Picture: Social workers often fail to challenge the poor treatment of older people in hospitals
Potential elder abuse can go unchecked by social workers because they fail to stand up to professionals in partner agencies. Angie Ash reports
Recognising the signs that an older person could be suffering abuse and raising the alert are the basics of safeguarding training for social workers and other professionals.But what do social workers do when faced with barely compliant care that borders on the negligent or abusive? Or when their partners fail to show up to meetings, or do not carry out agreed actions?
Research I carried out shows social workers may tolerate this to make partnerships work. The research set out to better understand the dilemmas social workers in a local authority faced when dealing with the potential abuse of an older person.
Most social workers in this authority had little direct experience of dealing with abuse. As elsewhere, they typically spent little time with older people, beyond being involved in assessment and care management. Again, as elsewhere, there was a shortfall of community-based provision to meet the needs of older people, particularly the very old. Dementia services and support for older people who were victims of domestic abuse were known shortfalls.
What care home provision remained met national minimum standards, but in some cases was only just compliant. The poor quality of one home in particular was known and discussed by social workers.
Incidents were recounted of, for example, an older person standing up to attract the attention of a care assistant and being told to “sit down and shut up”. Social workers had seen staff swearing in front of older people. Yet none of this was challenged at the time, through agency reporting lines or safeguarding forums. Instead, social workers (and nurses) continued to place older people there.
In adult safeguarding, delays to police investigations into alleged abuse were not uncommon. Social workers accepted that investigations might be delayed or protracted, as the police (like adults’ services) had too few staff to deal with too many other priorities. NHS partners, whether managers, doctors, nurses or GPs, seldom attended safeguarding meetings.
Social workers infrequently challenged the views of other professionals in safeguarding cases. The disrespectful treatment of older people in hospital was something to be managed, not confronted. This was the way of things: social workers knew that every agency was in the same boat.
However, this was not a failing authority; regulatory activity had not found it wanting. Relationships between social workers and their managers were good; staff and managers had been open to this research and to learning from it.
What was remarkable about this tacit acceptance of delays and lack of respect shown to older people was its very familiarity. Partnership working that is neither mandated nor funded – and adult safeguarding has no distinct legal framework – relies on cutting partners a bit of slack.
Rather than being dysfunctional, this lack of challenge had an internal logic. It may have done little for older people enduring their final months being sworn at by care home staff, but it reflected an uncritical accommodation with underfunding.
So what is to be done? Simply beseeching social workers to buck up and challenge poor practice ignores the organisational cultures they work in and managerial demands placed on them. Managers and elected councillors have their part to play in encouraging cultures of self-questioning in relation to safeguarding older people.
The codes of practice for social care workers and their employers lay obligations on both to uphold professional standards. These give some leverage to create organisational cultures where challenge to poor practice is not only expected, but welcomed.
Angie Ash is a registered social worker, Economic and Social Research Council research fellow [award PTA-026-27-2617] at Swansea University, and principal of consultancy Angela Ash Associates. This is a summary of her doctoral research, Street Level Implementation of Policy to Protect Elders from Abuse.
Tips for social workers
● Read your code of practice and that of your employer. You have a duty to report service shortfalls and bad practice to managers. Report it and ask for feedback.
● Challenge poor practice. If you can’t do that, write down what you saw or heard, report it, and ask for feedback. If you don’t get it, ask again, and go up the management line.
● Review safeguarding cases that go well as well as badly. Present these cases to your managers and your adult safeguarding board.
● Make sure they know the impact of the constraints you are under working with adults at risk.
● Don’t use partnership working as a reason not to challenge poor practice.
● If you’re uncomfortable about challenging high status people like doctors, talk to your manager. Get advice on how to do it effectively.
For more information email Angie Ash
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This article is published in the 31 March 2011 edition of Community Care under the headline “A culture of complicity”