Background
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.
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 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).
Research Questions
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 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.
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 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 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.
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 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 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 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 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 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 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 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 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 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. 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 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, 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 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 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.
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 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 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 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, 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 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.
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:
- 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.
- 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.
- 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).
- 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 collaborative effort that will successfully remove the possibility of abuse and neglect from the aged care scenario (Cooper et al. 2013).
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