A recent Panorama programme revealed shocking incidents of abuse of disabled people at Winterbourne View care home in Bristol. In doing so it highlighted serious shortcomings in the inspection and regulation of residential care homes. We must all hope this leads to real improvements.
A question that arises out of the Panorama programme is “how prevalent is the abuse of people in residential homes?” The Department of Health has for some time wanted to carry out research to assess levels of abuse, neglect and lack of dignity in the institutional care of older people. It’s clearly timely that there is research currently underway to shed light on these questions. But this sort of research project raises many issues and makes us, as social researchers, realise that it may not always be possible for research to provide all the answers.
An important starting point for this sort of research is to ask “what is abuse?” The sort of behaviour seen in the Panorama programme is obviously abuse of the worst kind. But there are also areas where less obviously shocking poor practice slides into abuse and neglect leading to the loss of residents’ dignity. NatCen, with Kings College, has done some work around this complex issue to help researchers have a clear definition of what they are trying to measure
Then there’s the challenge of how you find out what is actually happening within a care home. While journalists can go undercover and collect information without the knowledge of the staff (albeit in accordance with strict editorial guidelines), this approach is less easily available to researchers. Researchers are bound by ethical codes that make it difficult, if not impossible, to take this sort of approach – the need for informed consent for what we do is paramount, and the practicalities of doing this across a wide range of homes would also be logistically difficult.
The current Department of Health approach plans to use observation within homes, including specific observational techniques designed to allow engagement with people with dementia. This approach makes a lot of sense, but there are still potential obstacles. To observe within the care home, you need the permission of the care home manager and the buy-in of the staff. Taking part in research is always voluntary, so would a manager who worried that their staff may not always provide decent levels of care allow researchers in to observe? Probably not. So any research trying to assess the prevalence of abuse, neglect and lack of dignity in residential care homes will always have that particular elephant in the room – what can you say about the homes that did not take part? Do we really have the whole picture?
Research of this sort is vital. It can shed light on levels of neglect, poor practice and loss of dignity. By doing this it creates a powerful vehicle to drive up standards by, for example, ensuring better training for staff. But it’s unlikely to uncover the sorts of criminal abuse seen on Panorama. So although it can help us to measure and understand abuse it will struggle to provide a complete answer to the prevalence question. It is only through a properly resourced inspection regime, with unannounced (and possibly undercover) visits, that the full extent of this sort of abuse can be revealed and stopped.