Facing up to funding complaints

Earlier this year, the Local Government and Social Care Ombudsman released a good practice guide in a bid to share common complaint themes and advise on the key principles of good practice in complaint handling (Local Government and Social Care Ombudsman, 2019). Since 2010, the Ombudsman has been the single independent source for redress against care providers, last year upholding 69 per cent of complaints.  Unsurprisingly, a large majority of complaints are focused on fee information, billing and invoices, particularly for those who are self-funding.

Home managers are often “piggy in the middle” when it comes to charging, particularly when there is such a vast gap between what the local authority are paying and the charging structures for private payers.  Sources suggests that self-funding residents are filling a gap of £1 billion a year (LaingBuisson, 2018) and often this gap cannot be justified.  The care home may be able to pitch room size or a particularly nice view as an upgrade, but a gap of hundreds of pounds per week is difficult to justify when the service provision for state and private payers is essentially the same.

Receiving unexpected bills for care home fees can be a shocking and stressful experience for residents and relatives, especially when the bill reaches thousands of pounds, and this issue is a common theme on forums such as Carers UK. Moreover, disagreements seem more likely to arise when procuring short-term or respite care.

In some areas, there is immense pressure on home managers by hospital discharge teams, who are needing to discharge ‘today’ without having explained potential costs to relatives and residents with any clarity. Residents are also facing long delays for financial assessments, with a decision about cost not being made until long into their care home stay.

There are also reported conflicts in advice about whether a person is entitled to reablement or intermediate care, which is free for up to 6 weeks.  In addition, some clinical commissioning groups (CCGs) will agree continuing care funding in order to secure a care home placement and speed up the discharge process, only to withdraw the funding after a short stay.  This leaves both the resident and home manager with an uncertain and potentially “debt-building” delay.

Residents and their families must receive clear and accurate information, and care homes need the support of adult social care in providing this, as often the first conversation about funding is with them. Residents should not be left in any doubt as to the payment terms so they can make an informed choice about their care options, and if a (free) reablement or intermediate care package is agreed, the care home should have this confirmed in writing before admission.

With the best will in the world, things will go wrong, and good leadership and a willingness to learn from mistakes is essential to drive improvement. This good practice guide offers real life examples to help avoid the pitfalls along the way, as well as sustainable long-term advice on policy, procedures and training (Local Government and Social Care Ombudsman, 2019).

 

Guest blogger Vickie Wylde RGN,
former care home manager

References

Carers UK. (2019) Forum. https://www.carersuk.org/forum

Local Government and Social Care Ombudsman (2019) Caring about complaints: Lessons from our independent care provider investigations.
https://www.lgo.org.uk/information-centre/news/2019/mar/ombudsman-issues-good-practice-guide-for-care-providers

LaingBuisson. (2018) Care home funding shortfall leaves self-funders filling £1 billion gap.
https://www.laingbuisson.com/blog/care-home-funding-shortfall-leaves-self-funders-filling-1-billion-gap/