The Ombudsman's final decision
Summary: Mr X complains about the care provided to Mrs Y after she was discharged from hospital and how this care was ended. Mr X said Mrs Y was not able to mobilise and developed pressure sores. We have not found the Council at fault.
The complaint
Mr X complains about the care his wife, Mrs Y, received after she was discharged from hospital. Mr X complains she was left on a chair at home and developed pressure sores and then the care provider ended its care.
What I have investigated I have investigated events from when Mrs Y was discharged from hospital in late June 2021 until the end of the complaints process in September 2021. Mr X will need to raise a new formal complaint with the Council if he has any concerns about the Council after this period.
The Ombudsman’s role and powers
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)
How I considered this complaint
As part of this investigation, I considered the information provided by Mr X. I discussed the complaint with Mr X over the telephone. I made enquiries with the Council and considered the information received in response. I sent a draft of this decision to Mr X and the Council for comments.
What I found
Intermediate Care and Reablement Intermediate care and reablement support services are for people usually after they have left hospital or when they are at risk of having to go into hospital. They are time-limited and aim to help a person to preserve or regain the ability to live independently. The National Audit of Intermediate Care lists four types of intermediate care: crisis response – services providing short-term care (up to 48 hours); home-based intermediate care – services provided to people in their own homes by a team with different specialties but mainly health professionals such as nurses and therapists; bed-based intermediate care – services delivered away from home, for example in a community hospital; and reablement – services to help people live independently which are provided in the person’s own home by a team of mainly care and support professionals.
Regulations require intermediate care and reablement to be provided without charge for up to six weeks. This is for all adults, whether or not they have eligible needs for ongoing care and support. Councils may charge where services are provided beyond the first six weeks but should consider continuing providing them without charge because of the preventive benefits. (Reg 4, Care and Support (Preventing Needs for Care and Support) Regulations 2014) What happened Mrs Y was admitted to hospital on 20 June 2021 after falling. She was diagnosed with an infected foot ulcer. The hospital completed a discharge to assess form for Mrs Y as there were concerns about her suffering self-neglect at home and declining care. This recommended Mrs Y received three calls per day with two carers. In addition, Mrs Y was to sleep on a riser recliner chair due to incontinence issues.
A moving and handling risk assessment and care plan was completed for Mrs Y. This stated two people needed to transfer using a re-turn aid. The risk assessment also stated Mrs Y would prefer to sleep in the riser recliner chair.
On 28 June 2021 the hospital staff identified Mrs Y had a pressure sore after reviewing her. The hospital discharged Mrs Y on 30 June 2021. The Council put in place intermediate care for Mrs Y and arranged for a care provider to visit Mrs Y three times per day with two carers on each call. Mrs Y was provided with a riser recliner chair, a commode and a re-turn aid for transfers.
Following Mrs Y’s return home, the Council commenced a care assessment to establish Mrs Y’s long term care needs and a financial assessment to determine what she would have to pay towards her care costs.
On 12 July 2021 Mrs Y asked to be moved to her king sized bed. The Council arranged for a hospital bed to be sent to Mrs Y. On 15 July 2021 the hospital bed and pressure relieving mattress was delivered. The Council also increased the package of care Mrs Y was receiving to make the visits of carers longer after Mr X reported carers were struggling to complete all care in the allocated visit times.
The Council carried out a care assessment and financial assessment of Mrs Y’s care needs. The social worker decided Mrs Y had care needs and the Council told Mr X and Mrs Y what they would have to contribute towards the costs of care.
On 26 July 2021, Mr X told the Council he was sending back all the equipment provided to Mrs Y as she wanted to go back to her own bed. The notes from the telephone call show the social worker told Mr X if the equipment was sent back, Mrs Y would not be able to safely transfer from her king sized bed with the support of carers.
Over the next week the Council offered further options to Mr X and Mrs Y. This included having the hospital single bed and another single bed side by side so Mr X and Mrs Y could sleep in the same room. The Council also visited Mr X and Mrs Y. On 29 July 2021 Mr X told the Council he had sent back all of the equipment for Mrs Y, including the hospital bed, riser recliner chair and commode.
The Council’s intermediate care team wrote to Mrs Y on 29 July 2021 to give her three options going forward for therapy. The Council said Mrs Y could go into a placement for two weeks of physio or have all the equipment back in her home and have physiotherapy at home. Alternatively, if Mrs Y did not want either of these she would not be able to receive therapy as this could not be delivered on her king sized bed.
On 30 July 2021 Mrs Y told the Council she did not want any care after 10 August 2021. This was when her 6 weeks of intermediate care was due to finish.
The care records show the Council did look at other options for Mrs Y such as raising her home bed, however this did not resolve the issue as the bed was too big. The Council also looked at the possibility of bringing the hospital bed back on a short term basis and the possibility of a double hospital bed. However, the advice the Council received from the district nurse was a double hospital bed would not be safe for two people to sleep on.
On 5 August 2021, the care provider told the Council it was cancelling its services with Mrs Y. This was due to carers not being safely able to care for Mrs Y as she was using her home bed. The care provider explained this was too low for carers to safely transfer or manoeuvre Mrs Y and there was not enough space for carers. In addition, the care provider raised concerns about the behaviour of Mr X towards carers.
Mr X said he started to pay carers privately to care for Mrs Y after the care provider ended its service. On 10 August 2021 the Council offered Mrs Y a package of long term care, however Mr X and Mrs Y declined this.
Mr X complained to the Council about Mrs Y’s financial assessment and social worker. Mr X said the costs for a care package were high. He also raised concerns about the behaviour of the social worker and that the Council was threatening to stop care. He said the social worker lied about Mrs Y getting bed sores in hospital and she got these at home. Mr X asked for the Council to refund him for the sixth week of intermediate care Mrs Y should have received.
The Council responded to Mr X’s complaint on 14 September 2021. The Council said: The financial assessment for Mrs Y was correct and based on the information given.
It carried out a care assessment and decided Mrs Y had care needs that would be met. The Council said Mr X declined support and declined to have the equipment offered by therapists. This resulted in the care provider cancelling care as they felt their carers were being put at risk of injury and harm. The Council said it was not the case care was withdrawn and would not refund him.
The care and hospital records showed Mrs Y did have a pressure sore before being discharged from hospital. The Council’s intermediate care team did offer Mrs Y two options for receiving therapy but both were declined.
It apologised if Mrs Y found comments by the social worker distressing but said these questions were necessary to establish support and whether they needed assistance cleaning.
It would arrange for a senior member of the adult social care team and a senior therapist to review the situation around care and support for Mrs Y.
Mr X emailed the Council on 15 September 2021. Mr X said Mrs Y developed pressure sores as she was left in a chair after being discharged from hospital. Mr X also said the social worker threatened Mrs Y with the loss of carers due to the wages care workers were being paid.
Following the Council’s response, it did review Mrs Y’s care situation and Mrs Y started to receive occupational therapy support for rehabilitation. The Council said it is willing to carry out a new care assessment for Mrs Y if she wants this, however a previous offer was declined.
Analysis Mr X complained Mrs Y was left on a chair after being discharged from hospital and this caused her to develop pressure sores. I have not found the Council at fault. This is because, from the case records, the hospital staff recorded Mrs Y as needing to sleep in a riser recliner chair due to incontinence issues. In addition, the risk assessment completed at the hospital for Mrs Y stated Mrs Y wanted to sleep in this chair and prior to her discharge the hospital records show she had a category 3 pressure sore. I therefore cannot say on balance that Mrs Y developed pressure sores as a result of poor care following her discharge from hospital. The Council put in place the intermediate care package which had been recommended by the hospital.
Once Mrs Y asked to be moved to her bed, a hospital bed was ordered and sent to her. From the case records, it appeared Mrs Y only used this for a few days and was then moved to her king size bed, where carers could not properly support her. The hospital bed was sent back by Mr X.
Mr X also complained the care provider ended its service and he did not receive the last week of free care Mrs Y was entitled to. I have not found the Council at fault here. From the care records, the care provider ended its service as it felt it could not guarantee the safety of its carers or Mrs Y while she was in the king sized bed. Mrs Y was provided with a hospital bed and other equipment to assist with care needs but this was sent back. The Council also looked at other options for Mrs Y, including raising the king sized bed or putting a single bed next to the hospital bed. Had Mrs X and Mrs Y kept the equipment provided to them carers would have been able to provide care for Mrs Y in accordance with her intermediate care plan.
Final decision
I have completed my investigation and found the Council was not at fault for the level of care Mrs Y received or for the care provider stopping its service.
Investigator's decision on behalf of the Ombudsman