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

2019 ◽  
Vol 22 (1) ◽  
pp. 35-48
Author(s):  
Steve Moore
Keyword(s):  
Private Sector ◽  
Older People ◽  
Design Methodology ◽  
Qualitative Data ◽  
Care Home ◽  
Significant Proportion ◽  
Care Homes ◽  
Research Projects ◽  
Content Type ◽  
External Scrutiny

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.

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 Encouraging managers of care homes for older adults to participate in research

2019 ◽  
Vol 20 (3) ◽  
pp. 120-129
Author(s):  
Nick Smith ◽  
Ann-Marie Towers ◽  
Grace Collins ◽  
Sinead Palmer ◽  
Stephen Allan ◽  
...  
Keyword(s):  
Design Methodology ◽  
Care Home ◽  
Care Homes ◽  
Research Projects ◽  
Research Partnership ◽  
Content Type ◽  
Advantages And Disadvantages ◽  
Proactive Measures ◽  
Personalised Feedback ◽  
Participation In Research

Purpose Research in care homes requires the co-operation of care home managers. Noting the challenges faced by the care home sector, the purpose of this paper is to consider ways in which research studies can encourage care home managers and their homes to participate in research. Design/methodology/approach The discussion is informed by two research projects which are used to explore methods of encouraging managers of care homes to participate in research. One of the studies included interviews with care home managers to understand their reasons for taking part in research. Findings This paper outlines and assesses three strategies for encouraging care home managers to participate in research: working in partnership, providing payment and providing personalised feedback on findings. Whereas all the strategies have the potential to encourage care home managers’ participation in research, partnership working in particular was found to be fraught with difficulties. Research limitations/implications This paper suggests that the research projects could employ any of these strategies to encourage managers of care homes to participate in research. It also suggests that proactive measures could help ameliorate the pitfalls of partnership working. Originality/value This paper shows the advantages and disadvantages of using a combination of strategies for encouraging the participation of care home managers in research.

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 The “Cameos of Care Homes” project – care home staff’s Vanguard involvement and reflections

2019 ◽  
Vol 23 (2) ◽  
pp. 107-115
Author(s):  
Jess Harris ◽  
Jill Manthorpe
Keyword(s):  
Design Methodology ◽  
Research Output ◽  
Care Home ◽  
Care Homes ◽  
Content Type ◽  
Care Home Staff ◽  
Learning Cultures ◽  
Care Workers ◽  
The Impact ◽  
Practical Implications

Purpose The Cameos of Care Homes project is an opportunity to use the medium of film to showcase the experiences and reflections of frontline care home staff whose employers participated in the National Health Service (NHS) England Vanguard programme. Reflecting on their involvement in one of the Enhanced Health in Care Homes Vanguards, 12 staff describe, in front of the camera, the impact on themselves and their colleagues, on their care for their older residents, and on the wider culture of the care home. The paper aims to discuss this initiative. Design/methodology/approach The paper reports the experiences of care home staff that were purposefully recorded on film about their participation in a care home Vanguard. The recruitment of the care homes and staff is described, as are the development of interview questions and approaches needed when filming is considered as a research method. Findings Participating care home staff reported that their involvement in the Vanguard programme had improved knowledge, confidence, morale, communication skills and the homes’ learning cultures. They were enthusiastic about reporting their experiences on film. Examples were given of proactive early support from local NHS staff leading to improvements in care, thereby reducing demand on the NHS. However, participation was resource intensive for care homes. Care home staff hoped the support that accompanied the Vanguard programme would continue but were uncertain to what degree this would happen once the Vanguard programme ceased. Research limitations/implications The interviews were undertaken with a self-selecting group of care home staff from two care homes operating in one of the six Vanguard sites in England. By their very nature, interviews for a public film cannot provide anonymity. Practical implications Researchers seeking the views of care home staff may wish to consider filming interviews and presenting the film as a research output that is engaging and informative for care home and wider audiences. Originality/value The paper presents an analysis of filmed interviews with care home managers and care workers working with older people. Their views on the Vanguard initiative have not been widely considered, in contrast to the sizeable literature relating to NHS activity and expenditure.

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 A guide to research with care homes

2015 ◽  
Vol 16 (4) ◽  
pp. 186-194 ◽  
Author(s):  
Rebekah Luff ◽  
Anne Laybourne ◽  
Zara Ferreira ◽  
Julienne Meyer
Keyword(s):  
Design Methodology ◽  
Best Practice ◽  
Care Home ◽  
Care Homes ◽  
Research Practice ◽  
Methodological Issues ◽  
Care Needs ◽  
Content Type ◽  
Key Issues ◽  
Complex Care Needs

Purpose – A growing older population with complex care needs, including dementia, are living in care homes. It is important to support researchers in conducting ethical and appropriate work in this complex research environment. The purpose of this paper is to discuss key issues in care homes research including examples of best practice. The intention is to inform researchers across disciplines, leading to more sensitive and meaningful care home research practice. Design/methodology/approach – Experienced care homes researchers were invited to provide methodological insights and details not already reported in their publications. These have been analysed, creating key themes and linked to project publications. Findings – The need for reflexivity was a key finding. In particular, researchers need to: appreciate that the work is complex; see participants as potential research partners; and consider how cognitive and physical frailty of residents, staffing pressures and the unique environments of care homes might impact upon their research. Other challenges include recruitment and consenting people who lack mental capacity. Research limitations/implications – As the care homes research landscape continues to develop and grow, there still remains limited reflection and discussion of methodological issues with a need for a “safe space” for researchers to discuss challenges. Originality/value – This review is an updated methodological guide for care homes researchers, also highlighting current gaps in the mechanisms for continuing to share best research practice.

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.

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