A review of literature exploring the possible causes of abuse and neglect in adult residential care
| Pages | 216-233 |
| Date | 10 August 2015 |
| DOI | https://doi.org/10.1108/JAP-11-2014-0034 |
| Published date | 10 August 2015 |
| Author | Andrew Hutchison,Biza Stenfert Kroese |
| Subject Matter | Health & social care,Vulnerable groups,Adult protection |
A review of literature exploring the
possible causes of abuse and neglect
in adult residential care
Andrew Hutchison and Biza Stenfert Kroese
Dr Andrew Hutchison and
Dr Biza Stenfert Kroese are
based at the School of
Psychology, University of
Birmingham, Birmingham, UK.
Abstract
Purpose –The purpose of this paper is to present a systematic review of empirical research, which explores
possible causal and risk factors linked to abuse or neglect in residential care facilities.
Design/methodology/approach –Electronic database searches were conducted to identify and
synthesise studies reporting on empirical research aimed at exploring causal and/or risk factors associated
with abuse or neglect in adult residential care services. Sample characteristics, design characteristics and
outcome data were extracted from each paper. This information was then collated and summarised. Each
study was evaluated using Sale and Brazil’s (2004), cross-paradigm framework of trustworthiness and rigour.
Findings –In all, 17 papers, reporting on 15 separate research studies, met the inclusion criteria for this
review. Results revealed that research in this area has utilised a diverse range of methodological approaches
to explore abuse and/or neglect within the context of residential services for older adults and adults with
learning disabilities. Possible causal and risk factors identified were separated into those that operated at a
cultural or organisational/environmental level and those that operated at an individual or interpersonal level.
Originality/value –While there are limitations associated with presenting a review of such a diverse group of
studies, this paper presents a valuable synthesis of the empirically derived causal and risk factors linked to the
abuse and neglect of adults in care. Additionally, readers are able to obtain a comprehensive overview of the
quality of empirical research in this area. Finally, a number of applied implications and future research
directions are highlighted, which may contribute to the development of further research and ultimately to
improvements in residential care standards and a reduction in future instances of abuse and neglect.
Keywords Abuse, Adults, Neglect, Risk factors, Causes, Residential care
Paper type Literature review
Introduction
Within the UK it was previously widely accepted that the complex care needs of specific groups
of people (e.g. people with learning disabilities, people with severe and enduring mental health
problems and older adults), were best managed in large scale residential institutions (Thane,
1978) and segregation from mainstream society was actively encouraged. However, since the
1980s the UK health and social care sector has adopted a more inclusive stance and placed
greater emphasis on the need to support and care for people at home or in the community (e.g.
Care Quality Commission (CQC), 2012a). Despite this, residential care homes remain a feature of
many health and social care services, typically catering for those with the most complex care
needs. For the purposes of this paper, the term residential care home refers to a multiple
occupancy home that provides 24 hour on-site personal and/or nursing care for residents.
Despite the specialist nature of existingresidential care facilities, high-profile cases of substandard
care and abuse in adult services (e.g. Flynn, 2012) have raised serious concerns regarding the
Received 20 November 2014
Revised 23 March 2015
19 April 2015
Accepted 5 May 2015
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appropriatenessof current UK care provisionsand practices. Abuse has been definedas a violation
of an individual’s human and civil rights by any other person or persons (Department of Health,
2000). Itmay be physical, verbal or psychological in nature;it may consist of a single act or repeated
acts; and it may also be an act of neglect or an omission to act. A number of reports have also
revealed that many residential care environments are failing to meet basic care and safeguarding
standards. For example, in 2012 a national (England) inspection and review of learning disability
services revealed that almost 50 per cent of hospitals and care homes did not meet approved
standards (CQC, 2012b). A similar reviewof older adult care homes also highlightedconsiderable
variation in the standards of care being provided (CQC, 2012c).
According to a 2010 review of UK adult protection data, approximately one-third of adult
protection referrals related to people with learning disabilities (Beadle-Brown et al., 2010).
Of those 63 per cent were found to be living in residential care and the most frequently reported
perpetrators were members of direct care staff (Beadle-Brown et al., 2010). Thus, prevalence
figures suggest that people with learning disabilities, living in residential care environments,
are more likely to be victims of abuse compared to those living in their own homes. While these
figures are likely to be susceptible to reporting bias (i.e. instances of abuse that occur at
home may be less likely to be reported), this provides compelling evidence to suggest that some
specialist residential care environments are not protecting potentially vulnerable people from
experiences of abuse or neglect. Additionally, in an audit of specialist inpatient learning
disability services in England, it was concluded that very few services existed where the quality
of care and attention paid to client safety was uniformly good across all aspects of care
(Healthcare Commission, 2007).
Within the older adult literature, an international review of the prevalence of elder abuse and
neglect revealed that one in six professional carers report committing psychological abuse and
one in ten physical abuse (Cooper et al., 2008). In addition, over 80 per cent of care staff had
observed abuse. Consequently, available self-report data suggests that abuse and neglect
represents a common feature of carers’work experiences. In the UK, recent high-profile media
reports and serious case reviews have also highlighted the on-going existence of cases of abuse
and neglect in specialist residential care environments (e.g. Sheather, 2011). A comparison has
also been made between different care settings (i.e. nursing home care, paid home care and
assisted living), which revealed that nursing homes have the highest rates of all types of abuse
and that a move from paid home care to nursing home care could more than triple the odds of a
person experiencing neglect (Page et al., 2009). Consequently, existing research and media
evidence highlights an on-going need to provide better care and protection for many adults living
in specialist care home environments with complex care needs.
An emerging body of literature documents attempts to understand possible causal factors
associated with abusive care environments and substandard care practices. For example, a
selective literature review on the abuse of adults with learning disabilities by those employed to
care for them concluded that historic and current cultural beliefs/attitudes towards people with
learning disabilities can contribute to the threat and likelihood of abuse (Moore, 2001). In addition,
the design and operational systems of specific services were also identified as predictors of
abusive environments. For example, large impoverished environments, isolated services and the
lack of a strong philosophy of care were all identified as factors that may facilitate and legitimise
the occurrence of abuse (Moore, 2001). Finally, Moore’s (2001) review also suggested that the
lack of a valuing relationship between carer and the person with a learning disability greatly
increases the likelihood of abuse or neglect.
Similar causal influences have also been identified within the older adult literature. For example, a
descriptive literature review of causes and risk factors associated with elder abuse identifies the
following causal categories: the sociocultural climate; the caregiving context; the characteristics
of the caregiver and the nature of the caregiving relationship (Jones et al., 1997). However, a
recent review has raised questions about the quality of much of this research material (Daly et al.,
2011). Specifically, the review demonstrates that research in this area is dominated by
observational/descriptive studies and case study evidence. In addition, much of the available
evidence within the older adult literature focuses on those living in the community, as opposed to
residential services (Lachs and Pillemer, 2004).
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