Elderly man was charged for care home stay while council was ‘too busy’ to arrange domiciliary care

The Local Government and Social Care Ombudsman (LGO) has ordered the council to re-calculate what it billed the man – who has since died – for a three-and-a-half month stay in early 2019.

A report on the case says the man, named only as Mr N, also had to stay in hospital for two months later that year because the council was once again unable to arrange a home care package.

The report identifies a string of failings on the part of the council, which the watchdog says caused “unnecessary distress”.

As well as re-calculating the amount owed for the care home stay, the authority has also been told to review policies and pay £200 compensation to the man’s daughter, who brought the complaint.

The report says Mr N first needed domiciliary care in 2018 following a number of falls requiring hospital admissions, but the council had trouble finding a provider able to visit him.

A contract was eventually agreed, but was terminated by the company after a few weeks.

By the end of that year, the council was again struggling to find a care provider and suggested he move temporarily into a care home.

The report says: “The council’s records suggest it could not put in place a care package for Mr N in 2018 because it did not have any providers able to take the package.

“I understand… this was because many providers would not come out to rural areas.

“The council accepts that, at the time, ‘…due to insufficient market availability… it was unable to deliver the care and support in Mr N’s home’. That was fault.”

A two-week placement was arranged to begin on December 28, but the council asked to extend his stay because it was “too busy” to find a home care provider for him. The ombudsman says this was a fault.

The council eventually arranged a domiciliary care company to visit Mr N at the required times, and he returned home on April 11, 2019.

Mr N was billed over £400 a week for the care home stay, but this was disputed by his daughter, Miss N, who said it was a result of the council’s failure to find a domiciliary care provider.

The LGO report says the council should have considered reducing Mr N’s care home fees because of the circumstances, and says the fact this did not happen was a further fault.

Mr N went into hospital for an assessment in May 2019, but when the hospital said he could be discharged in late June his previous domiciliary care provider told the council it did not have the capacity to re-start his contract.

The council began searching for a new provider, but within a few days had begun contacting care homes.

The ombudsman’s report says there was “no explanation for this change of approach”, and finds fault with the council’s “inadequate” record keeping.

The council offered Mr N a place back at his previous care home, but he declined as he wanted to go home.

A home care provider was found by July 10 but “at very high costs”. The council set about exploring other options, but had no records of any action between July 16 and 31. Mr N remained in hospital.

The report says: “There is no explanation for the reason for this lack of recorded action. I find fault.”

On August 9, Miss N, attended a multi-disciplinary meeting and agreed for him to go into residential care. She later described the meeting as “overwhelming” and said she felt she “had no choice ” but to agree, on the understanding that the longer-term goal was for him to go home.

This time the council had agreed to reduce the fees to what he would have been paying for domiciliary care.

Mr N moved into a nursing home on August 22, 2019, but within days Miss N contacted the council asking for him to be moved. She said he had called her “in great distress begging I get him out of there”.

By September 1 the council had found a domiciliary care provider, but was trying to negotiate a lower price before signing the contract.

The ombudsman’s report says there was an “over-emphasis on costs” and a failure to balance this against other considerations, namely Mr N’s wish to return home and the “positive impact” this would have had on his wellbeing.

On October 16 a GP visited Mr N and advised the nursing home to prepare for the end of his life. Miss N was not informed about this.

The report says: “As it is a reasonable expectation that somebody would have told Miss N this, I find fault this did not happen.”

Mr N died later that month.

The report concludes that the council should re-calculate the fees for Mr N’s initial care home stay between December 2018 and April 2019 and provide a written apology to Miss N.

It adds that the council should also pay £200 to Miss N “as a symbolic acknowledgement of the impact of the uncertainty and distress likely to have been caused by the faults I have identified”.

Miss N had also complained about some aspects of care at the nursing home, and the LGO agreed there was a fault in that staff had not washed and dressed a head wound appropriately.

However the report says: “The faults I have found with the actions of the nursing home are not so significant that I can link them to any suggestion of a reduction in fees, or an investigation of the home, which is in any case, the role of the Care Quality Commission (CQC), as the regulator.”

Natalie McFall, Assistant Director of Adult Social Care at Shropshire Council said: "We sincerely apologise for any impacts the delay to source a care provider had for the person in question. We take the discharge of all people from hospital very seriously and we have a dedicated team that work hard to ensure that all transfers of care from hospital happen in a timely manner. On this occasion the council offered an alternative option to facilitate the discharge from hospital. We do however recognise the importance in sourcing the right care for our citizens and remain committed to enhancing access to domiciliary care in the community."