Paths to perdition: exploring the trajectories of care staff who have abused older people in their care
| Date | 30 May 2019 |
| DOI | https://doi.org/10.1108/JAP-01-2019-0002 |
| Published date | 30 May 2019 |
| Pages | 169-189 |
| Author | Steve Moore |
| Subject Matter | Health & social care,Vulnerable groups,Adult protection,Safeguarding,Sociology,Sociology of the family,Abuse |
Paths to perdition: exploring the
trajectories of care staff who have abused
older people in their care
Steve Moore
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 perceptionsof 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.
Keywords Abuse, Older people
Paper type Research paper
Introduction
The most recent figures from NHS Digital (2017) irrefutably confirm the continued occurrence of
the abuse of older people living in care and nursing homes in England, and suggest that the
number of incidents of abuse may actually be increasing (p. 5). Moreover, despite the numerical
evidence that has now been produced by NHS Digital (2016, 2017) and its predecessors for over
six years to demonstrate largely consistent levels of abuse in care homes (NHS Information
Centre, 2013; Health and Social Care Information Centre, 2014a, b, 2015), there continues to be
a conspicuous vacuum in terms of effective national policy and practice guidance available to
both the strategists and practitioners of local authorities and their partner agencies that may help
them to begin to overcome this self-evident, enduring social problem.
Though a degree of insight can be gleaned about the kinds of abusive practices that occur in
care homes from reading the content of Serious Case Reviews (SCRs) and Safeguarding Adult
Received 16 January 2019
Revised 5 March 2019
20 March 2019
Accepted 4 April 2019
Steve Moore is Independent
Researcher and Consultant
based in Birmingham, UK.
DOI 10.1108/JAP-01-2019-0002 VOL. 21 NO. 3 2019, pp. 169-189, © Emerald Publishing Limited, ISSN 1466-8203
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Reviews (SARs), and, unfortunately, viewing covertly recorded moving images and sounds of
people actually being abused, much of what we read of and view are but manifestations of the
symptoms and consequences of the obstinately elusive influences that sometimes gives rise to
abuse. There continues to be little available, certainly from the perspective of care providing staff
themselves, to explain why they have perpetrated abuse, particularly when what has been done
often appears to be nothing other than cruelty that serves no obvious purpose.
This paper seeks to partially address this current circumstance by exploring the intra-personal
dynamics, personal characteristics and work experiences of three care staff who previously
worked in care homes for older people and engaged in abusive practices.
Reviewing the literature
Persistent organisational factors that tend to give rise to abuse
From the content of past SCRs and more recent SARs (or their summaries), it is apparent that
they contain a repetitive identification of certain factors that are cited as instrumental in leading to
the perpetration of abuse in care and nursing homes. These are usually insufficient staff training,
inadequate policies and procedures, closed, inward looking and isolated cultures, inadequate
quality assurance systems and poor management. Other issues identified in SCRs and SARs as
contributing to the occurrence of abuse with a degree of consistency, for example, ineffective
systems of risk assessment with regard to those receiving care, can, more often than not, also be
attributed in greater part to the presence of poor management, whether operational, tactical or
strategic, of the home(s) in question. Some of these common factors have been identified by,
among others, Brown (2009), Clay et al. (2014) and Aylett (2016), but unfortunately similar
phenomena may also be found in the many enquiry reports that significantly pre-date these more
recent analyses, for example, at Aranmore Care Home in Manchester (1986), Nye Bevan Lodge
in London (1987), Beech House in London (1999) and the Maypole in Birmingham (2002). It is
also informative to note that equivalent shortfalls and failings are consistently identified when poor
care and abuse has been determined in hospitals, for example, at North Lakeland NHS Trust
(Commission for Health Improvement, 2000), Portsmouth Healthcare NHS Trust (Commission for
Health Improvement, 2002), Manchester Mental Health and Social Care NHS (Commission for
Health Improvement, 2003), Sutton and Merton NHS Trust (Healthcare Commission, 2007),
Winterbourne View (Care Quality Commission, 2011) and Mid Staffordshire National Health
Service Foundation Trust (Francis, 2013). However, there remains an inveterate failure by the
relevant agencies to address the continuing occurrence of abuse in both care homes and
hospitals that the readily available figures demonstrate (NHS Information Centre, 2013; Health
and Social Care Information Centre, 2014a, b, 2015; NHS Digital, 2016, 2017), and there is little
doubt that more abuse will be revealed in both kinds of facility in the not too distant future.
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 (2017a, 2018a, b) 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.
Piercing the paradox of abuse in care homes
Nonetheless, there are also care homes where some of the inadequacies determined by SCRs
and SARs and listed above are present, but where the care provided to the older people living in
them is good, and meets both their physical and psychological needs. During the two decades
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