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Care home staff say neglect is ‘common’ but driven by pressure

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The largest-ever survey of care home staff in England has found that neglectful behaviours are widespread and appear to be driven by workload pressures and burn out.

Making a resident wait for care, avoiding residents with challenging behaviour and giving them insufficient time for food were found in the study to be the most common forms of neglect.

“Clinicians treating care home residents should be aware that neglect is common in care homes”

Study authors

The newly-published research saw care home staff asked anonymously about positive and negative behaviours they had done or had witnessed colleagues doing.

The London-based researchers behind the study said 1,544 care home staff from 92 care homes across England subsequently responded to the survey.

At least some abuse was identified in all but one of the 92 care homes, said the researchers from University College London and Camden and Islington NHS Foundation Trust.

Staff were asked whether they had witnessed a range of behaviours over the past three months, with their responses linked to data from each home describing a measure of workforce burnout.

“The abusive behaviours reported were largely matters of neglect”

Claudia Cooper

Some negative behaviours were categorised as “abusive”, of which the most common were making a resident wait for care, reported by 26% of staff, and avoiding a challenging resident, reported by 25%.

These were followed by giving residents insufficient time for food, reported by 19% of survey respondents, and taking insufficient care when moving residents, reported by 11%. In addition, verbal abuse was reported by 5% of respondents, and physical abuse by 1.1%.

Positive behaviours were reported to be much more common than abusive behaviours, though some positive but time-consuming behaviours were notably infrequent, said the researchers.

For example, 34% of staff were rarely aware of a resident being taken outside of a home for their enjoyment and 15% said activities were almost never planned around residents’ interests.

“This is the first large survey of abuse and neglect in English care homes, and the largest survey to date of abuse and neglect in care homes in any country,” noted the study authors in the journal PLOS ONE.

“If they understand and know how to respond to behaviour, they may be able to do more without greater resources”

Gill Livingstone

They stated: “Just over half of respondents reported that potentially abusive or neglectful behaviour towards residents occurred at least sometimes.” 

“Clinicians treating care home residents should be aware that neglect is common in care homes and that person-centred activities such as trips out or activities tailored to residents’ interests are often happening very infrequently,” they added.

They also noted that measuring harm to vulnerable people anonymously created “ethical dilemmas”, because the abuse could not be directly addressed. However, they highlighted that not measuring it at all, so that it remained “invisible”, was a “greater harm”.

Dr Claudia Cooper, the study’s lead author, said: “We found low rates of verbal and physical abuse; the abusive behaviours reported were largely matters of neglect.

“These behaviours were most common in care homes that also had high rates of staff burnout, which suggests it’s a consequence of staff who are under pressure and unable to provide the level of care they would like to offer,” she said.

“We would encourage people to flag any neglect or abuse”

Local Government Association

The study’s senior author, Professor Gill Livingston, added: “With the right training, care home staff may be able to deliver more effective care that doesn’t need to be more expensive or time-consuming.

“If they understand and know how to respond to behaviour, they may be able to do more without greater resources,” she said.

The study was funded by the Economic and Social Research Council and the National Institute for Health Research. It forms part of the wider UCL MARQUE cohort study, which is also looking into cost-effective interventions to improve care for the more than two thirds of care homes residents with dementia.

Dr Doug Brown, chief policy and research officer at Alzheimer’s Society, noted that 70% of people in care homes had dementia and it was “clear from these findings that they’re bearing the brunt of a chronically underfunded social care system”.

“It’s upsetting but unsurprising that abusive behaviours were more common in homes with higher staff burnout,” said Dr Brown.

He said: We’ve heard through our helpline of people with dementia not being fed, or not getting the drugs they need, because a carer isn’t properly trained, or a care home is too short-staffed.”

Alzheimer's Society

Dr Doug Brown

Doug Brown

He added: “The government must act now, with meaningful investment and reform, or we risk the system collapsing completely and people with dementia continuing to suffer needlessly.”

A Local Government Association spokesman said: “Any form of abuse is unacceptable. We would encourage people to flag any neglect or abuse in order to make sure that vulnerable adults in their communities are protected.

“Councils take allegations of abuse and neglect extremely seriously and work with local health, care and police partners both to prevent abuse and to ensure the wellbeing of anyone who has been affected,” he said.

But he added that the sector needed to “financially sustainable”, which required the government to “fully plug” the funding gap facing adult social care, which he said was set to exceed £2bn by 2020.

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Readers' comments (1)

  • And yet we now have a 10 weeks medication administration course for care assistants which has already led managers to replace RGNS, and caused RGNS to leave due to the ridiculous responsibility for someone else's mistakes. The finger has been taken out of the dike!

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