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Extent of ongoing abuse in nursing homes revealed


Abuse of older people in care homes is continuing to occur and is going undetected, despite the existence of safeguards and regulations, new research has revealed.

A study published in Nursing Times found more than 88% of staff at five newly-opened homes in four local authority regions in England said they had witnessed or suspected abuse in nursing homes where they had previously worked.

“The findings suggest the abuse of older people continues to occur and evade detection”

Study authors

Of these, 92.7% were previously employed in nursing homes for older people with dementia and 7.3% had worked in nursing homes for older people.

The anonymous survey of 156 staff members – the majority of whom were care staff, with 10% describing themselves as nurses – also revealed that more than three quarters who reported abuse said they had actually witnessed it.

Psychological abuse was the most common type staff reported seeing, followed by neglect and then physical abuse, according to the study, which was based on questionnaires completed between 2011 and 2015.

Among the 88 staff members who saw psychological abuse, denying people choice, ignoring residents, and calling them names were the three types cited most often.

Neglect, which was witnessed by 59 workers, most frequently involved residents not being given drinks, being left in wet incontinence pads, or not being given food.

Physical abuse, seen by 37 people, most often included physical restraint, residents being forced to get up against their wishes, or concealed physical restraint – such as tying older people to chairs with tights.

Respondents who reported witnessing abuse also described examples including dentures and toenails. One said: “The senior carer and her cronies took delight in the senior carer cleaning this man’s toenails with a fork, then putting it on the dinner table to watch another resident eat their dinner with it.”

“Nurses – who, in some cases, may have been the highest level of management – may sometimes have been active or complicit in the abuse”

Study authors

Another added: “It wasn’t uncommon for the care staff to lark about and put the wrong dentures in people’s mouths so they looked funny, y’know, like a man’s teeth in a woman’s mouth.”

Five survey respondents, who had previously worked in different local authority areas, also described a practice referred to as “hooking” or “snagging”.

The method was used to restrain residents needing to excrete by stretching their vest and hooking it to the protruding ends of the bolts that secure the toilet seat in place. It allowed staff to attend to other tasks while the resident, often with dementia, remained unsupervised but “secure”.

Often more than one type of abuse had been witnessed, with more than 90% of respondents saying they had seen repeated acts. The majority said abuse took place during the daytime.

Meanwhile, around 70% said they were referring to events that had taken place in the past 12 months, with just over a quarter saying they had seen abuse occur one to three years before.

Steve Moore, commissioner of care and nursing home services at Dudley Metropolitan Borough Council, who wrote the paper said the questionnaire results gave a “unique insight into some private-sector nursing homes”.

“Although the sample size is small, the findings suggest the abuse of older people continues to occur and evade detection despite the existence of governance, safeguarding and regulations,” said the paper, called Abuse of residents in nursing homes: results of a staff questionnaire.

Some abuse reported through the survey were practices not previously identified, which meant they were not readily detectable by current governance arrangements and regulatory methods, said the study paper.

The fact that abuse in care homes takes place behind closed doors – due to the intimate nature of care – and often at night also makes detection by authorities difficult, it added.

“That said, it also appears that qualified nurses – who, in some cases, may have been the highest level of management – may sometimes have been active or complicit in the abuse,” said the paper.

“More effective ways of assessing the suitability and capability of staff employed to provide care would be required [to help minimise the risk of abuse]”

Study authors

These practices are occurring despite the introduction of the Department of Health’s formal safeguarding policy 16 years ago and also formal regulation of nursing homes being in place since 1983, said the researchers.

In part, the ongoing presence of abuse was because relevant agencies were steered by policy and legislation that leads them to react to abuse after it has taken place, they added.

Investigators look at “superficial artefacts” in suspected organisations – such as statements of purpose, care plans, risk assessments and fluid intake charts – they said in the study paper.

“Until it is acknowledged that the governance, safeguarding and regulatory processes currently used to evaluate the quality of older people’s care in private-sector nursing homes are often ineffective, abuse will continue,” the researchers said.

“More effective ways of assessing the suitability and capability of staff employed to provide care would be required, along with new, and likely costlier, techniques of governance and regulation that look beyond appearances,” they said.

martin green

martin green

Martin Green

“If this is not done, the health and social care economy must accept that the abuse of older people in nursing homes will continue,” they concluded.

Professor Martin Green, chief executive of Care England, said: “One of the most worrying aspect of this study is the way in which professionals, some of whom are registrants and have accountability to a professional body, are not showing the values of health and social care, nor fulfilling their obligations to report this abuse.

“I would also be particularly concerned as to how the new employer is going to ensure that this practice of turning a blind eye to abuse is not going to be replicated now they have moved to a new organisation,” he added.


Readers' comments (7)

  • I have seen abuse in care homes, I have reported it. I have lost my job - many times That was the usual pattern
    In 2011, 2012 & 2013 I complained to the company, I raised grievances I had made numerous complaints to & reported to CQC and the County Safeguarding unit about dangerous staffing levels and of verbal & physical abuse. Nothing was done.
    One grievance regarding medicine safety & working environment they refuse to accept it.
    An incident did happen involving a HCA & drugs. I was blamed & referred to the NMC on trumped up charges by the 2 regional managers These two regional managers blamed me more to cover their own actions because it was partly due to their actions that the drugs were not safe. One regional manager was the referrer and the other was the NMC witness. Of course I was GUILTY AS CHARGED
    It took a High Court Judge to overturn the NMC decision but he couldnt hear about the lies and deceit as it was an appeal, he only got NMC papers.
    It cost the NMC (nurses) £11,000
    There needs to be a regulated CCTV system in place in all care home rooms & corridors
    A safe method of reporting abuse where staff are not simply dismissed.
    NMC to investigate cases properly & not just accept the word of the referrer & witnesses,many of whom will write statements to pleas the boss.
    * I was unable to attend the NMC hearing due to a family death and NMC refused to reschedule so the Care home company & NMC had a field day with lies and cover up.

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  • debbie bolton

    I have worked as a troubleshooter for 3 of the large national private providers and am cognisant of my PIN but not only I have I raised safeguardings, one home I was drafted into had 20 safeguardings raised against it by the local GP's. one home put into special measures by CQC could not be closed despite incredibly poor, neglectful care because there was nowhere in the locale for the residents to move to and in every case the manager was a nurse, who either knew or purposefully decided not to look.
    I believe the job of a nursing/care home manager is one of the hardest in our society. Not only are managers responsible for those in their care and their families, they are responsibile for managing all the HR issues appertaining to a large; often disparate staff group; the buildings; the kitchen and chefs/ cooks; activities; quality assurance; budget; cash flow; marketing; funding; legal documentation; nurse revalidation; training; housekeeping and hotel services. The result in my experience is a manager who burns out after around 2 years, is out of their depth and thus stops listening, looking and caring. Nurses do not necessarily make good business managers and the regulator needs to think long and hard about whether an active PIN is what's needed and then employers who I believe are complicit due to poor recruitment processes, need to take a long look at how they choose those they want to be both a manager and leader of services that are designed and expected to look after the safety of the most vulnerable in our society!

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  • I think it's time we had a monthly report on a nursing home that is doing well and cares with a person centered approach where only love, hugs and good care prevails.
    I appreciate that the above report is valid, but positivity too please.
    I also think that nurses make good managers, my previous and present managers are nurses.

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  • I accepted a deputy nurse manager post in a nursing home which had three call bells for 30 residents; residents were being washed in cold water; residents were left in soiled incontinece pads all day and the nurses practice was extremely poor.
    Within a few months, standards were greatly improved and the home was developing a good reputation. However, I was dismissed as the carers did not like receiving criticism of their often substandard and potentially damaging "care". I was horrified to discover that one of the carers had been present when a resident was sexually assaulted and was still employed by the home.
    Unless there is a stringent and clear support network in place, I fear incidents of abuse will increase. Nurses in particular need support in this particularly challenging specialism. Personally I will never enter one again.

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  • I love my job in a nursing and residential home. The manager is a nurse and we are encouraged to operate in accordance with the policies of our company. There is no avoidance of reporting safeguarding issues - more openness than I ever personally experienced in the NHS to be open and transparent, and we work with families and carers as well as residents to ensure the resident is always at the centre of every decision.
    I'm not saying that abuse and neglect don't happen in the health and social care sector- it does, in hospital, homes and at home, however please don't demonise all of us working in nursing and residential homes. The team I belong to love the home, our residents and being a community that welcomes our district nurse colleagues and GPs, TVNs and SALTs! I wouldn't swap nursing here for anything

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  • Having worked as a HCA since the late 90's I have seen all sorts, In my experience the bad starts at the top and filters down. A good top team and great training are the key to a good care home. Of course the fact that the pay is poor doesn't exactly mean you get the best candidates apply for positions, they often just need work and have no idea what it entails. Often care staff are seen as the lowest of the low, who are thick and unable to do anything else. When people find out I have a degree I am asked why work as a carer?? As if this is below me.
    I myself want to provide excellent and safe care, like nursing it is a vocation, and I love it.

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  • The days of GRAHAM PINK, the C/N on nights 20 - 30 years ago in Stepping Hill Hospital, who blew the whistle on poor care/neglect due to low staff levels have not moved on. He was pilliored, "offered" demotion then sacked. Many years ago, I stood up for patient care once, due to poor staff levels, and inappropriate, staff in dementia care. I voiced concern to management, and asked that for patient care, it was addressed. Not surprisingly, it ended my contract - under the auspices of something that was absolutely nothing to do with my concern. The decision cost management and patient care dearly, as many longterm reliable, staff resigned on principle, and cited that as their reason. They were then invited to meet management then asked to submit other resignation letters with different reasons - I wonder why....has nursing progressed - no. It represses standards by how it treats those on its staff who have/voice concerns.

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