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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

martin green Martin Green

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

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

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