Staff shortages, low wages and poor training are increasing the risks of vulnerable adults being abused in care homes according to a Community Care/CareTech survey.
More than two thirds of the 220 survey respondents, which included social workers and care home managers, agreed that insufficient numbers of care staff undermined safeguarding practice.
Other significant factors were felt to be a failure to recruit the right staff in care homes and closed cultures that discouraged whistleblowing.
A senior social worker, who responded to the survey, said: “I’ve found that most issues occur when there are too few staff, especially overnight. A care home, when whistleblowed in this area, was more concerned with who blew the whistle than what it was about.”
‘A serious lack of staff’
A care home worker commented: “I have only been working in care for two months but already I can see there is a serious lack of staff to cope with the needs and demands of the residents. Why do management have the responsibility of assessing resident needs to staff ratios? In my experience this is always underestimated.”
Training of staff was also a key issue, not only with how to deal with ‘challenging behaviour’ from residents but also around some of the legislation on safeguarding vulnerable adults.
A care home manager, who responded, said: “Local authorities have paid too little attention to the care of older people and 60% of staff working with them lack knowledge and ability to recognise a safeguarding issue regardless of how much training they have had.”
Martin Green, chief executive of the English Community Care Association, agreed more training was needed. He said directors of adult social services were responsible for all the workforce in their area not just those directly employed by the council and therefore had a role as a major training provider.
High-quality training needed
“However, there’s also an issue that plenty of training already goes on but very little evaluation is done on how effective the training has been. It’s not just about training or its availability, it’s about high quality training.”
Mike Briggs, joint chair of the adult safeguarding network group for the Association of Directors of Adult Social Services (Adass), agreed care home staff needed more and better training, but said local authorities were already paying for it as part of the fee paid to care homes.
“When you are buying a service you are buying a service that should meet Care Quality Commission (CQC) standards and the staff are trained and skilled to deliver that service,” added Briggs.
However many survey respondents pointed out that current staff shortages and poor skills could not be separated from the squeeze on fees by local authorities.
‘Society does not value the care industry’
Briggs said the economics were more complicated than that. “I think it goes much higher than that. Society in general does not value the care industry or those who work in it as evidenced by the amount of resourcing for it.”
However, he agreed there were serious issues around the “legal literacy” of those working in the industry when it came to safeguarding and directors did need to focus on it.
Gary Fitzgerald, chief executive of Action on Elder Abuse, said current legislation, particularly around the Deprivation of Liberty Safeguards (Dols), was difficult for care home staff and managers to understand.
“People are struggling to make a Dols application or even understand if what they are doing is a Dols issue or not.”
There was strong support among survey respondents for a tougher line from the Care Quality Commission on safeguarding issues.
CQC ‘must take tougher line’
Respondents overwhelmingly supported the idea of more frequent inspections, more specialist inspectors and more enforcement action against care homes. There was also strong support (87%) for the introduction of an offence of corporate neglect for managers of services where abuse or neglect was found. More than a third felt the number of perpetrators prosecuted for alleged abuse and neglect was much too low.
Andrea Sutcliffe, the CQC’s new chief inspector for adult social care, said she was pleased there was support for their proposal to have more specialist inspectors.
“In future, CQC, will be tougher, more responsive and more consistent. Where appropriate, we will not hesitate to take action.”
However Stewart Wallace, strategic director of care and support provider CareTech, which sponsored the survey, said the new tough approach was also uncovering another issue the sector and the CQC would need to grapple with.
“Many disgruntled members of staff who don’t want to be managed are increasingly using the whistleblowing powers around safeguarding to blight the careers of those managers making efforts to improve services.”
He said everything stopped once an allegation was made and the assumption was always that the whistleblower was right “which really goes against the laws of natural justice”.
“It’s a conundrum and I don’t know what the answer is because obviously we need whistleblowing powers in place for those times when a serious issue is uncovered but we also need to protect our staff and managers.”
Improve your safeguarding practice
For practice advice, expert presentation and the change to network with your peers, book your place on Community Care’s forthcoming conference on safeguarding adults in care homes and hospitals. It takes place on 4 December in Birmingham.