Safeguarding vulnerable older people: a job for life?

Abstract

Purpose – The purpose of this paper is to present the findings from one component of an empirical, mixed methods research project designed to determine the extent, nature and causes of abuse in contemporary independent sector care homes for older people. Design/methodology/approach – A self-completion, postal questionnaire was used to elicit both numerical and textual data that were subsequently subjected to both quantitative and qualitative analysis. The questionnaire was distributed to newly appointed care staff in five participating care homes to determine the nature of any abuse they may have witnessed in the homes in which they had previously worked. Findings – A significant proportion of respondents described instances of predominantly psychological and physical abuse and neglect and revealed hitherto undisclosed abusive practices. Research limitations/implications – Though the research draws upon the experiences of only 140 anonymous questionnaire respondents, of whom 94 had witnessed abuse, data suggest abuse continues to occur in some care homes for older people. Originality/value – The research has revealed staffs’ recent experiences of a range of abusive acts and practices. Findings suggest that changes are required to current methods of external scrutiny and investigation of practices in care homes.

Through a glass darkly: exploring commissioning and contract monitoring and its role in detecting abuse in care and nursing homes for older people

“…Further, as the Care Services Improvement Partnership (CSIP) (2007, p. 9) asserted, the quality of care services that are purchased by public bodies can only be the "[…] highest quality achievable for the price paid". This often ignored factor relating to the purchase of care services by local authorities takes on greater significance when considering the fact that fees paid by them to private sector care and nursing homes nowadays are likely below what is economically viable, preventing providers from aspiring to ensuring high-quality care, reflected in the tenacity of levels of abuse as demonstrated by the available statistics and recent research previously cited (The NHS Information Centre, 2012;The Health and Social Care Information Centre, 2013, 2014a, b, 2015NHS Digital, 2016;Moore, 2016aMoore, , 2017b. Similarly, given the cost savings that local authorities have been required to make by central government in recent years, investment in the capacity and capability of their monitoring functions has likely not proliferated and developed in line with the expansion in the numbers of places in care homes that has occurred, an expansion that is set to continue as the population of older people who need such care grows, including many with dementia and multiple, complex, age-related pathologies (Her Majesty's Government, 2005;Franklin, 2014), unless alternative models of care are determined, which seems unlikely in the medium term.…”

“…If individual older people were truly empowered, the majority of the estimated 300,000 older people currently in UK care homes (Office for National Statistics, 2017) would not be there, they would be at home. Second, the failures of ever increasing amounts of training for care home staff, of continued regulation, and of multi-agency safeguarding responses, to reduce the constancy with which abuse occurs in care homes for older people (Moore, 2016a(Moore, , 2017b and the ceaseless additions to the existing catalogue of abuse amassed over the decades, much of it nowadays captured by covert filming, similarly challenges the credibility and effectiveness of the vaunted principles of "protection", "prevention", "proportionate responses", "partnership" and "accountability" as applied to the activities of both commissioners and care homes for older people alike.…”

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

“…The data available on the prevalence of abuse in care and nursing homes have been limited for many years. However, a range of research in a number of countries have suggested that abuse can often be a common part of the lives of vulnerable older adults rather than an exceptional occurrence when they live in these institutions (Pillemer and Moore, 1989;Pillemer and Hudson, 1993;Cooper et al, 2008;Cambridge et al, 2011;Schiamberg et al, 2012), and more recent research has tended to confirm that this continues to be the case (Malmedal et al, 2014;Moore, 2016aMoore, , 2018aCooper et al, 2018). Moreover, studies using random samples undertaken by Pillemer and Moore (1989), Pillemer and Hudson (1993), College of Nurses of Ontario (1993), Saveman et al (1999) and Goergen (2004) in care and nursing homes have all determined notable numbers of nurses and care staff who have admitted to witnessing and/or perpetrating abuse against those in their care.…”

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

“…As Darlington and Scott (2002) maintain, a greater number of decisions on whether to take a qualitative (interpretivist) or quantitative (positivist) approach to conducting research are based not on the particular philosophical beliefs of positivism or interpretivism (or others), but on the design and methodology identified as best suited to the purpose of the enquiry. So, for example, we have the repeated collections of numerical data about abuse by NHS Digital (2016, 2017, 2018) referred to above that constitutes a predominantly positivist orientation, and the research of, for example, Moore (2016, 2018, 2019a) that makes use of a combination of positivist and interpretivist approaches to determine both the numerical extent and the nature of the abuses to which older people in care homes are sometimes subjected. Irrespective of the research philosophies that influenced these researchers, the findings of both contribute significantly to the current understanding of the prevalence and the nature of abuse in contemporary care and nursing homes.…”

“…Given that the abuse of older people is known to have been occurring in care homes for decades prior to the availability of such reliable data, and it has become increasingly apparent that abuse is a common part of the institutional life that many older people experience (Jenkins et al , 2000; Action on Elder Abuse, 2006; Cambridge et al , 2006; Cooper et al , 2008; Post et al , 2010; Fyson and Kitson, 2012; Moore, 2016, 2018, 2019a; Cooper et al , 2018) it is clear that current interventions by the responsible agencies, such as health and local authority commissioners of care home services, the statutory regulator of the care home sector and the adult safeguarding functions of local authorities, are all failing to respond effectively to what is evidently a obstinate social problem.…”