What’s in a word? The importance of the concept of “values” in the prevention of abuse of older people in care homes
| Published date | 12 June 2017 |
| Pages | 130-145 |
| DOI | https://doi.org/10.1108/JAP-01-2017-0001 |
| Date | 12 June 2017 |
| Author | Steve Moore |
| Subject Matter | Health & social care,Vulnerable groups,Adult protection,Safeguarding,Sociology,Sociology of the family,Abuse |
What’s in a word? The importance of the
concept of “values”in the prevention of
abuse of older people in care homes
Steve Moore
Abstract
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 al so confirms that the perceptions of “va lues”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.
Keywords Older people, Abuse, Adults at risk, Care homes, Policy and practice, Staff value frameworks
Paper type Research paper
Introduction
Previous papers (Moore, 2016a, b) have set out some of the findings from a mixed methods
research project confirming that not only does the abuse of older people in private sector care
homes continue to occur, but also that it is not always appropriately reported, and indeed,
may be actively concealed within care homes.
The research findings of continuing and hidden abuse detailed in the two preceding papers
referred to above have yet again been recently affirmed by the covertly filmed and televised
abuse occurring in Clinton House and St Theresa’s Nursing Homes in Cornwall during 2016.
The abuse in one of these homes included the preparation of morphine, a controlled drug, by a
registered nurse for use as a means of pharmacological restraint to “[…] shut her (the resident) up
[…]”. Were it not for the clandestine filming of the incidents, they too would likely have remained
undetected and thus, unreported.
It is clear then that despite the activities of the statutory regulator of care and nursing homes for
over 30 years, and health and social care commissioners of such services by means of contracts
for over 20 years, the abuse of older people living in these facilities continues to occur with
disappointing regularity.
As Moore (2016a, b) has also previously suggested, the activities of local authority-led adult
safeguarding functions that have been in operation since 2000 are predominantly reactive to the
Received 9 January 2017
Revised 28 February 2017
14 March 2017
Accepted 23 March 2017
Steve Moore is a
Commissioner at
Dudley Metropolitan Borough
Council, Dudley, UK.
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abuse of older adults in care homes after it has occurred. As a result, occurrences of abuse tend
to be attributed to individual or organisational failures or isolated acts of callousness and cruelty.
Consequently, the primary, fundamental and inveterate causes of the behaviours among some
care staff that are abusive, and that continue to endure in the sector year after year, remain largely
unidentified, unchallenged and unrectified.
This paper presents research findings that have determined the significance of the personal
value framework s of staff as one important contrib utory factor among the progenit ors of abuse
of older people in private sector care homes. Though the project identified many other such
factors, the role played by the personal values held by staff was salient amongst them.
The influence of these value frameworks was acknowledged by many interview respondents,
drawn from care home proprietors, managers and care staff, who clearly recognised the
important influence that personal values might have on the occurrence and prevention of
abuse. It is informative to contrast this with common perceptions elsewhere of what is meant by
the word “values”in the conte xt of providing car e and protecting th ose who are at risk,
particularly amongst the agents charged with tackling abuse, where the concept of “values”is
often ill-consid ered and misunder stood.
The definition and typology of abuse used in the explanatory notes accompanying the semi-
structured interview questionnaire schedules used in this research, and in verbal guidance
provided to participants prior to commencement of each individual interview, was that used in
“No secrets: guidance on developing and implementing multi-agency policies and procedures to
protect vulnerable adults from abuse”(Department of Health, 2000).
Reviewing the literature
There is a wealth of literature spanning several decades that identifies common factors present in
care homes that can contribute to poor care and abuse. These include, for example, inadequate
training for staff (Townsend, 1962; Willcockset al., 1987; Peace, 1993; Peace et al., 1997; Tadd,
Woods, O’Neill, Windle, Read, Sedden, Hall and Bayer, 2011; Faulkner and Sweeney, 2011;
Faulkner, 2012; Cavendish, 2013; Skills for Care, 2014), undue levels of stress amongst staff
(often as a result of lack of timeand insufficiencies of staff) (Townsend,1962; Menzies Lyth, 1988;
Wiener and Kayser-Jones, 1990; Macphersonet al., 1994; Baillon et al.,1996; Glendenning, 1997;
Mozley et al., 2004;Schneider et al., 2010; Tadd, Woods, O’Neill,Windle, Read, Sedden, Hall and
Bayer, 2011; Tadd, Hillman, Calman, Calman, Baye and Read, 2011), and dysfunctional
organisational cultures (Stannard, 1973; Ronch, 2003; Rader and Semradek, 2003; Fear, 2009;
Tadd, Woods, O’Neill, Windle, Read, Sedden, Hall and Bayer, 2011; Killett et al., 2011, 2013;
Institute of Public Care, 2013), that amongst other things, easily lead to a concentration upon
hurried task completion by staff rather than provision of holistic care focussed upon the
psychological andsocial needs of the person (Willcocks et al., 1987;Peace et al.,1997;Kitwood,
1997; Schneideret al., 2010). Yet despite this apparentplenitude of research,and guidance based
upon it from both the statutory regulator and commissioners of health and social care in order
to prevent abuse, abuse in care homes clearly continues. This is unequivocally demonstrated by,
for example, four successive years of figures produced by The NHS Information Centre (2013)
and its successor, The Health and Social Care Information Centre (2014a,b, 2015), showing that
36 per cent of all referrals of abuse emanate from care homes. This lamentable statistic is
compoundedby the ever-growing catalogue ofcovertly filmed instances of abusereferred to in the
introduction to this paper.
However, the literature on the role of human values and their influence on staff behaviour in care
homes that might contribute to understanding why abuse still continues is both limited and
constrained in its effectiveness because of how “values”are usually conceptualised within it.
Writings on the subject of values as they may operate in care provision largely ignore the
psychological bases of human value formation and their resilience to change. For example, the
Institute of Public Care (2013, p. 15) in its recent work for Skills for Care identify a number of
factors to support the provision of “[…] good quality care […]”. Among these are “[…] providing
leadership in developing the right values […] in the organisation […]”and thus there is a failure to
take account of the tenacity of personal value frameworks that already exist within individuals,
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