The Ombudsman's final decision
Summary: Ms Z complained the Council wrongly charged her mother, Mrs X, for care home fees, took too long to assess her and communicated poorly. The Council delayed significantly in assessing Mrs X’s care needs. This has caused Ms Z uncertainty about whether Mrs X is in the most appropriate care home to meet her needs. The Council has agreed to pay Ms Z £200 to remedy this injustice. It has also agreed to pay for Mrs X’s fees for the period under dispute. Therefore, we will not investigate this, and issues to do with communication, any further.
The complaint
Ms Z complains the Council: wrongly charged her mother, Mrs X, for care home fees after she was discharged from hospital to be assessed for her long term care; took too long to assess Mrs X which meant it became no longer possible to move her from the temporary care home; and communicated poorly with her.
Ms Z says that as a result, Mrs X remains in a care home that may not be the most appropriate for her, but she cannot be moved because it would distress her. She also says Mrs X has been financially disadvantaged.
The Ombudsman’s role and powers
This complaint involves events that occurred during the COVID-19 pandemic. The Government introduced a range of new and frequently updated rules and guidance during this time. We can consider whether the Council followed the relevant legislation, guidance and our published “Good Administrative Practice during the response to COVID-19”.
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) 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) Under the information sharing agreement between the Local Government and Social Care Ombudsman and the Care Quality Commission (CQC), we will share this decision with CQC.
How I considered this complaint
I spoke to Ms Z and considered her view of her complaint.
We made enquiries of the Council and considered the information it provided.
I wrote to Ms Z and the Council with my draft decision and considered their comments before I made my final decision.
Relevant law and guidance From 19 March to 31 August 2020, there was a requirement to free up hospital beds for the anticipated wave of COVID-19 admissions. Government guidance at that time directed rapid discharge of all patients who were clinically ready to leave hospital, either home or to another place of care. Where patients were discharged under this government guidance the NHS fully funded the cost of new or extended out-of-hospital health and social care packages.
For people discharged from hospital from 1 September 2020, the government provided funding to cover the cost of the care for up to six weeks whilst a care assessment was carried out to determine the person’s long-term needs. Either the NHS or the council would continue to pay for the care up to the point where the assessment was completed, even if it took longer than six weeks.
What I found
What happened In February 2021, Mrs X was admitted to hospital after she had been found wandering outside. She was discharged in March, under the rapid discharge arrangements, from hospital to a specialist elderly mentally infirm (EMI) nursing placement at a Care Home. This was to await an assessment by the Council to decide what long term care needs she had. The Care Home was chosen because it had specialist EMI nursing vacancies and not because it was Ms Z’s or Mrs X’s choice of placement.
The Council’s case notes record at the beginning of April that the staff nurse at the Care Home informed the Council that Mrs X had had a mental health assessment and the assessor had stated she needed an urgent review with a view to changing her placement. Ms Z also phoned the Council with concerns because she had been told Mrs X was too high functioning for the placement. At this stage the Council had not assigned Mrs X a social worker to assess her social care needs and support requirements.
On 14 April, the case notes recorded Mrs X needed a social worker allocating urgently to assess Mrs X and assist Ms Z in finding an appropriate care home for her.
Ms Z heard nothing further and so at the beginning of June, she began to regularly chase the Council.
On 7 July, a Council social worker contacted Ms Z and said she would assess Mrs X that week. However, before the assessment could take place, the care home went into lockdown for 14 days due to two staff cases of COVID-19.
On 30 July, a member of the Older People’s Mental Health Team contacted the Council. The notes record the team member said “Have you had a chance to assess her? She has been at [the Care Home] for some time now and I’m concerned that the environment isn’t the right one for her”. The team member said Mrs X could sometimes be distracted and her mood improved by distraction and activities.
On 4 August, the social worker assessed Mrs X’s care needs. Mrs X was very low in mood. The social worker asked if she would like to move to a smaller care home where there would be more activities and social interaction, but Mrs X said she was “scared of moving”.
The social worker felt Mrs X did not have sufficient capacity to make decisions about her care and accommodation and a best interest meeting would be needed. She spoke to Ms Z and asked if she thought Mrs X was in the right place. Ms Z said she thought she probably was because her mother became highly anxious with change and was very distressed for some time when she went to hospital and then moved again to the Care Home. The social worker advised a best interest meeting needed to be held to decide the best option for Mrs X.
Also in August, the Care Home sent Ms Z an invoice for Mrs X’s care home fees which was around £41,000.
The social worker carried out the best interests assessment at the end of October, after delays due to further lockdowns at the care home. She then telephoned Ms Z to discuss the next steps. The case notes record they discussed the fact Mrs X was settled, and a move might be detrimental for her. Ms Z stated she had not been told what the fees were at the Care Home when Mrs X was discharged there and, at over £1,400 a week, they were some of the most expensive in the area.
In November, Ms Z received another invoice from the Care Home. Ms Z contacted the Council and said Mrs X should not have to pay these fees because her assessment had not been completed. The Council responded and said Mrs X’s assessment had been completed at the end of July (the actual date was 4 August).
In December, Ms Z spoke to the social worker about Mrs X’s fees. Ms Z said she had received nothing in writing about Mrs X’s placement, when she became responsible for paying her fees and she was still waiting for an assessment and input from the older person’s mental health team and a best interest meeting.
The social worker sent Ms Z the paperwork relating to Mrs X’s assessment and best interest decision. Ms Z contacted the Council again to agree these had been completed and Mrs X would begin to pay her fees from 23 December 2021.
A disagreement then arose because the Council felt Mrs X should pay her fees from August 2021 when the best interests meeting took place.
Ms Z complained to the Council and said that: the Council had discharged Mrs X into one of the most expensive care homes in the area; Mrs X was on the rapid discharge pathway and therefore was only liable for care home fees after the assessment had been completed and a decision had been made about her continuing care. Ms Z said she believed Mrs X should only pay from December when a decision was made about her long-term care; because the Council took so long to assess Mrs X, it was too late to move her from the Care Home where she was settled; communication had been by phone and as a result she and the Council had differing views on what had been discussed. Ms Z said the Council should have put important information such as information about fees in writing to avoid discrepancies, particularly at such stressful times.
During my investigation, the Council contacted Ms Z and said it would charge Mrs X from 23 December 2021.
My findings
Care home placement and outstanding fees Mrs X was discharged from hospital under the rapid discharge to assess procedures which came into effect during the pandemic. This meant the Council did not have to take the family’s preference into account in doing so. It was sufficient that the care home could meet Mrs X’s needs.
The aim of the rapid discharge arrangements was that once in the care home, the Council would assess the service user with a view to determining their long term arrangements. This assessment should happen rapidly to ensure the service user was placed quickly in the most appropriate placement. The Council took five months to arrange the initial assessment and a further two months to complete the best interest meeting. Even taking into account the fact the care home went into lockdown twice, these delays were significant and are fault.
Ms Z believes that because of these delays, Mrs X became settled in the Care Home, which she feels may not be the most appropriate one for her. She also feels Mrs X is left in the position where she must pay higher than average fees.
The case records indicate Mrs X disliked change and became distressed when she had to go into hospital and again when she was discharged into the Care Home. Therefore, it is likely that Mrs X would have become distressed whenever she was moved, although I accept the possibility that the longer she remained at the Care Home, the greater her distress at being moved.
The case records also indicate concern from various professionals that the Care Home might not be appropriate for Mrs X because her dementia was mild and she was too high functioning.
Therefore, as a result of the Council’s delays in assessing Mrs X, Ms Z is left with uncertainty over whether Mrs X is in a placement which is the most appropriate to meet her needs, whilst feeling unable to move her because of the distress this will cause.
Ms Z is also unhappy that the Care Home fees are above average. However, we cannot say that if the Council had assessed her sooner, Mrs X would have wanted to move or it would have been in Mrs X’s best interests to do so. We also cannot know, if she did move, the cost of the new care home. However, Ms Z is again left with further uncertainty over these issues.
Mrs X has not experienced any injustice over the delays in her assessment. She does not wish to move and she is settled at the care home.
Ms Z is unhappy the Council communicated with her by phone and did not put important information in writing to her. She says that this has caused her confusion and resulted in misunderstandings over when Mrs X needed to start paying for her care fees.
The Council has now agreed to waive Mrs X’s care fees from December 2021. Therefore, I will not investigate this matter any further as there is nothing more I could achieve.
Agreed action
Within one month of the date of the final decision, the Council has agreed to pay Ms Z £200 to acknowledge the uncertainty she has experienced over whether Mrs X remains in the most appropriate care home and whether she could have moved if she had been assessed earlier.
Final decision
There was fault leading to injustice. The Council has agreed to my recommendation, so I have completed my investigation.
Investigator's decision on behalf of the Ombudsman