would receive a free reablement care package.
23. After our investigation began Mr X told us the Council had provided amended invoices showing no charge for the period after Mrs Y ended her care package.

Finding

24. The Council states Mrs Y was not eligible for a free six week reablement care package because she had ongoing care needs, as demonstrated by the care package in place prior to her admission to hospital. I do not agree.
25. Regulation 4, Care and Support (Preventing Needs for Care and Support) Regulations 2014 is clear reablement care should be free of charge for up to six week. This applies regardless of whether the person has eligible needs for ongoing care and support. Therefore, the Council should not have charged Mrs Y for the first six weeks of her care after she left hospital in April 2023.
26. The Council’s decision to charge for the first six weeks of Mrs Y’s care following her discharge from hospital has caused her injustice as she was wrongly told she must pay for this care. This has caused her worry. It has also caused Mr X an injustice as it put him to the avoidable time and trouble of complaining.
27. I note the Council state Mrs Y received a reablement package for longer than six weeks before her admission to hospital. I do not consider this offsets the injustice caused to Mrs Y and Mr X by the fault I found.
28. Mr X says he received contradictory information from the Council about whether Mrs Y would be charged for reablement care. I agree. The information in the email of 20 April was different to that given to Mr X in the telephone call of 18 April.
29. The Council has issued revised invoices for the period after Mrs Y stopped her care package. I consider this resolves Mr X’s concerns about this matter.

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Agreed action

30. Within in one month of my final decision the Council will:
• Remove charges from Mrs Y’s account for the six-week period she was entitled to free reablement care. (Mrs Y was charged £264.60 per week for her care and so she was charged £1587.60 for the six weeks she was wrongly charged. Mrs Y was also charged a weekly self-funders fee which totals £75 for this period. Therefore, the total amount to be deducted from Mrs Y’s outstanding balance is £1662.60).
• Apologise in writing for its handling of this matter; and
• Pay £100 in recognition of the avoidable worry and time and trouble caused to Mr X and Mrs Y.
31. Within in three months of my final decision the Council has agreed to take the following action to improve its service:
• Issue a memo reminding officers handling reablement requests of the requirement to provide free reablement care for up to six weeks whether or not a person has eligible needs for ongoing care and support.
32. The Council should provide us with evidence it has complied with the above actions.

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Final decision

33. I have found the Council to be at fault and the Council has agreed with my recommendations to remedy the injustice caused to Mrs X and Mr Y. On this basis, I have completed my investigation.

Investigator’s final decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman