The relativity of theory: applying theories of social psychology to illuminate the causes of the abuse of older people in care homes
| DOI | https://doi.org/10.1108/JAP-09-2018-0019 |
| Date | 28 March 2019 |
| Pages | 89-110 |
| Published date | 28 March 2019 |
| Author | Steve Moore |
| Subject Matter | Health & social care,Vulnerable groups,Adult protection,Safeguarding,Sociology,Sociology of the family,Abuse |
The relativity of theory: applying theories
of social psychology to illuminate
the causes of the abuse of older
people in care homes
Steve Moore
Abstract
Purpose –Through the lens afforded by two theories drawn from the discipline of social psychology, the
purpose of this paper is to explain the evident continuing abuse of adults at risk living in care homes by the
staff who should be looking after them.
Design/methodology/approach –By considering existing theories and research into the reasons why
vulnerable adults are abused the paper proposes the relevance of other extant theories on the degradation of
moral restraint and dehumanisation of victims, and on the social psychology of intergroup relations, to the
perpetration of abuse.
Findings –The paper demonstrates how theories that explain the psychology of human behaviour in certain
circumstances may be usefully applied to the inveterate social problem of the abuse of vulnerable adults living
in care homes.
Practical implications –The paper offers the opportunity for the reader to consider how these theories of
social psychology may be applied to explain and guide remedies to the persistent levels of abuse in
English care homes, abuse that continues despite government oversightof care provided to adults who may
be at risk by virtue of the activities of the statutory regulator and health and social care commissioners, and
the interventions of safeguarding personnel.
Originality/value –This is a conceptual paper from which future research and theorising may arise to better
understand the most fundamental causes of the abuse of older people in care homes in order to develop
feasible and effective measures to overcome it.
Keywords Preventing abuse, Abuse of older people, Abuse of older people in care homes,
Developing theory of abuse, Social psychology of abuse, Theories of abuse
Paper type Conceptual paper
Introduction
The figures published by NHS Digital in November 2017 confirm that abuse, including the abuse of
older people in care and nursing homes, continues and suggest that the prevalence of abuse is
increasing (NHS Digital, 2017). When considered alongside the equivalent data sets from five previous
annual periods between 2011 and 2016 (NHS Information Centre, 2013; The Health and Social Care
Information Centre, 2014a, b, 2015; NHS Digital, 2016), it is clear that abuse perpetrated in people’s
own homes, in care and nursing homes and in hospitals has endured despite the activities of
the statutory regulator, local authority and health commissioners and safeguarding personnel.
Remarkably, the figures confirm that levels of abuse have remained very constant in care and
nursing homes, from where 36 per cent of all safeguarding enquiries have arisen during every
one of the six periods from which data was secured. Though the information that is now collated
by NHS Digital continues to be produced as experimental statistics, it is the best numerical
information that is available to the health and social care economy and further reveals that as a
Received 28 September 2018
Revised 31 October 2018
15 November 2018
Accepted 27 November 2018
Steve Moore is an Independent
Researcher and Consultant
based in Dudley, UK.
DOI 10.1108/JAP-09-2018-0019 VOL. 21 NO. 2 2019, pp. 89-110, © Emerald Publishing Limited, ISSN1466-8203
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THE JOURNAL OF ADULT PROTECTION
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result of all safeguarding enquiries undertaken, between 41 and 75 per cent[1] of the allegations
of abuse were substantiated or partially substantiated in each of the periods reported on,
confirming that abuse in some form has definitely been perpetrated.
Concerningly, and as I have pointed out in a previous paper (Moore, 2018a), the 2015–2016
data collection exercise undertaken by NHS Digital (NHS Digital, 2016) referred to above
revealed that 102,970 enquiries were commenced relating to adults under Section 42[2] of the
Care Act 2014, and 109, 145 Section 42 enqui ries were carried ou t during the subseque nt
2016-2017 period (NHS Digital, 2017). These figures exclude what are referred to in the data
collection proce ss as “other enquires”, of which there were a further 42,015 during 2016/17.
Of the enquiries commenced under Section 42 of the Act, 63 per cent involved people over the
age of 65 years in each of the two most recent reporting periods, that is 65,085 during
2015/2016 (NHS Digital, 2016, p. 1) and 69,265 during 2016/2017 (NHS Digital, 2017, p. 5),
an increase of 6 per cent i n the second of these rep orting episodes. U nfortunately, the hoary
assertions that these figures simply represent an increase in the awareness of how and where
vulnerable adults can be abused and in how to report such transgressions holds little water
these days because it has now been eighteen years since “No Secrets”(Department of Health,
2000) was introduced, an occurrence that was followed by a steady torrent of related training,
policy and procedural guidance.
Abuse of some kind was proven to have occurred in 65 per cent of the safeguarding enquiries
identified during 2016/2017, meaning that the equivalent of some 124 older people at the least
were abused each day during that annual period. This figure, though disturbing, is of even greater
concern when considering the significant body of research evidence available to demonstrate
that instances of abuse are substantially underreported and sometimes actively concealed
(Wolf, 2000; Bonnie and Wallace, 2003; Buri et al., 2006; Cooper et al., 2008; World Health
Organisation, 2008; Greve, 2008; Moore, 2016a).
We have then a national circumstance in which the abuse of older adults at risk residing in care
and nursing homes (and elsewhere) continues without reduction. This ceaseless catalogue of
abuse has endured despite the efforts of the statutory regulatory function in its various
incarnations for the past 34 years since it came into being back in 1984, the purchase of services
in care homes under prescriptive contract terms by local authority commissioning functions, that
should include monitoring of service quality, following the inception of the National Health Service
and Community Care Act 1990 28 years ago, the activities of local authority safeguarding
functions following the arrival of No Secrets: Guidance on developing and implementing
multi-agency policies and procedures to protect vulnerable adults from abuse 18 years ago in
2000 (notwithstanding a strengthening of this guidance following provisions of the Care Act
2014), along with the more recent monitoring of service quality in nursing homes (predominantly)
that should be undertaken by Clinical Commissioning Groups.
The resilience of abuse perpetrated in care and nursing homes to the efforts of regulators,
commissionersand safeguarding personnelhas clearly remained patent,regardless of the veritable
masses of training and vaunted best practice, policy and procedure presented in particular by
interestedstakeholders for nearly twentyyears following the advent of “No Secrets”.Yet there is still
little in the way ofapplicable and robust fundamentaltheory as to why the abuse of older peoplein
care homes takes place at all, and why it has remained so tenacious for decades[3], including
in that long period before formalnational safeguarding policy was introduced. This paper seeks to
begin to address the current absence of coherent theory, an anomaly that will only serve to
perpetuate the current circumstance where nigh on 350 older people are abused each week in
care and nursing homes across England.
Reviewing the literature: theories of abuse and explanator y frameworks
The literatureon the abuse of adults tends to identify potentialrisk factors that may contributeto the
perpetration of abuse, and offer them as theoretical explanations of why it occurs, for example,
stress experienced by the care giver, and the absence of appropriate training. However, such
isolated factorsmay in turn be subsumed within a small number of theoretical models that seekto
build more fundamentalexplanations for abuse from interrelationships amongidentified risk factors
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