Elder Mistreatment in Long-Term Care

This assignment delves into the multifaceted issue of elder mistreatment within long-term care facilities. It examines various research papers that shed light on organizational factors contributing to abuse, societal perceptions surrounding nursing home care, and the impact of economic crises on family support systems. The analysis also considers strategies for improving quality of care and preventing elder abuse in these settings.

Running head: ABUSE AND NEGLECT IN AGED CARE HOMES OF UK
Abuse and neglect in aged care homes of UK
Name of the student:
Name of the university:
Author note:

1ABUSE AND NEGLECT IN AGED CARE HOMES OF UK
Table of Contents
Introduction:....................................................................................................................................3
Background:.....................................................................................................................................3
Literature review on the given topic:...............................................................................................7
Discussion:.....................................................................................................................................19
Conclusion and recommendation:.................................................................................................25
References:....................................................................................................................................28

2ABUSE AND NEGLECT IN AGED CARE HOMES OF UK
Introduction:
Old age comes coupled with many different health care complexities and these
complexities often demand special attention and care. According to a recent statistics of the
population of UK, close to one million aged members are known to suffer from dementia and
require special care to carry on with the daily activities. This is just the statistics regarding the
dementia and it prevalence on the aged population, here are various other health complexities
that accompany aging process in the current age like diabetes, renal diseases, osteoarthritis and
many more. Hence, it is common knowledge that in old age the elderly members of our society
needs special care from the professions and in most cases the complexity or severity of their
diseases cannot be provided to their home environment (Daly, Merchant and Jogerst 2011). This
is where the concept of residential aged care home comes into the picture, it has to be mentioned
in this context that residential aged care home is an institution where the aged members of the
society can avail care and attention that they need from the experienced aged care providers.
Although, there is one alarming fact associated with the residential stay at the aged care homes.
In the past decade the incidence of abuse and neglect in the aged care homes have raised the
concerns of the public health authorities and the statistics of UK is frightening. This paper will
attempt to present a review if literature on the topic of abuse and neglect in the aged care home
scenario taking the context of the UK.
Background:
Abuse can be defined as the violation of the individual civil and human rights of an
individual by another. In the aged care sectors, the abuse can be either directly by the means of
physical and emotional abuse or Indirect by the means of neglect on mistreatment. According to

3ABUSE AND NEGLECT IN AGED CARE HOMES OF UK
the recent statistics 50% of the people residing in the extension aged care homes or have families
have experienced residing in aged care homes in UK have been reported to have negative
experience which can even lead to abuse and cruelty. According to the report of CQC okay
equality commission of UK almost 4000 of UK based aged care homes has been reported to have
substandard care delivery and questionable physical environment in the care homes. In a recent
report the CQC has identified nearly 40000 safeguarding risks that are associated with the
environment and care quality of the aged care homes all across England in the year of 2016
(Jönson 2016). Close to 45% of the residential aged care receiving families belonging to England
have described the experience in the aged care homes as substandard or bad. One of the most
important contributing factors behind the questionable care quality and delivery in the aged care
homes of England is the lack of adequate infrastructure, equipments, and training and skill
enhancement in the staff to cope up with the differential needs of the critically ill aged residents
in the care homes. Many of the aged care staff has to find the main reason behind the neglected
mistreatment in the aged care homes of English due to the starting ratio lack of training and lack
of advanced infrastructure to support the needs of different aged individuals (Dixon et al. 2013).
It has also been discovered by the care home staff that the organizational policies and
practices and the noncompliance in the staff can contributed to the extreme neglect and
mistreatment in the care homes. However, the professional misconduct of the care staff and the
impact of extreme workload and exhaustive burnout due to acutely low staff to patient ration in
UK based care homes cannot be neglected as well. Considering the impact of the neglect that
these aged people receive at the care homes has a significant impact on the health and wellbeing
of the aged residents and increases the possibility of hospice referrals and in- hospital mortalities

4ABUSE AND NEGLECT IN AGED CARE HOMES OF UK
in UK (Eastman 2013). Hence, it has become one of the most significant public health priorities
in the UK and due to which it has been chosen as the topic for my literature review study.
Research questions:
With the passing of days, the increase of elder abuse and neglect cases are increasing in
number. However, it results in development of a query among all the citizens of the nation that
why such issues are becoming common when healthcare sectors in united kingdom is gradually
getting a higher place among the nations providing bets healthcare to it citizens. Medical
advancements in the United Kingdom have reached one of the topmost positions among the
nations with best scientific advancement. Therefore respected number of older abuse incidents is
creating a concern for the quality of life led by the veterans of the nation who had once been the
proud working generation for the country. Therefore a large number of questions can come into
the mind of the readers. The first questions that may come in the minds are “what are the specific
causes that are resulting in the older clients being abused and neglected?” Often, the query may
lead to another question that “What are the contributors that are resulting in development of such
stressful situation”. There may be also rising of question which involves “Are the governments
or researchers thinking of any ways to overcome the different issues of abuses and neglects faced
by the elders?” Often people are quite concerned that “will there be any strategy that would help
in stopping of the abuses and developing care culture where the elders will be leading a better
quality life?” These questions are not only the research question of the present assignments but
are also the concerns of the entire nations. The following literature review would be conducted in
order to find the answers and following the literature review, a discussion would be provided
where answer of all the questions would be attempted to answer by proper literatures. Once the

5ABUSE AND NEGLECT IN AGED CARE HOMES OF UK
research questions would be answered, the reader will be able to find a clear scenario on the
topic which would help to fulfill the goal of the assignments.
Search strategy:
In order to search for the correct set of data and information from the internet, specific steps need
to be followed. The very first step which should be considered is the choosing of the proper
databases. The data bases which had been included for gathering of the information are called the
CINAHL, AMED, Medline and psycINFOR data bases. Each of the databases had been
thoroughly searched for with the help of using the correct keywords. The different types of
keywords which were used are the “elders and abuse at care home”, elders and abuse”, “elders
and neglect”, neglect to old patients in care homes”, and many others. Proper Boolean operators
were used so that the proper papers can be collected and can be used for the literature researches.
Each and every of the databases had been researched thoroughly which led to the collection of
huge number of resources. However, some of the articles had to be rejected as they were not
following the inclusion criteria. The exclusion criteria which was finalized for this assignments
was that the articles which would be taken would b published after 2012. This is mainly done so
that the recent studies could be included and no older information would be incorporated. Not
only that, other exclusion criteria which were also considered were that no other language other
than the English language should be taken. Therefore all other articles which were not in English
language were excluded. The inclusion criteria mainly incorporated in the study was that recent
articles after 2012 would be included. Another inclusion criterion was that the papers should be
based mainly on the reports and researches conducted in the United Kingdom. Other inclusion

6ABUSE AND NEGLECT IN AGED CARE HOMES OF UK
criteria mainly included taking articles form authentic sources and from good journal papers so
that the data obtained from them are authentic and valid. With the help of the above mentioned
steps, 14 articles ultimately were chosen which matched all the inclusion criteria. Not only that,
it also helped in the collection of articles which helped in answering all the research questions
that were developed for his assignments. Therefore following this step, each of the paper was
reviewed and its articles were analyzed thoroughly. Following this, literature review was
conducted and incorporated in the assignment with the help of a thematic analysis format.
Literature review on the given topic:
Themes: different types of abuses faced by care home elder residents and the factors that
result in abusive behavior among the care-workers.
Cooper et al. (2013) have provided the version of the care workers where they have
conducted a qualitative study in order to develop an understanding of the perceptions of the care
workers working in the aged homes. They have stated that they accept that abusive behaviors are
often noted towards the patients but such behaviors are not done on a deliberate basis by the
care-workers. Residents often became inquisitive about how long they have to wait for personal
care or they wanted to know whether they had enough to eat or others which disappointed the
care-workers. They also became quite concerned about whether they were moved safely or
wanted to know why they were emotionally neglected. Many care workers seemed to behave
abusively as they did not know how to handle such interrogations effectively. Some also behaved
abusively as they were not able to realize the patients; illness. Many forced the old clients to
accept care and also even restrained them as they were at a high risk of fall. The main reasons for
which al such negative behaviors took place was the lack of resources. Moreover, many of the

7ABUSE AND NEGLECT IN AGED CARE HOMES OF UK
care workers were not properly trained and had limited knowledge. They even had no knowledge
about how to handle the challenging behaviors of dementia. All these resulted in severe issues
affecting the quality care of the patients. Although it is the version of the care workers, it
extremely important to know the version of the patients as well. The clients who are admitted in
the ward need to interact with the care workers. Here, the authors have taken the perception of
only care workers but they also have to take the version of the clients in order to understand the
situations. Every organization has to set up monitoring bodies where they would be hearing both
the version of the workers and patient before coming into a conclusion and actinga accordingly
(Twig et al., 2011).
Themes: Minimal investments in the development of good practices for the elders’
management skills, proper training and poor time-focused approach of care and absence of
social workers advocacy and responsibility are contributors to abuse at aged care
Researchers Milne et al. (2013) have identified two important sites which have high levels of
elder abuse. These are the aged care homes and the elder’s own homes. They have stated that
neglect and multiple abuses are more common with elders who are suffering from mental health
issues. Institutional abuses were the most prevalent type of abuse which was referred to the
concerned authorities for those elders who stayed in aged care. He is of the opinion that abuse
which takes place in the institutions are more of the result of the consequence of the culture
where the routines, norms as well as the systems of the organizations are provided more
importance and even overrides the need which is there to support the health of the elders. They
are of the opinion that abuses are indirectly contributed by minimal investments in the
development of good practices for the elders’ management skills, proper training and poor time-
focused approach of care. Researchers have also noted that the dependency status as well as

8ABUSE AND NEGLECT IN AGED CARE HOMES OF UK
powerlessness of the care home residents is contributors of the institutional abuse. These show
that the social workers should play an important role on advocating n the elder person’s behalf.
The Care Quality Commission CQC therefore should take the responsibility of proper
immunization of the inspectors for the regulatory of the activities conducted in the aged care
homes. However a concern arises regarding the budget which needs to be allocated. From the
political point of view, many of experts suggest that investing a huge maount of money on old
aged care service is noy plausible. This is mainly they heive that the amount which gets allocated
on aged care services cannot be returned back as the old people do not provide higher
productivity in the society. therefore they try to allocate the laest money. However, there has
been arguments still in this fields where the older clients are still experiencing the negative
aspect of the feud of fund allocation (Hilmer et al., 2015).
Theme: infrastructure, inappropriate culture, improper leadership, staffing and residential
population statistics are contributor to ineffective care and abuse of elders in organizations.
Such claims of institutional abuse had been more strongly supported by Hyde et al. in the year
2016. They had successfully been able to find out five most important contributors of
institutional abuse. The paper is quite explanatory as it had described the five contributors in
details helping the leaders to develop a deeper understanding of the factors that lead to abuse in
care homes. The first contributor as stated by them is the infrastructure. Organizational
infrastructure refers to the physical environment and the building design, architecture general
upkeep of the housing and similar others. Rundown facilities, cramped conditions, overcrowding
of residents lack of equipments and poor physical environments had been associated was the
contributors of the abuse. Second contributor is management and procedures which involves
leadership, supervision, management systems and others including policies and procedures. Poor

9ABUSE AND NEGLECT IN AGED CARE HOMES OF UK
management and leadership are found to be a key role in elder abuse in aged care homes. The
third factor is staffing. Inadequate staging levels and staffing shortages have contributed to
improper care for the patients. Quality of relationships between residents and staffs were also
seen to be poor who increased abuse rates. Resident population statistics have also been
associated with mistreatment. This includes the type and level of dependency, complexity of care
ns and the residents own behaviors. There are many patients who have cognitive impairment due
to dementia, are physically aggressive and uncooperative in behaviors. There is very less
understanding of the staffs and management about how to handle this staffs and help them live a
better quality life. Quickly changing levels of care are important to be identified but it was not
present in the care homes. Cultures have been the fifth contributor. Culture associated
mistreatment is also common where organizational had closed inward looking cultures.
Managers and institutionalized and remains closed to possibilities of change. Poor
communication, autocratic culture, entrenched routines all culminated into improper care
delivery which abuse leaders by harming their dignity and autonomy. The study is one of the
best as it is covering all the important aspects of the present day issues faced by aged care
homes. It has stated some of the most obvious factors which need to be cared by the government.
The government should provide policies which should be including all the important aspect
mentioned above. It would indeed bring out positive incomes (Prince et al., 2013).
Theme: More the nursing home beds availability, there will be higher chances of older
patients being admitted to long term inpatient care and this will lessen the abuses
occurring in homes and in overcrowded aged cares due to improper informal care
Researchers like Pilny and Stroka (2015) have supported the views of the above researches. They
have stated that the structure of the nursing home market is related with the inpatient care

10ABUSE AND NEGLECT IN AGED CARE HOMES OF UK
services. The researchers are of the opinion that old informal care givers are at a higher chance of
being the care recipients in the near future and therefore burden of care giving tasks on them is
very important to be reduced. Therefore, it is very important to reduce the informal care giving
task burden of the elderly caregiver. This can be only done when the care homes and the nursing
homes would be increasing the number of beds. Increasing the numbers of beds would be
allowing more number of elderly clients to seek in for inpatient care. This would automatically
reduce the pressure felt by the old informal care givers and in turn will reduce the chances of
becoming care recipients due to caring for old family members. Therefore this research supports
the view that better the infrastructures of the aged care homes and nursing homes, the lesser will
be the suffering for the elder people as they would be receiving formal care form the
professionals. However, the researchers here have not discussed about the provision of funding
and availability of nursing care staffs. Therefore the research remains half hearted as limitations
may affect the implementation of the strategy of saving the old patients form abuses. However,
nursing homes’ bed increase only cannot singly develop the condition of the aged care homes.
Having beds and getting more patients will not survive the purpose of compassionate care until
the workers are trained properly. Training of the workers and their recruitments in huge numbers
can only change the scenario (Aiken et al., 2014).
Theme: Different strategies can be implemented in preventing the incidents of abuse in the
coming future days.
This paper which had been written down by Fisk in 2016 is quite interesting as it had went ahead
of the discussion of the contributing factors of abuse in elder people. The researcher has stated
that any level of surveillance even including video camera would be appropriate for public and
common places in the care homes so that the concerned authorities can keep an eye over the

11ABUSE AND NEGLECT IN AGED CARE HOMES OF UK
activities that take place in the wards. Secondly, care homes should also plant such technologies
in the resident’s room and other private areas to increase the rate of monitoring. Thirdly, the
presence of such surveillance technologies should be known to all about their presence and
should be made visible. Fourthly, the staffs should be fully being aware of their responsibilities
in relation to the different technologies to be implemented. The fifth principle is that the
accessing of data, images, audios and other video footage should be only restricted to authorized
persons or concerned agencies only. On the sixth point, it is stated that the data can be only
handed to any other individuals other than the client and the authorized body only after the
consent of both. This should be done strictly after providing a strong rationale for doing so. The
seventh principle is more or less the extrusion of the sixth one where the concerned authority is
to know before allowing the intrusion of the data by a second individual. However, many ethical
issues may arise. Presence of a camera always in the room of the patients can hamper their
privacy and dignity. Many nurses may utilize the information and video clips for their own
benefits and can extract and tamper with the data. In all these privacy of clients will be
hampered. Moreover it will also require extra allocation of funds which may provide pressure on
the organization. Therefore all these need to be considered before introduction of such systems
(Hayword 2017).
Theme: severe punishments and fines for care home owners will reduce abuse rates.
In this article, the former care minister Paul Burstow is of the opinion that government needs to
be quite strict with the care home owners. The care home owner should be criminally liable if
they are found to abuse and neglect any old clients in the care homes. Unlimited fines as well as
criminal sanctions should be imposed on such care homeowners who support such abuse
incidences or are not responsible for reporting any such incidences to concerned authority. He

12ABUSE AND NEGLECT IN AGED CARE HOMES OF UK
believed that it is highly unethical to take fees from such clients and then not provide the service
for which the money had been taken. In place abusing the clients and not providing proper
service is breaking of any corporate laws and fall in criminal conviction cases. Therefore such
owners should be imposed with criminal charges. This would result in creation of awareness and
the penalties and charged would ultimately make all the owners careful. These would make them
develop proper monitoring strategies and as result of that abuse will eventually reduce. However,
in many cases organizations themselves remain unaware that their workers are not following
norms. They also suffer from budget constraints. So organization’s perspectives should also be
acknowledged before taking such actions. They should conduct proper audits to check the quality
of care by their workers given to aged people and also escalate budget constraint issues to
government in order to avoid legal issues (Haluza and Jungwirth 2016).
Theme: Proper multi-factorial fall prevention is found by researchers to be a cost effective
procedure by which aged care homes can prevent falls and thereby reduce the levels and
events of abuse and neglect by the staffs of such healthcare centers.
Researches like Heinreich et al. (2012) have conducted a research where they have developed a
properly planned multi-factorial fall prevention technique. This had been mainly helpful in
reducing the cost which remains associated with the surgeries related with femoral fractures.
Such surgeries result in huge inflow of resources from the clients which result in financial
burden. Therefore if the nursing homes implement this technique they can prevent the falls that
occur to patients due to neglect of the staffs and other professionals. The success rate of the the
fall prevention program has been found to be 83%. Moreover this prevention program is also
found to save a huge amount of flow of resources that our due to the femoral facture surgery.
Hence, if aged care homes are able to adopt such systems, and proper manage me and monitor

13ABUSE AND NEGLECT IN AGED CARE HOMES OF UK
the system, the fall of aged people due to neglect and abuse can be prevented to a high degree.
Researchers have suggested that till to this day, nursing homes residents have been neglected in
economic evaluations of fall prevention technique so far. Therefore they had developed this
procedure and measured its cost effectiveness in order to make it suitable for implementation in
aged care homes. Fall prevention program is only one aspect of proper care. Similar such
strategy is also important. Researchers should come up with innovative ideas so that the chances
of abuse get decreased in care homes. Smart emotional regulation has been proposed by
Fernández-Caballero (2014) as another such issue which would be helping in overcoming cases
of abuse
Theme : The most important perpetrator of abuse in the aged residential care sector is the
overexpectation prevalent in the trust relationship between the care provider and the
elderly.
Aged care can be considered a sector that is still very contemporary or new to the health
care sector, and there still are a large number of gaps or challenges left behind in identifying and
addressing the particular and specify population or needs expressed by the elderly population of
the society or community. According to the article by Dixon et al. (2013), in the current age the
elderly population is subjected to a significant amount of abuse, both physical and emotional, in
the residential care homes. Considering the impact of this issue in the care homes within the
context of UK, neglect and loss of dignity has been identified as the most predominant
grievances experienced by the aged individual residing in the care homes of UK. In this article
the authors have suggested that the in order to explore the prevalence of the abuse or prevent the
magnitude of the care home abuse, it is very important to discover the perpetrator of abuse. In
this article the authors attempted to all the underlying external and internal factors associated

14ABUSE AND NEGLECT IN AGED CARE HOMES OF UK
with the entire procedure of abuse to the aged in the care homes and the authors have discovered
that there are an abundance of different definitions and ideologies in this concept and the most of
the abuse occurs due to over-expectation and trust relationship in the scenario (Dixon et al.
2013). Although, it has to be mentioned that the authors have only emphasized on discovering
the different definitions associated with the abuse and neglect however has failed to emphasize
on how the varying definitions and ideologies associated with the entire procedure affect the care
outcomes in aged care scenarios (Alexander et al. 2016).
Theme : Residential aged care home abuse and neglect often leads to significant health risk
for the elderly.
According to the article by the Wolff1, Stuckler and McKee (2015), the abuse and
neglect that the aged population of our society living in the care homes is the topic of concern for
the UK authorities since a long time. The authors have discussed in this article that the neglect is
much more prevalent in the UK care home scenario for the elderly in the present scenario in the
UK, over the occurrences of abuse. Although, it needs to be mentioned in this context that the
neglect to the aged members can eventually lead to many health related complications that can
even lead to hospital admissions as well. This article discusses that the patients admitted to the
emergency care homes have a much higher risk of hypernatraemia, which indicates at the neglect
that the individuals in the care homes receive at the hands of the care providers. This study also
entertains evidence that the care quality is more or less consistent in different care homes, and
the aged patients admitted into hospitals from particular care homes have higher pattern of risk to
severe dehydration in the patients, which even affects the statistics of in-hospital mortality.
Hence, it can be stated that even the neglect that critically ill aged patients receive in the care
homes in basic chores like feeding and hydrating leads to severe consequences for the victim of

15ABUSE AND NEGLECT IN AGED CARE HOMES OF UK
neglect, and the alarming high rate of this occurrence in the UK based care homes raises further
concerns about the care quality in the care homes in UK. Although the authors have emphasized
on a very small sample size and hence the findings of the article cannot be applied to a broader
scenario and hence it limits the external validity of the article as well.
Theme : Spousal dementia care leads the way to a compassionate and resilient aged care
delivery with more optimal results.
One of the most common and most challenging health adversity that the aged people are
associated with is dementia and hence, caring for a aged dementia patients is also associated with
many a challenges. When discussing the quality of care and the prevalence of abuse and neglect
in the UK based care homes it has to be mentioned that almost 27% of the care providers in UK
are spouses, and the majority of the spousal dementia care givers live under paramount stress for
the burden of caring. Although, the Donnellan, Bennett and Soulsby (2015), describe that
psychological resilience in this sector can be extremely beneficial for the health and wellbeing of
the care providers and the patient as well. In this article the authors have discussed that the
psychological assets like resilience can be extremely beneficial for car providers to provide
optimal care to the aged members of the society and avid any abuse or neglect. In this sector the
theoretical model of resilience can be applied as well to develop resilience as observed in the
spousal care scenario, and it has been observed that the components like social policy,
community and familial support are facilitators of generating resilience in the care providers. The
authors have argued in this article that resilient care providers emphasize on providing optimistic
care which is extremely advantages for the critically ill aged patients whom they are caring for.

16ABUSE AND NEGLECT IN AGED CARE HOMES OF UK
The authors have discussed that resilient carer can easily incorporate compassionate and
responsible care for the aged and hence will inevitably overcome any urge for abuse or neglect.
According to authors however, resilience power is subjective to the individual care provider and
hence the concept of compassion associated with just the resilience in the care providers is
flawed. As argued by the Algoso et al. (2016), the compassionate care can only be implemented
with adequate training the care providers and experience rather than resilience.
Theme: the mistreatment to the residents can be improved in the aged care sector with
adequate training and skill enhancement of the staff involved.
Resident to resident mistreatment is prevailing in the aged care sector of the UK based
care homes, and the consequences are leading to extremely high in hospital mortality rates for
the critically ill elderly patients. And hence in this paper the authors have argued that in order to
improve the scenario it is crucial for a reform in the techniques and policies in place for the aged
care in UK. The Ellis et al. (2014) in this article have discussed that the most of the abuse and
neglect in the aged care sector is heavily dependent on the lack of skill and expertise on
understanding and addressing the differential needs of the aged people in the care homes. In this
article, the authors have suggested the utilization of SEARCH strategy for caring for the critical
aged people, Support, Evaluate, Act, Report, Care plan, and Help to avoid approach which can
help in understanding the critical; requirements of the aged patients and will also help in
designing a care that will address all the grievances and preferences of aged. Along with that the
authors have also recommended that the use of the above mentioned systematic strategy will
effectively reduce the risk of mistreatment and neglect to the aged individuals residing in the
care homes of UK. It has to be understood that the authors in this article just have emphasized on
a particular intervention strategy, the care aspects are interdisciplinary at large and emphasizing

17ABUSE AND NEGLECT IN AGED CARE HOMES OF UK
on a single strategy for care will not elicit optimal results that are required to address the issues
thata re prevailing in the aged care scenario (Alexander et al. 2016).
Theme : a safeguarding system or framework can be another effective strategy to reduce
abuse and neglect in residential aged care homes.
It has to be mentioned in this context, that health care is not just about providing remedy
to the health care adversities of the patient, rather it also needs to be mentioned that optimal
holistic care is also concerned with safeguarding the overall health and wellbeing of the patients,
both physically and psychologically. This is applicable for the residential care homes as well and
the author Green (2015), has argued in this article that all the care providers are equally
responsible for safeguarding the physical and mental health and well being of each and every
resident, and hence in order to avoid the risk of abuse or neglect occurring in the care home,
there is a need for implementation of a safeguarding framework. This article argues that the
vulnerable adults are at much higher risk of abuse and neglect and hence the need for additional
measures taken for the vulnerable adults. Now the authors have discovered that the additional
measures that needs to the taken in order to improve the care home experience of the critically ill
aged patients, must take into consideration safeguarding the residents from any possible abuse or
neglect scenario. The safeguarding legislations in place in UK is just dependent on the physical
health of the residents, the authors here have argued the need for a multidimensional
safeguarding protocol or legislative policy that monitors the care quality in the residential homes
and penalizes the health care professional severely for mistreating or neglecting the care needs of
the aged residents. However, is has to be understood that the impact of the such safeguarding
infrastructure will be a severe financial blow to the health care facility, and according to authors,

18ABUSE AND NEGLECT IN AGED CARE HOMES OF UK
the budget constraint can also affect the safety and the quality of the care provided to the patients
(Chen 2017).
Theme: Training, institutional flexibility and team working can reduce the intensity of
aged care abuse and neglect in UK.
It has already been established in the literature study that the occurrences of abuse and
neglect in a predominant health priority for UK in the present age. A vast majority of the aged
members of the UK based communities are living in drastic conditions in the care homes of UK,
where violent physical and emotional abuse results into severe medical concerns for the flailing
elderly members of this society already struggling with various health related complexities.
According to the article by Cooper et al. (2013), the most influential factors discovered behind
the escalating rate of abuse and neglect in care homes is due to the extremely increasingly
competing care demands and insufficient resources. The authors insist in this article that the most
of the abusive instances that have been occurring were due to extremely low training and skill in
the aged care staff which led to them taking steps or actions which inevitably led to abusive or
neglecting situation for the adults. Another very important aspect associated with caring for the
elderly in this situation has been discovered to be the alarming staff ratio in the UK based acre
homes. The majority of the aged care staff had affirmed to the fact that the most of the abusive
occurrences have been occurring had been due to severe work load and low staff to patient ratio.
The burnout and work pressure inevitably leads to neglecting and abusive behavior due to which
the aged patients need to suffer severe consequences. One of the strategic recommendations that
this article has clearly described can be the fact that training, skill improvement and optimal team
work can defeinitely improve the scenario for the aged acre staff. Majority of the staff in the
research study agreed to the fact that training will help them understand the particular

19ABUSE AND NEGLECT IN AGED CARE HOMES OF UK
requirement of a critically ill aged patient and therefore, they will be able to take the clinically
reasonable steps that will not threaten any abusive situation for the aged resident. The article has
shed light on the fact that there is a significant lack of evidence based intervention for reducing
the instances of abuse and neglect in the aged care scenario; hence, there is acute need to
measuring the contributing factors of the abuse and neglect. The authors have discussed that any
intervention in an attempt to improve the care home scenario for the aged residents will need to
reform the entire residential care home environment and culture, and hence in order to do so,
institutional reform will be extremely crucial. Hence, the authors have advocated based on the
data collected from the aged care staff themselves that an amalgamation of training, institutional
effort and team- working can be an impactful strategy that can be the first step towards removing
the risk of abuse and neglect from residential care home scenarios. Although, regular training
procedure and workshops for the staff of the health care facility will be another financial weight
that will not be possible for the most of the heal.th care facilities that are running on financial
constraint (León and Pavolini 2014).
Theme: Organizational aspect of abuse and neglect in the residential aged care sectors.
It has already been discussed above that the abuse and neglect that the aged residents of
the care home are never due to the professional misconduct of the care providers only. There are
a multitude of other factors involved with the entire procedure and one of the most influential of
those factors can be considered the institutional or organization factors and its inevitable impact.
According to the article by Hyde et al. (2014), the authors explore and discuss 5 factors
associated that potentially impart the most impactful effect on the abuse and neglect scenario of
the residential aged care homes. The first organizational factor that has been discussed in the
article is the inadequate infrastructure in the residential care homes, it has to be mentioned that

20ABUSE AND NEGLECT IN AGED CARE HOMES OF UK
the physical environment of the care home scenario has a significant impact on the quality of
care provided to residents. With facilities that have run-down equipments, overcrowding of the
residents and poor hygienic conditions, the care quality cannot be expected to be good. The
organizational management practices is the second factor discussed in the article, which
discusses the detrimental impact of the management procedure, leadership practices, policy and
protocol and staff support characteristics on the care quality and incidence of abuse and neglect.
The third factor discussed the impact of low staffing on the care quality of the aged residents and
the article agrees to the consensus that the low staffing has a significant link between the care
qualities provided to the aged residents of the care homes. The fourth and fifth factor discussed
as the most impactful factors associated with this scenario is the resident population
characteristics and the organizational culture of the care home. It has to be mentioned that the co-
operation and adjustment from the residents of a care home has direct link between the care
provided to the residents. However, it also needs to be mentioned that the cultural context of the
staff in the care homes and the workplace environment also has an indirect link with the
increasing abuse and neglect in the care home scenarios. The article has only emphasized on the
organizational cultural contexts of the health care facility and has not addressed the multicultural
background that the health staff may belong to, and the impact of differences between the culture
between the patient and the care provider on the care experience (Betancourt et al. 2016).
Therefore, without addressing these factors, an overall reform in the residential care home cannot
be possible and reducing the abuse and neglect situation predominating in the care homes can not
be possible as well.

21ABUSE AND NEGLECT IN AGED CARE HOMES OF UK
Discussion:
A thorough analysis of the literature had helped in providing many insights into the abuse
and neglect of the older citizens mainly in the nation of the United Kingdom. Researchers have
shown that not only the elders and family member of such elderly people, even care givers of the
aged homes believe that abuse does take place in the centers. However, they have clarified that
such abuses are not deliberate. They are of the opinion that often they feel burdened while
handling a large number of aged persons (Milne et al. 2013). The work is physically and
emotionally draining for which irritations becomes a part of their care delivery. Improper staffing
and care worker shortage are mainly responsible for this. Moreover another research suggested
that the caregiver admitted that often they fail to understand how to handle many challenging
behaviors of the elders such as those which occur in the cases of dementia and many others.
Therefore, from this instance, it becomes clear that the social workers are not properly trained to
handle such patients (Hyde et al. 2014). Therefore the concerned authorities should take in more
responsibilities while recruiting care workers in the aged homes. Moreover, it should be taken
into care that while recruiting individuals, the organizations should either incorporate individuals
who hold proper degrees or can train them later so that the care given to them is free from any
neglect and any abuse.
The organizations, itself plays a very important role. Many of the researchers are of the
idea that lack of proper management systems and lack of effective leadership may result in the
occurrence of neglects and abuses on the patients (Heinrich, Rapp and Konig et al. 2013). The
higher authorities should have to care that they not only manage the workers effectively but also
set up a proper monitoring and evaluating bodies which would help them keeping an eye on the
entire care system of the aged clients. It is seen that lack of effective leadership leads to such

22ABUSE AND NEGLECT IN AGED CARE HOMES OF UK
unfortunate events. Secondly another cause that remains intricately associated with the abusing
of the aged clients is improper architecture, unhygienic building, lack of proper, maintenance of
building, rooms and other factors. Moreover, many of the researchers say that lack of allocation
of proper funds mainly remain the cause of such issues. Many cases have been directed where
the management does not allocate proper funds, equipments and resources for the caseworkers to
work. In some other cases, it is also seen that proper allocation of resources does not take place
from the government levels which are resulting in to this (Pilny and Stroke 2016). Therefore, it
gives rise to a debate that how the modern policies should be developed so that patient abuse can
be neglected. Many researchers are of the opinion that not always the funds and resources mainly
inhibit proper care delivery but the strict culture of the management becomes the main reason
where the management is not only rigid but non-cooperating, selfish and are less bother for
emotions that need to be harbored as a healthcare center. There are also many instances where
the localities have less care centers and hence nurse to client ratio becomes misbalanced. As a
result abuse and neglect automatically comes in the scenario as low number of care workers
cannot provide quality care to the patients. Increasing the number of nursing homes and also the
number of care centers would be of immense help to meet the demands of care by old people.
With the advancements of the medical science in the recent generations, the life expectancy has
increased. However it has not assured quality life for all the older patients as medicines and
treatments are making them live lives but it has failed to provide quality to it (Fisk 2015). They
are living with co-morbid and condition which needs to be taken care of. Hence the nursing
homes and aged care centers have to be more competent in their care.
It is seen that different aged care facilities and nursing homes are trying their best to
implement strategies which would prevent neglect and abuse of the aged care. One of the

23ABUSE AND NEGLECT IN AGED CARE HOMES OF UK
researches when reviewed have shown that it had tried to implement fall prevention techniques
so that the chances of femoral fractures cases that arise due to fall (due to neglect or abuse) can
be prevented (Heinrich et al. 2014). The research suggested that it would be saving a huge
amount of finance and resource of the client and their family members. Similar strategies need to
be taken by the government and also by the aged cares so that neglects can be prevented. Often it
is seen that providing surveillance in the residents’ rooms, public areas and common rooms will
help the aged care authority to monitor the different occurrences that take place (Learner 2013).
Care should be taken that the data, images, video footages and others are maintained by strict
authority and do not get mishandled by other dishonest individuals. Higher position leaders are
also of the opinion that strict punishments and penalties should be imposed on the aged care
owners if any sort of abuses re noticed or complained about. This would help in reducing the
number of abuse issues occurring in the nation (Cooper et al. 2013).
It has to be understood in this context that with the rapidly deteriorating health of
the individuals in the care homes, it is crucial for the residential care homes to be eligible with all
optimal care facilities to address each and every need of the elderly population. However as
discovered from this literature study, the infrastructure and environment of the residential care
homes of UK are heavily dependent upon the environmental characteristics of the residential
care homes (Cooper et al. 2013). Many of the facilities do not have enough infrastructural
equipments or facilities that are capable of meeting the complex needs of the elderly population
who are already dealing with a multitude of different health complexities that comes coupled
with aging. This phenomenon is being experienced not only by the aged members residing in the
aged care facilities. However, it has to be mentioned in this context that the importance of
adequate equipments and facilities are extremely important for meeting the extremely competing

24ABUSE AND NEGLECT IN AGED CARE HOMES OF UK
demands of the residents. As explained by the article by Cooper et al. (2013), the aged care staff
working in the residential services has expressed their grievances on the fact that the inadequate
infrastructure and facilities in the residential care services are one of the most crucial factors
behind the alarmingly increasing instances of neglect on the residential aged care homes. In
agreement the article by Hyde et al. (2014) has also explained that the infrastructure is
undoubtedly one o the most influential factors when the care quality and support provided to the
aged members of the society residing in aged care homes is discussed. It has to be mentioned that
most of the critical aged residents in such care homes are already struggling with mobility
restrictions, dementia, or other such restrictive medical concern. In such a situation where the
caring activities for these aged patients are already tiresome and burdening, the lack of adequate
infrastructure or equipments facilitate more frustration and agitation in both the resident and the
carer, leading inevitably to mistreatment (Dixon et al. 2013).
Along with that, the impact of the organizational factors on the prevalence of the
mistreatment and neglect in the aged care scenario cannot be overlooked. It has to be mentioned
that impact of staffing, organizational culture, management practices need to be discussed. The
lack of adequate staffing has a significant impact on the professional competence and
performance quality in any organizational sector and the aged care sector is no exception to this
rule. The lack of staff had been considered to be the most influential stakeholder behind the
rapidly increasing statistics of aged care home abuse and subsequent in house mortality. It also
needs to be mentioned that low staffing and its consequent burnout is the main perpetrator of
abuse and neglect in the care home scenarios (Eastman 2013). The neglect in the care homes are
equally impact in the aged care sector as violent abuse, as mentioned in the article by Wolff1,

25ABUSE AND NEGLECT IN AGED CARE HOMES OF UK
Stuckler and McKee (2015), the neglect in the aged care homes oven leads to chronic
dehydration which increases the probability of in house mortality of the aged patients.
Similarly, the impact of different management policies and protocols also direct the path
where the care delivery to the aged resident will take. As explained by the article by Green
(2015), there is need for a safeguarding policy that will monitor the physical and mental well
being of the patients in general and hence considerably judge implications of any abuse or
neglect that take place in an aged care home. It has to be mentioned in this context that the
importance a legislative monitoring policy is massive to reduce the frequency of aged care
mistreatment scenarios. Along with that it also needs to be mentioned that training and skill
enhancement of the care staff has also been discussed to be extremely beneficial strategies that
can contribute effectively in reducing the incidence of abuse and mistreatment. In agreement, the
authors have discussed that, in most cases the care4 staff are not aware of adequate caring
activities that will optimally meet the care needs of the aged residents dealing with complex
health adversities like dementia, osteoarthritis, diabetes and other such restrictive con-
communicable diseases. It has to be mentioned that the dependency that these health care
restrictions are associated with demands a mutually respectful and trusting relationship between
the care provider and resident and hence, the over- expectations from the care provider often
results into mistreatment or non-cooperation from the resident itself. As per Dixon et al. (2010),
the impact of the over- expectation in the trust relationship between the care provider and the
care receiver often is the main perpetrator of abuse and mistreatment. As per the McDonald et al.
(2012), the impact of the resident non-cooperation or mistreatment is also a significant
organizational factor that influences the environment of the care facility and inevitably leads to
ether neglect or abuse. Hence, proper training and skill enhancement activities will inevitably

26ABUSE AND NEGLECT IN AGED CARE HOMES OF UK
lead to the care staff developing expertise that will eliminate the possibility of mis- treatmemt
altogether. It has also been discovered that the importance of organizational reform is also
crucial for the obliteration of abuse and mistreatment from the aged care sector completely.
According to Post et al. (2010), the need for reform in the institutional flexibility, and
organizational culture is crucially important for the aged acre scenario to be efficient and devoid
of any instances of neglect or mistreatment. Although, this literature study has taken into account
research articles that are mainly London based studies and with considerably smaller sample
population which restricts the external validity of the articles chosen. There are many gaps left
behind by the previous research, however, the research articles have provided a fertile ground for
further research to explore the intricate factors associated with the abuse and neglect and
determine strategies that will overcome those challenging factors and will attempt to rid the aged
acre scenario from the abuse and mistreatment.
Conclusion and recommendation:
On a concluding note, it can be stated that there are different factors associated with the
abuse and neglect that the aged residents are receiving. However the most influential factors that
have been discovered in the context of aged care abuse and mistreatment are the lack of training
and skilled expertise in the care staff, the lack of modern and advanced assistive equipments and
infrastructure, lack of team work and organizational flexibility in the aged care homes. However,
the literature review could discover a series of strategies that could potentially reduce the
advancement of the aged care scenario of the UK based residential care home.

27ABUSE AND NEGLECT IN AGED CARE HOMES OF UK
There are a few recommendations that can be implemented in this scenario so that the
abuse and neglect can be overcome and the aged care scenario can be flawless for the critically
ill and dependent aged members of the society can be supported optimally:
1. First and foremost, there is a dire need for training and skill enhancement for the
aged care staff. It has to be addressed that the most reported contributing factor
behind the alarming situation of abuse and neglect in the aged care homes has
been due to the lack of expertise in the nursing staff. Periodical training can be
extremely helpful in enhancing the expertise to handle the critically ill aged
patients in the care homes.
2. Along with that, the need for better infrastructure is also evident in the present
scenario, with the aid of proper assistive equipments and facilities the frequency
or magnitude of abuse and neglect can be minimized effectively.
3. The need for a legislative safeguarding framework for monitoring and improving
the aged care scenario of UK had been discussed by the majority of the research
studies. A legislative framework or protocol will not only emphasize on more
compassionate care in the aged care homes and will also monitor the level of
compliance in the care staff (Eastman 2013).
4. Lastly, it must not escape notice that the present frightening scenario of the
residential aged care sector in the care homes is the culmination of a myriad of
interconnected factors, hence, in order to eradicate all the factors that contribute to
absue or neglect there is need for an overall organizational reform. Hence, the
national health authorities and the organizational bodies will need to impart a

28ABUSE AND NEGLECT IN AGED CARE HOMES OF UK
collaborative effort that will successfully remove the possibility of abuse and
neglect from the aged care scenario (Cooper et al. 2013).

29ABUSE AND NEGLECT IN AGED CARE HOMES OF UK
References:
Aiken, L.H., Sloane, D.M., Bruyneel, L., Van den Heede, K., Griffiths, P., Busse, R.,
Diomidous, M., Kinnunen, J., Kózka, M., Lesaffre, E. and McHugh, M.D., 2014. Nurse staffing
and education and hospital mortality in nine European countries: a retrospective observational
study. The Lancet, 383(9931), pp.1824-1830.
Alexander, G., Abbott, P., Fossum, M., Shaw, R.J., Yu, P. and Alexander, M.M., 2016. The
future of informatics in aged care: an international perspective.
Algoso, M., Peters, K., Ramjan, L. and East, L., 2016. Exploring undergraduate nursing students'
perceptions of working in aged care settings: A review of the literature. Nurse education
today, 36, pp.275-280.
Betancourt, J.R., Green, A.R., Carrillo, J.E. and Owusu Ananeh-Firempong, I.I., 2016. Defining
cultural competence: a practical framework for addressing racial/ethnic disparities in health and
health care. Public health reports.’
Chen, J., 2017. Evaluating the Cost of Mental Illness: A Call for a Cost-Effective Care
Coordination Model.
Cooper, C., Dow, B., Hay, S., Livingston, D. and Livingston, G., 2013. Care workers’ abusive
behavior to residents in care homes: a qualitative study of types of abuse, barriers, and
facilitators to good care and development of an instrument for reporting of abuse
anonymously. International psychogeriatrics, 25(5), pp.733-741

30ABUSE AND NEGLECT IN AGED CARE HOMES OF UK
Cooper, C., Dow, B., Hay, S., Livingston, D. and Livingston, G., 2013. Care workers’ abusive
behavior to residents in care homes: a qualitative study of types of abuse, barriers, and
facilitators to good care and development of an instrument for reporting of abuse
anonymously. International psychogeriatrics, 25(5), pp.733-741.
Daly, J.M., Merchant, M.L. and Jogerst, G.J., 2011. Elder abuse research: A systematic
review. Journal of Elder Abuse & Neglect, 23(4), pp.348-365.
Dixon, J., Biggs, S., Stevens, M., Manthorpe, J. and Tinker, A., 2013. Defining the “perpetrator”:
abuse, neglect and dignity in care. The Journal of Adult Protection, 15(1), pp.5-14.
Dixon, J., Manthorpe, J., Biggs, S., Mowlam, A., Tennant, R., Tinker, A. and Mccreadie, C.,
2010. Defining elder mistreatment: reflections on the United Kingdom study of abuse and
neglect of older people. Ageing & Society, 30(3), pp.403-420.
Donnellan, W.J., Bennett, K.M. and Soulsby, L.K., 2015. What are the factors that facilitate or
hinder resilience in older spousal dementia carers? A qualitative study. Aging & mental
health, 19(10), pp.932-939.
Eastman, M., 2013. Old age abuse: a new perspective. Springer.
Ellis, J.M., Teresi, J.A., Ramirez, M., Silver, S., Boratgis, G., Kong, J., Eimicke, J.P., Sukha, G.,
Lachs, M.S. and Pillemer, K.A., 2014. Managing resident-to-resident elder mistreatment in
nursing homes: The SEARCH approach. The Journal of Continuing Education in Nursing, 45(3),
pp.112-121.

31ABUSE AND NEGLECT IN AGED CARE HOMES OF UK
Fernández-Caballero, A., Latorre, J.M., Pastor, J.M. and Fernández-Sotos, A., 2014, December.
Improvement of the elderly quality of life and care through smart emotion regulation.
In International Workshop on Ambient Assisted Living (pp. 348-355). Springer, Cham.
Fisk, M.J., 2015. Surveillance technologies in care homes: seven principles for their
use. Working with Older People, 19(2), pp.51-59.
Green, D., 2015. Safeguarding and protection of vulnerable adults. Nursing And Residential
Care, 17(5), pp.293-296.
Haluza, D. and Jungwirth, D., 2016. ICT and the future of healthcare: Aspects of pervasive
health monitoring. Informatics for Health and Social Care, pp.1-11.
Hayward, B.A., 2017. The arguments against camera and closed-circuit television surveillance in
the homes of people with disabilities to protect from abuse and neglect. Research and Practice in
Intellectual and Developmental Disabilities, 4(2), pp.121-137.
Heinrich, S., Rapp, K., Stuhldreher, N., Rissmann, U., Becker, C. and König, H.H., 2013. Cost-
effectiveness of a multifactorial fall prevention program in nursing homes. Osteoporosis
international, 24(4), pp.1215-1223.
Hillmer, M.P., Wodchis, W.P., Gill, S.S., Anderson, G.M. and Rochon, P.A., 2015. Nursing
home profit status and quality of care: is there any evidence of an association?. Medical Care
Research and Review, 62(2), pp.139-166.
Hyde, P., Burns, D., Killett, A., Kenkmann, A., Poland, F. and Gray, R., 2014. Organisational
aspects of elder mistreatment in long term care. Quality in Ageing and Older Adults, 15(4),
pp.197-209.

32ABUSE AND NEGLECT IN AGED CARE HOMES OF UK
Hyde, P., Burns, D., Killett, A., Kenkmann, A., Poland, F. and Gray, R., 2014. Organisational
aspects of elder mistreatment in long term care. Quality in Ageing and Older Adults, 15(4),
pp.197-209.
Jönson, H., 2016. Framing scandalous nursing home care: what is the problem?. Ageing &
Society, 36(2), pp.400-419.
Keogh, K., 2014. Debate rages over how to improve the quality of care for older people:
Undercover TV filming captured distressing scenes in two residential nursing homes. But is
surveillance the best way to stamp out abuse? Kat Keogh reports. Nursing Standard, 28(37),
pp.14-15.
Learner, S., 2013. Calls for care home abuse penalties for owners.
León, M. and Pavolini, E., 2014. ‘Social Investment’or back to ‘Familism’: The impact of the
economic crisis on Family and Care Policies in Italy and Spain. South European Society and
Politics, 19(3), pp.353-369.
McDonald, L., Beaulieu, M., Harbison, J., Hirst, S., Lowenstein, A., Podnieks, E. and Wahl, J.,
2012. Institutional abuse of older adults: What we know, what we need to know. Journal of elder
abuse & neglect, 24(2), pp.138-160.
Milne, A., Cambridge, P., Beadle-Brown, J., Mansell, J. and Whelton, B., 2013. The
characteristics and management of elder abuse: evidence and lessons from a UK case
study. European Journal of Social Work, 16(4), pp.489-505.
Pilny, A. and Stroka, M.A., 2016. Determinants of received long-term care–Individual responses
to regional nursing home provisions. Health care management science, 19(4), pp.326-337.

33ABUSE AND NEGLECT IN AGED CARE HOMES OF UK
Post, L., Page, C., Conner, T., Prokhorov, A., Fang, Y. and Biroscak, B.J., 2010. Elder abuse in
long-term care: Types, patterns, and risk factors. Research on Aging, 32(3), pp.323-348.
Prince, M.J., Wu, F., Guo, Y., Robledo, L.M.G., O'Donnell, M., Sullivan, R. and Yusuf, S.,
2015. The burden of disease in older people and implications for health policy and practice. The
Lancet, 385(9967), pp.549-562.
Twigg, J., Wolkowitz, C., Cohen, R.L. and Nettleton, S., 2011. Conceptualising body work in
health and social care. Sociology of Health & Illness, 33(2), pp.171-188.
Wolff, A., Stuckler, D. and McKee, M., 2015. Are patients admitted to hospitals from care
homes dehydrated? A retrospective analysis of hypernatraemia and in-hospital mortality. Journal
of the Royal Society of Medicine, 108(7), pp.259-265.