Summary: Mrs X and Mrs W complain the Council failed to properly explain the charges for their late mother’s care home. They also say they were denied a choice of alternative care provider. There is evidence of fault by the Council, but this did not cause injustice to the family. Nevertheless, the Council needs to improve its working practices.

The complaint

1. The complainants, Mrs X and Mrs W, complain the Council failed to properly explain the charges for their late mother’s care home. They also say they were denied a choice of alternative care provider.

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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 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)
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:
• considered the complaint and the documents provided by Mr X;
• discussed the complaint with Mrs X and Mrs W;
• considered the comments and documents the Council has provided in response to my enquiries;
• considered the Ombudsman’s guidance on remedies; and
• invited comments on a draft of this statement from Mrs X, Mrs W and the Council, for me to consider before making my final decision.

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What I found

What happened

5. Mrs X and Mrs W had power of attorney for their mother’s health and welfare, and her finances. Their mother, Mrs Y, lacked the capacity to decide where to have her care needs met. When their mother left hospital in November 2022, she went to stay in a care home for six weeks of reablement care funded by the NHS, but arranged by the Council. Mrs W raised no objection to the placement, noting it had a good rating from the Care Quality Commission. The Council told her it would review the placement, to see if the NHS should continue funding it or if the Council would fund it in the long-term. If the latter, it said Mrs Y would have a financial assessment. Mrs X signed a “charges for care and support declaration”. She suggested Mrs Y may have capital over £23,250, noting this was mostly in fixed term accounts.
6. The Council spoke to Mrs W on 16 December. It said funding for the care home placement would be extended if Mrs Y needed further therapy to get back to her baseline. The plan was for her to return to her own home after that. The Council said a financial assessment would identify how much she had to contribute towards the cost of her care.
7. The NHS funding was due to end on 10 January 2023, but it was extended because of cases of COVID-19 in the care home, which delayed long-term care planning.
8. On 25 January the NHS told the Council Mrs Y had a fall when using her three wheeled walker. This left her in pain and needing help from when using a walking frame.
9. The Council told Mrs W they needed to look at long-term care planning. It noted Mrs Y had been assessed as a self-funder in 2018 (i.e. having capital over £23,250) and asked if that was still the case. It provided a consent form for a financial assessment.
10. Mrs W said they still hoped Mrs Y could return home. The Council said it should be possible to support her with a care package at home, but it needed to know if she had savings over £23,250, as it would not commission her care if she did. Mrs W told the Council her mother would not be a self-funder (i.e. had less than £23,250 in savings).
11. On 6 February the Council told Mrs W it would assess Mrs Y and arrange her care when she returned home, but could not say when this would be. It said;
• they would be looking at a care package based on four calls a day, given the decline in Mrs Y’s mobility;
• Mrs Y would have to remain in the care home until a care package was in place;
• the financial assessment would say how much Mrs Y had to contribute while she remained in the care home.
12. The Council produced a care and support plan for Mrs Y. It did this in consultation with an occupational therapist. The plan provided for a personal budget of £324.73 a week to pay for four calls a day (one 45-minute call and three 30‑minute calls). This was to meet her need for help with meal preparation, personal care, medication, transfers/mobility and continence. Although the form said “Please ensure that the provision of direct payments is fully explained to the service user/their representative”, the Council did not offer Mrs Y’s family direct payments so they could arrange her care themselves. There is nothing to explain why the Council did not do this.
13. On 10 February the Council told Mrs W it was proposing a care package based on four calls a day. It noted Mrs Y would be assessed in her own home on 20 February (by an occupational therapist), to see what equipment she would need when she returned. It said Mrs Y would receive further therapy from the NHS after she returned home, which could result in a reduction in her care package (i.e. if her mobility improved). Mrs W said they would need notice if they had to remove furniture from Mrs Y’s home.
14. On 15 February the Council told Mrs W her mother would have to contribute towards the cost of her care from 20 February. It said she would have to pay the same towards the cost of the care home as she would towards the cost of her care when she returned home.
15. An occupational therapist visited Mrs Y on 20 February. The visit identified the need to:
• Reactivate Mrs Y’s careline;
• Provide a toilet frame to reduce the risk of falls when getting on/off the toilet;
• Provide a profiling bed, so Mrs Y could reposition herself electronically, a pressure mattress and bilateral grab rails;
• Remove the existing bed and mattress;
• Assess the shower when Mrs Y had settled back in at home.
16. On 21 February the Council sent the manager of the care home a letter of agreement for Mrs Y’s placement for her to sign. I understand Mrs Y signed this with the help of the manager. The agreement said:
• it covered 20 February to 13 March 2023.
• the total cost of the placement was £900 a week, but it did not say how much Mrs Y would have to pay (as there had been no financial assessment).
17. On 23 February the Council told Mrs W and Mrs X the cost of Mrs Y’s care package (when she returned home) would be £324.73 a week.
18. On 28 February the Council sent Mrs W a financial assessment form for her to complete for her mother. It asked her to return it by 28 March.
19. On 6 March a care provider agreed to provide Mrs Y’s care package. During a telephone call with Mrs Y’s daughters the next day, they asked for the morning visit to be put back from 06.00 to 07.30. The plan was for the care package to start on 20 March, provided a hospital bed and bed rails were delivered that day.
20. On 10 March the Council told Mrs W the family would have to arrange transport for Mrs Y from the care home back to her own home.
21. On 14 March Mrs W told the Council Mrs X could take their mother home on 25 March. She noted this would enable them to make sure the home was ready for her return, including the delivery of the hospital bed. She also said this meant family could stay over the weekend, while Mrs Y settled back into life at home. The Council agreed to fund Mrs Y’s care package from 20 to 25 March, to protect it from being cancelled.
22. Mrs W returned the financial assessment on 23 March.
23. Mrs Y returned to her own home of 25 March. The care provider arrived late for the first two visits because the Council had given it an old address for Mrs Y. Mrs X raised other concerns about the quality of the care provided by the care provider, to which the Council responded.
24. On 11 April the Council sent another letter of agreement to the manager of the care home for Mrs Y to sign. It said the agreement would run from 13 to 25 March 2023. A signed copy was not returned to the Council.
25. The Council completed the financial assessment on 13 April. This said Mrs Y would have to pay the full costs of her care, as she had savings over £23,250.
26. Mrs Y died on 28 July.
27. Mrs X and Mrs W complained to the Council about the way it had dealt with the charges for Mrs Y’s care. They also complained the Council did not complete Mrs Y’s assessment until after she had left the care home, preventing them from making their own arrangements for Mrs Y’s care.
28. When the Council replied to Mrs X and Mrs W’s complaint on 30 August it said:
• It should have sent the letters of agreement to them as they had power of attorney for Mrs Y and apologised for its error.
• Apart from that error, there was evidence it had explained about the charges.
• Although the Council received Mrs Y’s financial assessment form on 23 March, it did not pass it on to the Financial Assessment Team until 13 April.
• It offered to discuss its response with Mrs X and Mrs W;
• It also said it was open to them to complain to the Ombudsman.
29. The Council did not address the concerns that:
• There had been a delay in arranging Mrs Y’s return home after the visit on 20 February;
• The failure to complete Mrs Y’s assessment prevented them from making their own arrangements for Mrs Y’s care.
30. Mrs X and Mrs W were not satisfied with the Council’s response, so they asked to discuss it with the investigator. They say the investigator led them to believe their request for a waiver of half the charges was reasonable. However, their concerns were put to a more senior officer to review them. That officer wrote to Mrs X and Mrs W on 1 December saying the Council’s position remained the same. The officer accepted the Council could have managed the arrangements better, but said it had told them there would be a cost to the care and support arrangements.
31. Mrs X and Mrs W say they would have arranged their mother’s care if the Council had told them she was ready to leave the care home on 20 February. They say they would have used the care provider they had used before Mrs Y went into hospital and this would have saved her money.

Is there evidence of fault by the Council which caused injustice?

32. When Mrs Y moved to the care home there was no expectation that she would have to pay for it. Had it not been for the outbreak of COVID-19, it should have been possible for her to return home before she had the fall and without the need to contribute towards the cost of the care home. It was due to an unfortunate sequence of events, rather than fault by the Council, that her stay in the care home was extended and, after nearly 12 weeks, the need for her to pay for it arose.
33. The evidence shows the Council told Mrs W it would charge her mother for her care from 20 February 2023. It also said it would charge for the care home placement until a care package for Mrs Y’s return to her own home could be arranged. It said the charge would be the same for both, because Mrs W had said her mother had less than £23,250 in savings. So, although this was not correct, it was not due to fault by the Council.
34. The Council accepts it was at fault over the failure to send the letters of agreement to Mrs X and Mrs W. That failure meant they did not know what the full cost of Mrs Y’s placement at the care home was. But there is no evidence to suggest this caused injustice to the family.
35. It is unclear why the Council waited until 28 February to send a financial assessment form to Mrs W. It had been aware since January that it would arrange a care package for Mrs Y when she returned home. The Council was also at fault for the three-week delay in passing the completed form on to its Financial Assessment Team. However, Mrs X and Mrs W should have been aware that their mother would have to pay for her own care, as she had over £23,250 in savings.
36. Mrs X and Mrs W say they would have made arrangements for their mother to return home before 25 March with a cheaper care provider, if they had known she was ready to return home on 20 February. However, the evidence does not support that claim. Mrs Y could not have returned home safely until a hospital bed was in place. Mrs W asked for the return to be postponed until 25 March, so they could make sure all the arrangements were in place.
37. The Council was at fault for not telling Mrs Y’s family they could have direct payments. However, it did tell them it would not arrange Mrs Y’s care if she had over £23,250 in savings. So there was nothing stopping them from arranging her care, if that is what they had wanted to do.
38. Although I have identified some faults by the Council, there is not enough evidence to say this caused injustice to the family to warrant a remedy.

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Agreed action

39. I recommended the Council within eight weeks:
1. reminds officers of the need to tell people they can have direct payments, if they want them;
2. takes action to ensure financial assessments are not subject to delays;
3. takes action to ensure letters of agreement are sent out at the right time and to the right person.
40. The Council has agreed to do this. It should provide us with evidence it has complied with the above actions.

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Final decision

41. I have completed my investigation on the basis there has been fault by the Council. Although this did not cause injustice requiring a remedy, the Council needs to improve its practices.

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Investigator's decision on behalf of the Ombudsman