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

Moore, Steve

doi:10.1108/jap-10-2017-0034

Cited by 10 publications

(4 citation statements)

References 20 publications

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“…With this in mind, it is certainly time to look to other fundamental, substantive theory for explanations of why abuse endures in care homes, for example those drawn from social psychology (Moore, 2019c), and consequently, means by which it might be effectively countered. Though inspectors and contract monitoring staff, if suitably experienced and qualified (sometimes they are not, see Moore, 2018b), can provide some direction to care home owners, managers and care staff, what they impart often fails to have any impact because the essential foundations of good, safe care are in part, or in whole, absent. If the personal value frameworks of many staff who are employed in care homes to provide care are incompatible with the work they undertake (Moore, 2017b;Kirkley et al, 2011;Kitwood, 1997), the possibility that abuse will occur and remain unreported endures (Greve, 2008, p. 152;Moore, 2016b, p. 16).…”

Section: Discussionmentioning

confidence: 99%

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

Moore

2019

WWOP

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Purpose The purpose of this paper is to present findings from a research project designed to enhance knowledge of the current extent and nature of abuse in contemporary 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 providing care to older people 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 had witnessed numerous occurrences of primarily psychological and physical abuse and neglect, perpetrated against the older people living in the care homes in which they had previously worked. Research limitations/implications Although the research draws upon the experiences of only 197 anonymous questionnaire respondents, of whom 180 had witnessed abuse, data suggest that 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. When combined with two previous studies using the same or a similar methodology, the research also confirms the enduring presence of abuse in care homes. Findings again suggest that changes are required to current methods of external scrutiny and investigation of practices in care homes.

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Section: Discussionmentioning

confidence: 99%

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

Moore

2019

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“…The practices revealed by respondents are likely to reduce the effectiveness of current regulatory and performance monitoring regimes that remain fundamentally largely unchanged in terms of the incisiveness of methods used since the 1980s and 1990s, respectively. These methods focus predominantly only upon readily observable "organisational artefacts" of the care home and are incapable of penetrating the façade of care home life that is often presented so that they might otherwise reveal the "tacit assumptions", the unspoken organisationally ingrained ways of working, as depicted by Schein (2004, p. 25), for example, that may contribute to the occurrence, concealment and thus perpetuation of abuse (Moore, 2018b). It is in these ways that many of the potential voices that might otherwise reveal the true extent and persistence of abuse in care homes are effectively silenced.…”

Section: Discussionmentioning

confidence: 99%

The sound of silence: evidence of the continuing under reporting of abuse in care homes

Moore

2019

JAP

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Purpose The purpose of this paper is to present findings from two research projects undertaken between 2015 and 2019 that reveal continued underreporting and sometimes active concealment of abuse in private sector care homes for older people in England. Design/methodology/approach An anonymously completed questionnaire was used among newly appointed staff in 11 newly opened care homes to elicit both quantitative and qualitative data relating to the reporting of occurrences of abuse within the care homes in which they had previously worked. In total, 391 questionnaires in total were returned, 285 of which indicated that respondents had witnessed the perpetration of abuse on at least one occasion. Findings A significant number of respondents indicated their awareness of acts of abuse that had not been reported within the care home(s) in which they had worked, or externally to the appropriate authorities. Some respondents were aware that where occurrences of abuse had been reported within care homes no subsequent action was taken, or that external authorities were not always involved in responses to abuse. A significant number of respondents described strategies that had been used to deter reports of abuse to external agencies and to conceal its occurrence from the statutory regulator and service commissioners. Research limitations/implications Though the research draws upon the experiences of only 285 questionnaire respondents who had witnessed episodes of abuse, data suggest that a significant proportion of abuse in care homes remains unreported. Originality/value The research has revealed experiences of continued underreporting and concealment of abuse among staff in private sector care homes. Findings indicate that a strengthening of incentives and protections extended to the staff who should report abuse are essential, and that changes to current methods of external scrutiny to which care homes are subject are required.

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“…It is clear that despite the content of SCRs, SARs and the long procession of abuse enquiries conducted in care homes and hospitals that preceded them, not a great deal of organisational or industry learning has taken place, although this is held as one intended major outcome of such enquiries (Walsh, 2002). The fundamental reasons for why this is the case has not been explored to any significant extent and remains paradoxical, though Moore (2017aMoore ( , 2018a has suggested that it is, in part, due to the flawed methodologies and approaches still used by service commissioners who should be ensuring that they purchase good quality care, and in part, to a long standing, pervasive absence of altruistic motivations among the staff of care home providers, service commissioners and regulators. Moore asserts that both of these phenomena contribute to the obstinacy of abuse in care homes by fostering circumstances under which it can persist, despite the many years of research claiming to identify its causes, and the corresponding developments in safeguarding practice, policy and guidance that have taken place.…”

Section: Reviewing the Literaturementioning

confidence: 99%

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

Moore¹

2019

JAP

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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.

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

Cited by 10 publications

References 20 publications

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

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

The sound of silence: evidence of the continuing under reporting of abuse in care homes

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

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