Summary: Ms X complains that the care home should have deducted funded nursing care payments from its fees. She complains that the care home did not explain funded nursing care, and the contract is not transparent.
The Ombudsman does not find fault.
The decision maker refers to LGO’s own guidance issued in Jan 2018. This report says where a contract is ambiguous, inconsistent or poorly drafted, we are likely to find fault. It says we may also find fault if a contract contains conflicting information or is silent on how the care provider treats funded nursing care.
In October 2018, Mr F was admitted to the care home. The admission schedule set out the fees Mr F would pay. Ms X also signed a contract with the care home on behalf of Mr F. This contract said:
“If you have been assessed as eligible for funded nursing care, the funding is received by us and is in addition to the fee set out in your Admission Schedule.”
LGO Decision – Explanation
I do not find this contract to be ambiguous, inconsistent or poorly drafted. While it may be the case that the care home did not provide further explanation of funded nursing care to Ms X when Mr F was admitted, it is stated in the contract which Ms X signed. For these reasons, I do not find fault
LGO missed key guidance
In England, the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care from the Department of Health and Social Care makes clear that contracts between residents and care homes should include transparent and fair terms governing how FNC payments are treated, explaining what will happen if a resident is admitted to hospital or what happens if a resident dies
This guidance was issued in Nov 2018 to Help care homes comply with their consumer law obligations
Your terms, together with the upfront information you provide to residents about your fees, should clearly explain what FNC is, the resident’s potential entitlement to it, and how you treat FNC payments when the eligible resident is self-funded. In particular, you should clearly set out: (a) The relationship, if any, between FNC payments and a self-funded resident’s own contribution to their overall residential fees (ie very clearly defining the services that are paid for by the FNC payments and those paid for by the resident).95 (b) What will happen to a resident’s own contribution to their fees if there is a change in the amount of the FNC payment (ie where it increases, decreases or ceases).
If your terms do not clearly define the services that are paid for by the eligible resident and those paid for by the NHS, you are at risk of unfairly reserving the right to charge an eligible resident for nursing services which are covered by the FNC payments.
Although the contract clearly states that if awarded FNC is paid in addition to the fees, the contract does NOT satisfy the Competitions and Market Authority guidance on transparency of FNC Payments.