How to reduce risk of abuse in care homes

More evidence of abuse in care homes emerged in a Panorama documentary last month (April). The home in question had been designated “excellent” by the CQC and yet anyone with a relative in a care home (and indeed most people) would regard the treatment shown to a helpless person as horrendous. Footage obtained by a camera hidden in an alarm clock provided incontrovertible evidence. The camera had been placed by a concerned relative.

The owners claimed the behaviour was an isolated incident and dealt with it by re-training. It is conceivable that the managers did not know their staff were abusing residents. More likely, I think, they had an inkling but chose to ignore the signs. I can understand. Managing a care home is a task of under-rated difficulty. Arguably employees have far more rights than the people for whom they are caring. Asserting those rights is certainly easier for employees. For managers, tackling suspected abuse is extremely time-consuming involving, potentially, endless rounds of meetings, meticulous documentation and significant stress. While the management are distracted by this demanding task there can be a real risk the care home will become dysfunctional.

It would be encouraging to think that disciplinary processes could become simpler and less onerous. Equally it would be helpful if mischief making by employees and ex-employees (making an Employment Tribunal claim because one can) could become more difficult; although some progress has been made recently. Finally it would be comforting if one could feel that the balance of probability (in establishing that, say, abuse had taken place) could mean 60:40 rather, as it often feels, needing to be 90:10.

None of these desirable changes is within the power of the care manager or care home owner. But there is still much they can do and I would like to examine just a few options here.

Recruitment and selection

When few applicants turn up for interview and of those that do, none are very good it is easy to under estimate the importance of selection. And yet good selection creates an upward spiral. Some years ago one of my students found that the supermarket managers (in a national discount store chain) were spending almost all their time on recruitment. By implementing some small improvements in the process, staff retention improved dramatically and recruitment quickly became a much smaller part of their time. Repeating that task less frequently meant that recruitment and selection then cost less overall, not more.

Poor selection can have two adverse effects. The wrong person leaves quite quickly and you have to start the process all over again. The wrong person stays and you spend years wishing you’d never selected them!

Big businesses take selection seriously. One of the big supermarkets (or perhaps them all, I don’t know) selects till-operators via assessment centres. This valuable process, normally reserved for selecting senior managers, enables them to select people who are naturally social-able and friendly. Interviews alone do not necessarily reveal such qualities. One could envisage a similar process being used to identify people with a compassionate nature.

An “HR Health check” can give you useful feedback on your selection processes as well as on the other people management practices outlined here.

Training

Far too many people, not necessarily just the wrong people, leave an organisation in the first four months – so much so that it has a term: “The induction crisis”. Yet a simple induction programme can make people not only feel at home but also start to contribute effectively much earlier in their employment. Reducing turnover of staff further reduces costs, leaving more resource to concentrate on other training.

Have you ever noticed how the level of service varies in different restaurant chains? Each recruits from a similar level of the “labour market” so something must be different and, invariably, training is the greatest factor.

You, if you are a care home manager, know far more about the demands of being a carer than do I. But it seems to me it is not work where one can simply rely on intuitive compassion. Even if that exists, rather more is called for.

Training employees will not only help them perform better (and not be tempted to abuse, out of frustration for example) but will do more to motivate them than do wage differentials. It will keep the good ones and help you attract other good employees (meaning more turn up at interview!) The resources you allocate (internal or external) will be an investment and help protect you from difficult and embarrassing revelations because there should be nothing to reveal.

Culture

Many large organisations give huge attention to culture. There are ASDA people and Waitrose people; Shell people and BP people. Engage them in any form of work conversation and they exude the values and principles of their respective employers. Employees’ attitudes are developed so that they align with those of the organisation; invariably these are positive attitudes which help individuals to grow as people.

The relationships between managers and employees are crucially important – managers need to take time to get to know their staff and spend time on ‘positive’ performance management – as a way of building trust, engagement and being able to intervene early before things escalate.

Team building is a valuable process for creating a positive culture and building relationships. Training, mentioned before, is another and a whole range of good people management practices all contribute. One way of understanding the existing culture at your organisation is to undertake an employee attitude survey. More often these reveal more commitment and positive attitudes than the managers expect. But they also measure levels of trust and engagement and give “steers” to their improvement.

Discipline

At the outset of this article I mentioned how time consuming tackling abusive behaviour can be.

But tackling it is an important part of the culture. The “bad apple” analogy is pertinent here and the converse applies even more so. In employment, dealing with the one bad apple actually improves all the other “apples”. Despite a natural temptation for employees to protect and cover for a renegade employee most also have a conflict and that is to see poor behaviour is dealt with (perhaps without involving them!)

In my experience if you deal with poor behaviour before it reaches a point where it directly threatens employment (ie before it reaches the level of being a dismissible offence) then nine times out of ten (roughly) the poor behaviour is remedied. If the process is started early then very, very few cases result in the time consuming processes created by a dismissal.

Finally, if you genuinely suspect abuse you can put a covert camera in an alarm clock. If that reveals evidence of abuse then you will have to act. But at least the footage won’t appear on Panorama.

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