“If you do that again, I’ll stop your family from visiting
you.” This may sound more like something from a prison than a care
home, but the threat is just one example of how older people can be
abused inside institutions.
Action on Elder Abuse estimates that at any one time 500,000 to
800,000 older people in the UK face abuse, most often in their own
homes but also in institutions.
Last week, the House of Commons health select committee
announced that it was to look into the issue. It intends to examine
how widespread elder abuse is, what causes it, and what can be done
to combat it.
When we think about abuse we most often think of physical
punishment. We hear stories of older people who have had their
fingernails ripped out or scalding water poured over them.
In reality, psychological abuse is more common. For example, a
relative may threaten to put an older person in a care home unless
they agree to certain things but a care home may threaten to evict
them unless they “behave”.
Financial abuse is also common. The older person may have their
possessions stolen or be denied access to their money. In extreme
cases, some older people have had their houses sold, after being
led to believe they had no choice but to hand over the deeds.
The select committee is due to hold just one session hearing
evidence in December so its remit is limited. But holding an
inquiry will bring elder abuse to the public’s attention,
which is something welcomed by Gary Fitzgerald, chief executive of
Action on Elder Abuse.
He relates the case of Margaret Panting, a 78 year old, who died
after suffering significant abuse and whose injuries included
cigarette burns and cuts from razor blades. He points out that
while everyone has heard of Victoria Climbié, few know of
“That says a lot about how abuse is perceived in society. If a
child is abused we all know about it, but if it’s an older
person the local community may know but not the rest of us,” he
In six years, Action on Elder Abuse’s helpline has
received more than 10,000 calls relating to abuse. And often it is
the very people paid to care who are the perpetrators.
Over time the General Social Care Council will be registering
all social care workers, but Fitzgerald believes that its focus on
registering social workers first is wrong.
“At the current rate it could take 10 to 18 years before care
assistants and home helps are registered. Less than 3 per cent of
people identified as abusers through our helpline are social
workers but 36 per cent are care assistants or home helps. There is
clear evidence that we need to look at the other end of the scale,”
The select committee intends to look at whether regulatory
bodies, including the National Care Standards Commission, need to
take a stronger role in protecting older people. There is concern
over whether enough inspections are carried out to identify
problems. In addition, providers may be assessed on whether or not
they have an adult protection procedure. But, the difference
between having a policy and actually implementing it can be
Fitzgerald is also concerned that the commission is so keen to
work with providers that it might have lost sight of what is
And inspection of other policies has also fallen short. Two
years ago the government published the No Secrets guidance on adult
protection procedures, but has failed to check its
Paul Burstow, Liberal Democrat health spokesperson and a member
of the select committee, believes there should be a proper auditing
process. “There’s been research to develop codes of practice,
policy statements, and training manuals, but when it comes to
practical adult protection there is not the budget, staff, or time
being allocated. There’s a lot of documentation but not a lot
of delivery on the ground,” he says.
Another area in need of investment is training. Many of those
looking after older people will not have a care qualification and
this can result in unintentional abuse. An untrained worker might
think it is all right to put a coffee table in front of an older
person to stop them from getting up and hurting themselves, when in
fact it’s an inappropriate use of restraint.
The government has set itself an ambitious target to make half
of all care home staff have NVQ level 2 by 2005. While sceptical
about whether this level of training will be achieved, Burstow
feels the government must not be allowed to backtrack. Research
shows that training staff can reduce the amount of intentional and
unintentional abuse in institutions, he says.
Further training is also necessary for professional staff to be
able to identify and deal effectively with abuse. The Community and
District Nursing Association has been campaigning for all nurses to
have mandatory training on elder abuse in addition to that which
they receive on child abuse.
And there are areas where social work practice could improve
too. Jill Manthorpe, chairperson of Hull and East Yorkshire adult
protection committee, says there needs to be greater understanding
of what helps to prevent elder abuse, and proposes relevant
post-qualifying training for social workers.
“Social workers need support around prevention and how to deal
with people therapeutically,” says Manthorpe, who is also professor
of social work at King’s College, London.
However, more importantly, a culture change is needed so that
whistle-blowing is more acceptable and practitioners feel confident
that if they voice their concerns they will be well received.
But while improvements in these areas are welcome there is no
getting away from the fact that more resources are needed.
Manthorpe says local agencies are managing “on goodwill” with no
statutory requirement to fund their adult protection committee
“The government has to ensure that if there’s a national
system of protection the funding implications are recognised,” she
Further guidance could also be useful, says Bridget Penhale,
European representative for the International Network for the
Prevention of Elder Abuse. But she is all too aware that guidance
alone isn’t enough. “If staff don’t know what to do
about abuse then procedures are not going to help them in terms of
And she says it’s not always clear which intervention is
best for which type of abuse. “If there’s a situation of
physical and psychological abuse, is it better to provide lots of
home care support to monitor it, or is it better to focus on
relationship work?” she asks.
But tackling elder abuse is not just down to those directly
involved with older people, as Penhale explains. “People jump up
and down over a child needing protection and assistance. But
it’s different for older people. As a society we are
ambivalent about what happens to older people and ageism militates
against dealing with this.”