The Ombudsman's final decision
Summary: The Council acknowledged a delay in Mrs Y receiving rehabilitation services during her stay in nursing home before the complaint came to this office, and waived care fees for five months. Any further investigation by this office could achieve no more.
The complaint
Mrs X complains her mother, Mrs Y did not receive rehabilitation services during a stay in a nursing home, and this resulted in a deterioration in her condition.
The Ombudsman’s role and powers
We investigate complaints about ‘maladministration’ and ‘service failure’, which we call ‘fault’. We must also consider whether any fault has had an adverse impact on the person making the complaint, which we call ‘injustice’. We provide a free service, but must use public money carefully. We do not start or continue an investigation if we decide: we could not add to any previous investigation by the organisation; or further investigation would not lead to a different outcome.
(Local Government Act 1974, section 24A(6), as amended, section 34(B))
How I considered this complaint
I have: considered the complaint; considered correspondence between Mrs X and the Council, including the Council’s final response to the complaint; information the Council provided to this office; taken account of relevant legislation; offered Mrs X and the Council an opportunity to comment on a draft of this document, and considered the comments made.
What I found
Relevant legislation Discharge to assess The Government introduced the Hospital Discharge Service. The service facilitates timely discharge from hospital for patients who are clinically optimised and do not require an acute hospital bed.
The ‘discharge to assess’ model consists of four care pathways. Pathway 2 applies to people who are discharged from hospital to residential care within the independent and community sector to enable further assessment of a person’s long-term health and social care needs. Services are generally provided free of charge for up to six weeks.
Should a person require ongoing support, they may be required to make a financial contribution towards the cost of the services provided.
Charging rules The charging rules for residential care are set out in the Care and Support (Charging and Assessment of Resources) Regulations 2014 and councils should have regard to the Care and Support Statutory Guidance.
When the Council arranges a care home placement, it must follow the regulations when undertaking a financial assessment to decide how much a person has to pay towards the cost of their residential care.
Background
Mrs Y is in her nineties. Following a fall at home on 11 November 2023, she was admitted to hospital and found to have a broken wrist and ribs. Mrs X says she was initially told Mrs Y would stay in hospital for around four weeks and then be transferred to a residential care home for rehabilitation with a view to returning home.
A meeting took place shortly after Mrs Y’s arrival in hospital. Mrs X was informed Mrs Y would shortly be moved into a care home. At the time, there were no available beds within the Council’s area, so at Mrs X’s request Mrs Y was placed in a nursing home in another area, to be closer to family.
Mrs X says she was told Mrs Y’s stay would be around 4-6 weeks and that she would receive physiotherapy and occupational therapy.
As Mrs Y’s placement was under ‘discharge to assess’ scheme, care was free of charge for up to six weeks.
Mrs Y did not receive physiotherapy / occupational therapy until fifteen weeks after she went into the nursing home, during which time, Mrs X says Mrs Y deteriorated. Mrs X says had she received these services sooner, then she would have returned home sooner and achieved a greater level of independence than she did.
The delay was due to issues about the rehabilitation services providing services to people in nursing homes outside of the Council’s boundary.
The records show the Council sent an email to Mrs X’s husband on 31 March 2023, to say Mrs Y’s say would become chargeable, and provided a breakdown of the costs.
Mrs Y’s family disputed the charges and corresponded with the Council by email explaining the reasons they believed her stay in respite care should be free of charge.
Mrs Y returned home in June 2023 with home care services in place.
The Council accepts there was a significant delay in Mrs Y receiving physiotherapy/occupational therapy. It says some of the delay resulted from Mrs Y contracting Covid.
In acknowledgment of the delay, the Council waived care fees between 25 November 2022 and 2 April 2023. The Council charged Mrs Y from April 2023 to when she returned home in June 2023.
Mrs X was dissatisfied and submitted a formal complaint to this office. The Council responded in August 2023. The letter addresses each point of complaint in detail. The author reiterated the Council’s earlier acknowledgement of delay in providing physiotherapy and occupational therapy to Mrs Y and said the waiving of care fees from November 2022 to April 203 was a fair outcome.
Analysis I am satisfied the Council investigated and responded to Mrs X’s complaint properly.
The Council accepts there was a significant delay in providing rehabilitation services to Mrs Y which caused a shortfall in her care and delayed her return home. This is fault.
In terms of Mrs Y’s rehabilitation potential, it is not possible to know what the outcome would have been had she received rehabilitation services sooner.
Mrs Y’s family were aware in March 2023 that her placement had become chargeable and what the costs would be.
In recognition of the delay the Council waived care fees for five months, almost equal to the period of delay. I consider this to be fair and proportionate.
Any further investigation by this office could achieve no more.
Final decision
The Council acknowledged a significant delay in Mrs Y receiving rehabilitation services during her stay in nursing home before the complaint came to this office. Its decision to waive care fees for an extended period is fair and proportionate.
Any further investigation by this office could achieve no more.
It is on this basis; the complaint will be closed.
Investigator’s decision on behalf of the Ombudsman
Investigator's decision on behalf of the Ombudsman