It is comforting to assume that those who neglect and abuse vulnerable people are themselves bad people. Better that than acknowledge they are the same as you and me and that given a certain set of circumstances we are all capable of the indifference recently revealed to be widespread in the care of elderly hospital patients.
A few bad apples can be removed and better recruitment and supervision could identify the “wrong uns” at an early stage. So why is abuse and neglect of people with a learning disability and older people such a recurring problem?
Neglect and abuse persists despite recruitment practises aimed at selecting people who have a positive attitude to old age. Bad practise and indifference to the discomfort of individuals continues despite renewed emphasis on supervision.
We should acknowledge that the problem is not simply one or two bad people. We need to recognise that disciplining and dismissing the worst offenders and providing more training for the rest won’t stop abuse and neglect from happening if the causes lie outside of the individual.
Of course we should dismiss those who are found to carry out their duties inadequately but we know this is just the tip of the iceberg. Those who shout or swear at a patient for being incontinent, or steal their money and valuables, or bruise them through rough handling are easily identified and dealt with.
But neglect and indifference is subtler than this: it is ignoring requests for assistance so that the individual soils or wets themselves, it is putting off cleaning them up in the hope that it can be left to someone on the next shift. It’s making the individual feel that they are being a nuisance with their requests for a drink or to be helped sit up when you are so busy. It is giving a patient a bath whilst carrying on a conversation with a colleague as if you were washing a car not a person as you share what you did last night and what you are having for tea later.
This is the real problem - the staff group as a whole stop seeing patients as individuals. They are just another incontinent, confused, feeble body that needs washing, feeding and toileting. The way things get done is organised to make life easier for the overworked under-resourced staff. The good patient is the one who places no demands on staff but is grateful for any help, the good patient is cooperative and cheerful.
It is the group who decides how things are done, not management, who are considered distant and out of touch. Educating the group is as important as identifying underperforming individuals if the record in elderly care is to turn around.