Paths to perdition: exploring the trajectories of care staff who have abused older people in their care

Abstract

Purpose The purpose of this paper is to present findings from face-to-face interviews with three former care staff who were proven to have abused some of the older people living in the care and nursing homes in which they had once worked. The research sought to explore the intra-personal dynamics, personal characteristics and work experiences that led these staff to perpetrate abuse. Design/methodology/approach Semi-structured interviews were undertaken with three former care and nursing home staff who had committed abusive acts and the data secured subjected to thematic narrative analysis. Findings None of the three people interviewed had intended to become care staff and reported that the interview and induction processes they experienced did little to establish their suitability for the work they would be undertaking or to prepare them for its demands. Participants expressed their generally negative perceptions of older people, particularly those living with dementia, and told of how they also felt that they were under pressure to conform with the often abusive care home regimes that they had entered. They also recounted some specific abusive practices developed to allow them to manage the constant tension between the time available to complete all of the tasks required when “caring” for older people, and revealed their perceptions of external scrutiny of care home conduct and the behaviours developed to deflect the effectiveness of this oversight. Two interview participants also revealed their unfavourable attitudes to some of the people they were employed to care for that were based upon perceptions of ethnic differences, and of how this had contributed to the abuse they perpetrated. Research limitations/implications Though the research draws upon the experiences of only three former care staff, the data reveal some of the intra-personal dimensions of individual staff who have engaged in abusive acts, and illuminates how the care home environment with which they interact can engender conditions under which abuse is more likely to occur. Originality/value Unusually, the paper explores the characteristics, perceptions and experiences of care staff who have actually committed abusive acts against those entrusted to their care.

Sharpening Occam’s razor: developing theory to explain the persistent abuse of older people living in care homes

“…In the field of the abuse of adults who may be vulnerable it is the testing of theories that are developed, such as that proposed by Moore (2019c, d) above, that will in time, enable fuller comprehension of the social, intrapersonal and environmental factors that interact in the aetiology of different types of abuse in a range of diverse situations. In turn, this understanding will finally render the development of effective preventative strategies and interventions in specific circumstances possible.…”

“…To this end, the recent research and theorising undertaken by Moore (2019c, d) that has focussed specifically on the physical and psychological abuse and neglect of older people in care homes in England, the majority of whom were living with dementia, has led to the theory that their abuse occurred in these specific circumstances as a consequence of three identifiable factors, as follows: Older people, particularly those living with dementia are, or come to be regarded as less than fully human by those who should be providing for their care needs. The care that is provided becomes routinised over time and fails to take account of the specific needs and wants of individuals, in greater part because they have ceased to be perceived as individuals. The routines that are adopted and that become prevalent are instead designed to save time and provide for the convenience of staff rather than residents. Both macro-level societal institutions, and peers and managers at the micro-level of the care home give implicit and explicit permission through their attitudes and behaviours for staff who should be providing care to engage in the abuse of the people who are no longer regarded as fully human.…”

“…It is unclear from the research undertaken by Moore (2019c, d) whether these three factors occur in any particular temporal order, and future research using the same operational definitions may illuminate this aspect of the relationship between them. Yet what is clear, should this theory for the explicitly delimited area of practice be accepted, is that the changes indicated as necessary by the research present significant challenges for policy makers at both macro-societal level, in terms of changing prevailing perceptions of older people, and at micro-level in terms of recruiting staff to care homes who value positively the people they are to care for and by ensuring the employment of such staff in sufficient numbers to provide properly for the care needs of care home residents without resorting to routinised practices.…”

The road goes ever on: evidence of the continuing abuse of older people in care homes

“…Some researchers estimate that only one in every four or five cases are reported (Wolf, 2000, p. 7;Bonnie and Wallace, 2003, p. 9;Cooper et al, 2008, p. 1), whilst the World Health Organisation (2008, p. 1) estimate that as few as one in every 15 cases come to light. Some studies have indicated that it is only the most severe and visible occurrences of abuse that are reported from all types of care setting, and that many incidents remain unreported or even actively hidden (Health Select Committee, 2004;Buri et al, 2006;Hussein et al, 2007;Moore, 2016b) and may, in some cases, not even be identified as abuse (Choi, 2000;Bergeron, 2001;Tadd et al, 2011;Moore, 2019a). Research has revealed that under reporting of abuse by victims may occur as a result of a range of factors, confounding studies that seek to quantify its prevalence.…”

“…Consequently, apart from the research conducted by Moore (2016aMoore ( , 2018aMoore ( , 2019a) quoted in paragraphs above, much of what is known of the actual nature of abuse of older people in care homes has arisen from the investigations that have followed instances of proven abuse, particularly those where authentic abusive behaviours have has been covertly filmed, for example, Ash Court in Kentish Town (2011), Oban House in Croydon ( 2012), The Granary in Bristol ( 2012), The Old Deanery in Sussex ( 2012), Bethshan Nursing Home in Powys ( 2013), Orchid View in Essex ( 2013) and Keldgate Manor in Yorkshire ( 2015) and Serious Case Reviews (now called Safeguarding Adults Reviews), after abuse has been revealed. Nonetheless, what is apparent from these sources, is that older people do sometimes suffer active abuse and neglect, some of which is deliberate and pre-meditated, including psychological and physical torments, insults, illegal restraints, slapping, crude manhandling, dangerous lifting techniques and being ignored for long periods, even when beseeching staff for help.…”