Research into practice

Jill Manthorpe looks at the lessons to be
learned from good practice in preventing elder abuse as highlighted
in inspection reports.

Combating elder abuse has been re-invigorated
in 2001 by the implementation of the policy guidance No
Secrets in England, and In Safe Hands in
Wales. But new local policy, procedures, committees and structures
may concentrate on matters of assessment and response. Preventing
elder abuse can take a back seat.

This makes Claudine McCreadie’s overview of
Social Services Inspectorate reports timely and instructive. In
concentrating on prevention of abuse she demonstrates that this is
in fact part of a range of activities. Care management, assessment,
training and carer support services all have a key role in
preventing abuse.

McCreadie, a research fellow at the Age
Concern Institute of Gerontology at King’s College, London, trawls
through a series of SSI inspection reports produced since the
publication in 1993 of No Longer Afraid, the first
advisory document on the prevention of elder abuse.¹ She
noted that while these inspection reports had reported increasing
awareness of the possibility of abuse, this awareness was still
patchy. The policy documents scrutinised were generally similar but
some appeared more connected to other formal documents, some were
more explicit than others about racial abuse and harassment, and
some, but not all, had been broadly disseminated.

This research throws up helpful ideas about
risk and vulnerability. McCreadie makes the point that
vulnerability or frailty, by itself, does not lead to abuse. Often
it is the behaviour or needs of another person which is
significant. She warns that risk policies and adult protection
policies need to be linked. Similarly, restraint in residential
care is linked to abuse and to risk, but connections were not
always made. If used, restraint needs to reflect good practice and
may helpfully include advice from inspection units.

In a recent article, J Harris has argued that
it may be time to replace the term “restraint” by “physical
intervention”.² He suggests this may have more neutral
overtones. Like many people, he calls for work on policy to inform
good practice. Such initiatives, often spurred by developments in
training and, at times, outside traditional social care settings,
are important in making links between good practice and prevention
of abuse.

McCreadie found that research findings
paralleled SSI reports. Both note the importance of multi-agency
and inter-professional work. Both accept that abuse is only an
umbrella term, covering a range of behaviours, in a multitude of
settings and for a myriad of reasons. She notes the importance of
carers’ assessments to find out what is going on and warns against
equating relatives with carers or co-residence as implying care is
being provided.

Few of us get the chance to read all SSI
reports, still less to consider them over time and with a
particular focus. This research is helpful in setting adult
protection initiatives in the context of the day-to-day practice of
care management and service provision. Recognition that adult
protection has to link with other systems, other competing demands
and other priorities, should help to embed it within practice,
rather than bolting it on. This research is furthermore a useful
demonstration that research should involve thinking about existing
data rather than setting off to do yet another survey.

– Claudine McCreadie, Making Connections:
Good Practice in the Prevention and Management of Elder Abuse:
Learning from SSI Inspection Reports in Community and Residential
Settings, Department of Health, 2001

Jill Manthorpe is reader in community
care at the University of Hull and chair of the Hull and East
Yorkshire adult protection committee.

References

¹ Social Services
Inspectorate, No Longer Afraid: the Safeguard of Older People
in Domestic Settings, HMSO, 1993

² J Harris, “Physical
interventions – from policy to practice”, Journal of Adult
Protection, Vol 3 (2), 2001