A council was at fault for failing to provide a service user with information about his care charges, leaving him with “a very large and unexpected bill”, the Local Government and Social Care Ombudsman has found.
Living in temporary residential care following a period in hospital, Mr F racked up a bill of around £15,000 in care charges that he and his daughter, Ms C, were unaware they would have to pay.
The social worker involved in the case was also found to be at fault for failing to discuss the option of Mr F returning home and explaining why home care would be insufficient to meet his need.
Mr F went into hospital for a blood transfusion in June 2016. He agreed with his social worker to a short free stay in a residential home when he came out of hospital. Essex council said it would arrange a care package that would enable him to return home. Mr F moved into the home at the end of July.
Despite arranging home care support to begin from 8 August, the hospital social worker and Ms C felt that Mr F would benefit from staying in the home longer until his health needs were clearer. This prompted the council to suspend the scheduled home care support for the man.
According to the ombudsman, Ms C said the social worker failed to involve her father, who had capacity, in the decision to cancel his care. She also said that she only supported the decision for Mr F to stay in the home because she did not know that he would receive home care if he returned home – something she said the social worker did not tell her. However, the ombudsman concluded that the council had informed Ms C that home care would be available.
Mr F was due to have a care review on 19 August, before his four weeks of free residential care came to an end, but was admitted to hospital on 18 August, remaining until 23 August, after which he was discharged back to the care home.
Mr F attended a hospital appointment on 9 September in which his consultant asked him to remain there until his next appointment in October because he was very ill and his condition could change rapidly. Mr F’s haematologist also advised him not to return home as he would need to be monitored after his medication was changed.
On 13 September 2016, the social worker carried out the care review. This was three weeks after Mr F returned from hospital and four weeks after his one month of free residential care had ended.
During the review, it was noted that Mr F’s mobility had “declined significantly”, and he needed support with “maintaining personal hygiene”. But Mr F advised the social worker that he was eager to return home and use his car.
Concerned about her father’s health, Ms C, along with the care home manager and the social worker, advised Mr F it was better for him to remain at the home, to which he agreed. Again Ms C said she supported this decision because she did not know Mr F would receive care at home if he returned.
Lack of information
According to the ombudsman, the social worker said she explained to the family that Mr F would have a financial assessment to determine how much he would pay towards the cost of his residential care, and that people whose assets were greater than £23,250 would have to meet the full cost. However, she said the council did not have any leaflets or booklets about charging to give to service users.
Mr F returned to hospital on 28 October after his health deteriorated. A month later, the social worker had a discussion with Ms C about Mr F’s wish to go home. However, Ms C said her father could not go home until the family had fixed the heating in his house.
There was a delay in completing Mr F’s financial assessment that was not the fault of the council, but a result of the difficulty the family faced in obtaining the information and an appointment having to be rescheduled because of his hospital admission.
Ms C claimed her father could not make an informed decision about his care because he was unaware he had to pay the full amount of his care. She also told the ombudsman that the family believed the only other alternative to Mr F staying in the care home was to go back home without support and was unaware that her father could have received home care support.
When Mr F eventually returned home at the end of January 2017, he had to pay fees of around £15,000 to the home.
Care options unclear
The ombudsman concluded the social worker was at fault for failing to discuss the option of Mr F returning home and explain why she was believed home care would be insufficient to meet his needs, at his care review on 13 September, given he had said that he wanted to return and had capacity to make the decision.
Essex council was also at fault for failing to provide “sufficient information about care charges”, when discussing Mr F’s future care arrangements.
It said the council “should have provided [information] by giving him a leaflet or booklet about charging or information about where he could obtain this online.”
However, the ombudsman did not conclude that there would have been a different outcome, but for the council’s failings in this case, because:
- all agreed at the 13 September review that it would be best for Mr F to remain in the home and that his health;
- his health deteriorated subsequently, increasing the risks of a return;
- Mr F was aware that people with assets over £23,250 had to pay the full costs of care, so could have been able to predict that he would have to fund the full fee.
The council has agreed to pay Mr F £2,000 for the delay between the end of the free interim placement, and the social worker’s visit to discuss the need for a financial assessment.
‘Committed to learning’
Essex has accepted the ombudsman’s recommendation to review what information it should provide to people about financial assessments and charging.
It said it would also share faults identified in relation to the 13 September care review staff involved in care assessments, as recommended by the ombudsman
A spokesperson for Essex council said: “We acknowledged the findings of the Local Government and Social Care Ombudsman and we are working with them on the agreed recommendations.
“We remain dedicated to ensuring all our residents receive the highest quality of care and are committed to learning to improve”.