Let residents speak out

How can I empower a resident to speak out?

This question came from a deputy manager in a residential unit
for older people. One evening he was putting residents to bed
because they were short of staff. A male resident said as he was
being put into bed: “I’m glad it is you. Some of the staff
here are so rough with me. They don’t care. They don’t
take time with you or talk to you.”

The deputy manager tried to gain more information about this.
The resident mentioned two particular members of staff, but refused
to give their names “because I have to live here and they have to
put me to bed. You’re not here every night”.

The deputy manager said he felt powerless to do anything,
because the resident would not say anything more. Also he had
thought that currently there was “quite a good staff group”.

This is a very common scenario. Do we ever really know what is
going on between staff and residents? We like to think we do and we
have systems in place to monitor practices.

However, there are going to be many situations like the one
described that remain hidden. Residents are sometimes scared to
speak out as they are fearful of the repercussions.

The deputy manager should not ignore the situation. Once the
resident has started to say something, it may be that he will
disclose more given the right support.

It is important to point out to him that it is not right that he
is being treated in this way. Rough handling could be seen as bad
practice or abuse.

Neither should the emotional harm to the resident be minimised.
It may be difficult to measure emotional damage, but it is
necessary to consider and work with the long-term effects on the
resident.

Many older people become resigned to their situation. They feel
that whatever is happening to them is their “lot in life”. This is
where empowerment work is so vital. It is important to build the
resident’s self-esteem so that he or she feels valued and
that life is worthwhile. The resident needs to see that there can
be objectives to strive for in the future. Being in residential
care should not be seen as the end.

Empowerment work should be incorporated into the care plans. If
a resident does not have support from family or friends, it is
important to find a befriender or advocate, so that he or she does
not become isolated and may have support from “outside” if he
chooses to speak out.

So what about the staff? The deputy manager does not know who
the resident is referring to and admitted he felt unsure about how
to raise the issue. It must be addressed otherwise bad practices
will continue.

Supervision sessions or staff meetings could be used to discuss
current practices. However, this problem could have been
prevented.

Managers in all residential units should think about the
following issues.

• Recruitment of staff. Many homes are short of staff and have
  high staff turnover. Consequently, the recruitment process may not
  always be as rigorous as it should be. Quality rather than quantity
  should be the priority. Staff should want to do the work, not just
  see it as “a job”.
• New and established staff need ongoing training about good
  practice in caring for older people. NVQ training can help staff
  with their practice, but there can still be a need for specialised
  training such as care practices to meet physical needs, how to meet
  the emotional needs of older people, how to communicate
  appropriately, and ageism.
• How to make it safe for residents to speak out. Complaints
  procedures can be in place, but management must strive to ensure
  that a resident will not be victimised.

Managers need to be pro-active in thinking about prevention
rather than just responding to a problem.

Jacki Pritchard is an independent consultant.