What’s in a word? The importance of the concept of “values” in the prevention of abuse of older people in care homes

2017 ◽  
Vol 19 (3) ◽  
pp. 130-145 ◽  
Author(s):  
Steve Moore
Keyword(s):  
Older People ◽  
Mixed Methods Research ◽  
Care Home ◽  
Care Staff ◽  
Care Homes ◽  
Contributory Factor ◽  
Structured Interviews ◽  
Content Type ◽  
Personal Value ◽  
Provision Of Care

Purpose The purpose of this paper is to present some of the findings from an empirical, mixed methods research project that reveal the importance of the personal value frameworks held by individual staff in the prevention of abuse of older people in private sector care homes. Design/methodology/approach Semi-structured interviews were undertaken with a sample of 36 care home personnel, including proprietors, care managers and care staff. Findings A significant number of respondents identified the importance of personal value frameworks among staff providing care as a potential contributory factor in the prevention of abuse of older people. Research limitations/implications Though the research draws upon the experiences of only 36 care home personnel through interviews, data suggest that the personal evaluations of staff towards those in their care is a significant contributory factor to the occurrence of abuse. Originality/value The research has identified individual staff value frameworks as a causal factor in the occurrence of abuse. The research also confirms that the perceptions of “values” among respondents directly involved in the provision of care are at odds with common understanding of “values” often cited elsewhere in connection with staff recruitment and training as a means of preventing the occurrence of abuse.

scholarly journals Swimming upstream: the provision of inclusive care to older lesbian, gay and bisexual (LGB) adults in residential and nursing environments in Wales

2014 ◽  
Vol 36 (2) ◽  
pp. 282-306 ◽  
Author(s):  
PAUL WILLIS ◽  
TRACEY MAEGUSUKU-HEWETT ◽  
MICHELE RAITHBY ◽  
PENNY MILES
Keyword(s):  
Sexual Orientation ◽  
Older People ◽  
Care Home ◽  
Care Staff ◽  
Same Sex ◽  
Structured Interviews ◽  
Qualitative Evidence ◽  
Future Care ◽  
And Bisexual ◽  
Provision Of Care

ABSTRACTThis paper examines the ways in which older people's residential and nursing homes can constitute heteronormative environments – social spaces in which the same-sex attractions and desires of residents are disregarded in the provision of everyday care. The aim of this discussion is to examine the synergies and differences between older lesbian, gay and bisexual (LGB) adults' expectations for future care home provision and the expectations of care staff and managers in providing residential services to older people with diverse sexual backgrounds. We present qualitative evidence from research into the provision of care environments in Wales. In this paper, we present findings from two cohorts: first, from five focus groups with care and nursing staff and managers; and second, from 29 semi-structured interviews with older LGB adults (50–76 years) residing in urban and rural locations across Wales. We argue that residential care environments can constitute heterosexualised spaces in which LGB identities are neglected in comparison to the needs and preferences of other residents. To this extent, we discuss how care staff and managers can be more attentive and responsive to the sexual biographies of all residents and argue against the separation of care and sexual orientation in practice.

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

2019 ◽  
Vol 21 (3) ◽  
pp. 169-189 ◽  
Author(s):  
Steve Moore
Keyword(s):  
Older People ◽  
Narrative Analysis ◽  
Care Home ◽  
Personal Characteristics ◽  
Care Staff ◽  
Work Experiences ◽  
Structured Interviews ◽  
Content Type ◽  
The People ◽  
Negative Perceptions

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.

Safeguarding vulnerable older people: a job for life?

2016 ◽  
Vol 18 (4) ◽  
pp. 214-228 ◽  
Author(s):  
Steve Moore
Keyword(s):  
Older People ◽  
Mixed Methods Research ◽  
Significant Proportion ◽  
Postal Questionnaire ◽  
Care Staff ◽  
Care Homes ◽  
Content Type ◽  
Anonymous Questionnaire ◽  
Textual Data ◽  
Abuse And Neglect

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.

See no evil, hear no evil, speak no evil? Underreporting of abuse in care homes

2016 ◽  
Vol 18 (6) ◽  
pp. 303-317 ◽  
Author(s):  
Steve Moore
Keyword(s):  
Mixed Methods ◽  
Private Sector ◽  
Mixed Methods Research ◽  
Design Methodology ◽  
Qualitative Data ◽  
Care Home ◽  
Significant Proportion ◽  
Care Homes ◽  
Structured Interviews ◽  
Content Type

Purpose The purpose of this paper is to present some of the findings from an empirical, mixed methods research project that reveal underreporting and active concealment of abuse in private sector care homes. Design/methodology/approach Semi-structured interviews were undertaken with 36 care home personnel. An anonymously completed questionnaire was also used concurrently among newly appointed staff in newly opened care homes, to elicit additional quantitative and qualitative data. Findings A significant number of respondents reported awareness of acts of abuse that had not been reported within the care home or externally to the authorities. Some respondents were aware that where occurrences of abuse had been reported, no subsequent action was taken, and external authorities were not always involved in responses to abuse. A significant number of respondents were aware of deliberate strategies used to deter reports of abuse to external agencies. Research limitations/implications Though the research draws upon the experiences of only 36 care home personnel through interviews, and 94 questionnaire respondents who had witnessed occurrences of abuse, data suggest that a significant proportion of abuse in care homes remains unreported. Originality/value The research has revealed staffs’ experiences of underreporting of abuse in private sector care homes. Findings indicate that changes are required to current methods of scrutiny of occurrences of abuse in care homes and the strengthening of incentives to report it.

If you always do what you have always done, you will always get what you have always got: commissioning and regulating care homes to prevent abuse

2017 ◽  
Vol 19 (6) ◽  
pp. 418-430 ◽  
Author(s):  
Steve Moore
Keyword(s):  
Older People ◽  
Design Methodology ◽  
Care Home ◽  
Care Homes ◽  
Content Type ◽  
Limited Impact ◽  
Regulatory Processes ◽  
Limited Efficacy ◽  
Regulatory Functions ◽  
Practical Implications

Purpose The purpose of this paper is to present a review of some of the fundamental theoretical and contextual components of commissioning and regulatory processes as applied to care home services, revisiting and examining how they impact on the potential prevention of abuse. Design/methodology/approach By revisiting a number of the theoretical bases of commissioning activity, some of which may also be applied to regulatory functions, the reasons for the apparent limited impact on the prevention of the abuse that occurs in care homes by these agencies are analysed. Findings The paper demonstrates how the application of commissioning and regulatory theory may be applied to the oversight of care homes to inform proposed preventative strategies. Practical implications The paper offers strategies to improve the prevention of abuse in care homes for older people. Originality/value A factual and “back to basics” approach is taken to demonstrate why current strategies that should contribute to tackling abuse in care homes are of limited efficacy.

Oops! Its happened again! Evidence of the continuing abuse of older people in care homes

2018 ◽  
Vol 20 (1) ◽  
pp. 33-46 ◽  
Author(s):  
Steve Moore
Keyword(s):  
Older People ◽  
Design Methodology ◽  
Significant Proportion ◽  
Postal Questionnaire ◽  
Care Staff ◽  
Care Homes ◽  
Content Type ◽  
Anonymous Questionnaire ◽  
Textual Data ◽  
Abuse And Neglect

Purpose The purpose of this paper is to present findings from an empirical 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 was subsequently subjected to both quantitative and qualitative analysis. The questionnaire was distributed to newly appointed care staff in six 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 described instances of predominantly psychological and physical abuse and neglect. Research limitations/implications Though the research draws upon the experiences of only 194 anonymous questionnaire respondents, of whom 140 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. Findings suggest that changes are required to current methods of external scrutiny and investigation of practices in care homes.

scholarly journals A qualitative study of older people with minimal care needs experiences of their admission to a nursing home with Registered Nurse care

2015 ◽  
Vol 16 (2) ◽  
pp. 94-105 ◽  
Author(s):  
Alice K. Stevens ◽  
Helen Raphael ◽  
Sue M. Green
Keyword(s):  
Decision Making ◽  
Grounded Theory ◽  
Qualitative Study ◽  
Older People ◽  
Registered Nurse ◽  
Care Home ◽  
Care Homes ◽  
Care Needs ◽  
Content Type ◽  
Health And Social Care

Purpose – Residential care for older people in the UK includes care homes with and without 24-hour Registered Nurse (RN) care. Reduced autonomy and personal wealth can result when people assessed as having minimal care needs, enter and reside in care homes with RN care. The purpose of this paper is to explore the experiences of older people with minimal care needs admission to care homes with RN care. Design/methodology/approach – A qualitative study using a grounded theory method was undertaken. In total, 12 care home with RN care residents assessed as not requiring nursing care were interviewed. Initial sampling was purposive and progressed to theoretical. Interviews were analysed using the grounded theory analysis method of constant comparison and theory development. Findings – Two main categories emerged: “choosing the path”, which concerned the decision to enter the home, and “settling in”, which related to adaptation to the environment. Findings suggested participants who perceived they had greater control over the decision-making process found it easier to settle in the care home. The two categories linked to form an emerging framework of “crossing the bridge” from independent living to care home resident. Research limitations/implications – The findings contribute to the understanding of factors influencing admission of older people with minimal care needs to care homes with RN care and highlight the importance of informed decision making. Practical implications – Health and social care professionals must give informed support and advice to older people seeking care options to ensure their needs are best met. Originality/value – This study enabled older people with minimal care needs admission to care homes with RN care to voice their experiences.

scholarly journals Quality improvement through the paradigm of learning

2015 ◽  
Vol 16 (4) ◽  
pp. 195-207 ◽  
Author(s):  
Trish Hafford-Letchfield ◽  
Peter Lavender
Keyword(s):  
Quality Improvement ◽  
Older People ◽  
Social Care ◽  
Care Home ◽  
Care Homes ◽  
Project Staff ◽  
Content Type ◽  
Health And Social Care ◽  
Learning Interventions

Purpose – Achieving meaningful participation and co-production for older people in care requires radical approaches. The purpose of this paper is to explore an innovation where learning interventions were introduced into care settings and older people matched to community-based learning mentors to develop partnerships. The authors explore how the concept of learning might be used as a paradigm to raise the quality of care in institutionalised settings using a co-productive and relationship-based approach to promote wellbeing. Design/methodology/approach – A structured evaluation drew on qualitative data captured from interviews with older people (n=25) and learning mentors (n=22) to reflect on the potential benefits and challenges involved when introducing learning interventions in care settings. This was contextualised alongside data captured from stakeholders (n=10) including a care home manager, social care and education commissioners, trustees and project staff to assess the interdisciplinary contribution of lifelong learning to quality improvement. Findings – Introducing learning interventions to older people within care settings promoted participation, advocacy and relationship-based care which in turn helped to create a positive culture. Given the current challenges to improve quality in care services, drawing on a paradigm of learning may encourage older people to retain their independence as care homes strive towards a person-centred approach. Promoting social activities and leisure using learning was found to foster closer working relationships between older people and the wider community. These had a levelling effect through reciprocity, using an asset based approach. There were benefits for the care provider as the partnerships formed enabled people to raise both individual and collective concerns about care and support. Originality/value – Raising and sustaining the quality of support for older people requires input from the wider public sector beyond health and social care. Purposeful engagement with other disciplines such as learning and leisure offers the potential to realise a more sustainable model of user choice, person-centred support and user involvement. Being engaged through learning can nourish membership in the community for marginalised populations such as older people living in care homes.

Care homes lay assessor project – using volunteers to improve the quality of life of older people living in care homes

2016 ◽  
Vol 20 (2) ◽  
pp. 94-100
Author(s):  
Kenneth Walter Dolbear
Keyword(s):  
Quality Of Life ◽  
Older People ◽  
Care Home ◽  
Care Homes ◽  
Meaningful Change ◽  
Content Type ◽  
Local Council ◽  
Practical Implications

Purpose – The purpose of this paper is to outline the learning from an innovative approach to using volunteers as lay assessors in order to secure improvements in the quality of life of older people in care homes. Design/methodology/approach – The paper describes the implementation of pilot lay assessor scheme in Bristol and systematically explores the learning from this case study. Findings – The paper concludes that despite a number of important challenges and limitations, a lay assessor approach, particularly when conducted in close co-operation with a local council, can indeed provide demonstrable quality of life benefits for older people in closed institutions such as care homes. Practical implications – The case study highlights a number of key implications for practice including: it is possible to recruit, motivate and train volunteers to provide a lay assessor scheme; working with a local council and providers of care homes can produce real improvements in quality of life; lay assessor schemes are an important way of “shining a light” into closed institutions; defining quality of life and balancing this with institutional attitudes towards risk can be extremely challenging; and working with care home managers, providing them with ideas and support can be effective in bringing about meaningful change. Originality/value – This case study reports on one of the first volunteer lay assessor initiatives in the country. There has been very little if any reporting or analysis of such schemes. This paper therefore adds significantly to this important are of public policy and provision.

scholarly journals Media reports of abuse in adult residential care: implications for staff and practice

2019 ◽  
Vol 23 (3) ◽  
pp. 177-184
Author(s):  
Yvonne Pedley ◽  
Paul McDonald
Keyword(s):  
Older People ◽  
Residential Care ◽  
Media Coverage ◽  
Single Case ◽  
Care Home ◽  
Health And Safety ◽  
Public Perceptions ◽  
Care Staff ◽  
Content Type ◽  
Care For Older People

Purpose There is often a focus on the negative aspects of residential care for older people. In the UK, there has been increasing media attention on abuse in these and other care settings and this has impacted upon public perceptions and subsequent government policy. Consequently, care staff are “tarred with the same brush”, yet narratives of their views have rarely been investigated. The paper aims to discuss these issues. Design/methodology/approach This undergraduate, qualitative, single-case study aimed to investigate the views of staff and explore the implications for them and their practice. The views of 15 participants in a residential care home were obtained through interviews and a focus group. Findings Although the findings reveal sensitivities to the negative portrayal of care roles, they also reveal positive responses through a willingness to change practice, a strengthening of care values and a reduction in risks. Originality/value This study will be of interest to those multi-disciplinary residential teams who care for older people as it uncovers a striking sense of guardianship amongst residential care staff, and a willingness to reflect on, and change, practice. The study endorses the value of small practitioner-led research as an illustration of how a residential care team consisting of managers and staff can strengthen its resolve against adverse media coverage and negative public perceptions. This study suggests that this will have positive implications for the health and safety of older people living in residential settings.

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