Neglect most common in care homes with high rates of staff burnout

Neglect is widespread in care homes in England where staff are under huge amounts of pressure, unable to offer person-centred care, according to researchers.

The study by University College London (UCL) surveyed care home staff and asked them about positive and negative behaviour they had witnessed or done themselves.

The most common negative behaviours were: making a resident wait for care (26 per cent of staff reported that happening); avoiding a resident with challenging behaviour (25 per cent); giving residents insufficient time for food (19 per cent); and taking insufficient care when moving residents (11 per cent).

Five per cent of staff reported verbal abuse and just over one per cent reported physical abuse. Dr Claudia Cooper (UCL Psychiatry), the study’s lead author, said: “We found low rates of verbal and physical abuse; the abusive behaviours reported were largely matters of neglect.

“These behaviours were most common in care homes that also had high rates of staff burnout, which suggests it’s a consequence of staff who are under pressure and unable to provide the level of care they would like to offer.”

The researchers questioned 1,544 staff from 92 care homes in England and the report was published in PLOS ONE.

More than one in three care home staff were rarely aware of a resident being taken outside of the home for their enjoyment, and 15 per cent said activities were almost never planned around a resident’s interests.

“Most care homes, and their staff, strive to provide person-centred care, meaning that care is designed around a person’s needs, which requires getting to know the resident and their desires and values. But due to resources and organisational realities, care can often become more task-focused, despite intentions and aspirations to deliver person-centred care,” said co-author Dr Penny Rapaport (UCL Psychiatry).

“Carers can’t just be told that care should be person-centred – they need to be given the support and training that will enable them to deliver it,” she said.

The study is part of the UCL MARQUE cohort study, which is also looking into cost-effective interventions to improve the quality of care for people with dementia, and will be using this anonymous reporting as a measure of how well training interventions are working.

The majority of people in care homes have dementia, which can trigger agitated behaviour such as pacing, shouting or lashing out. This can make caring for people with dementia very challenging.

“With the right training, care home staff may be able to deliver more effective care that doesn’t need to be more expensive or time-consuming. If they understand and know how to respond to behaviour, they may be able to do more without greater resources,” said the study’s senior author, Professor Gill Livingston (UCL Psychiatry).

Dr Doug Brown, chief policy and research officer at Alzheimer’s Society, called it “upsetting but unsurprising that abusive behaviours were more common in homes with higher staff burnout”. He added: “We’ve heard through our helpline of people with dementia not being fed, or not getting the drugs they need, because a carer isn’t properly trained, or a care home is too short-staffed.

“By 2021, a million people in the UK will have dementia. The Government must act now, with meaningful investment and reform, or we risk the system collapsing completely and people with dementia continuing to suffer needlessly.”

The study was conducted by researchers at UCL and the Camden and Islington NHS Foundation Trust, and funded by the Economic and Social Research Council and the National Institute for Health Research.