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Elder abuse Understanding the ‘real worlds’ of
practitioners using policy to safeguard older people from mistreatment
Paper given to IFA 11th Global Conference on Ageing, Prague, 30 May 2012
Dr Angie AshEconomic & Social Research Council grant PTA-026-27-2617
UN Madrid International Plan of Action on Ageing, 2002, Article 5:
“ … We are determined to enhance the recognition of the dignity of older persons and to eliminate all forms of neglect, abuse and violence” (emphasis added)
Plan1. Outline findings of research in Wales,
UK, on safeguarding older people from mistreatment
2. Highlight some messages for policy & practice
Angie Ash © 2012
Research questions• What constraints and dilemmas are social
workers & their managers grappling with when they deal with potential elder mistreatment?
• What factors influence whether or not they use adult protection procedures?
Angie Ash © 2012
Lipsky, M (1980) Street-Level Bureaucracy. Dilemmas of the individual in public services. New York: Sage.
Lipsky’s Street- Level Bureaucracy
Lipsky’s Street-Level Bureaucracies “(to) understand how and why …
organizations often perform contrary to their own rules and goals, we need to know how the rules are experienced by workers in the organization and to what other pressures they are subject” (emphasis added) Lipsky 1980, p. xi.
Angie Ash © 2012
Lipsky’s Street-Level Bureaucracies • “ in important ways (policy) is actually made in
the crowded offices and daily encounters of street-level workers”
• “the decisions of street-level bureaucrats, the routines they establish, and the devices they invent to cope with uncertainties and work pressures, effectively become the public policies they carry out” (emphasis in the original).
Lipsky 1980, p.xiiAngie Ash © 2012
Case study - social services department
• Methods – interviews, focus groups, observed meetings– documentary & statistical analysis of adult
protection data• Information sources
– social workers, managers, adult protection staff– adult protection annual reports, meeting minutes,
implementation plans & activity data
Angie Ash © 2012
Findings• Low awareness of domestic abuse in older
age – “domestic violence grown old” (Straka & Montminy 2006)
“It tends to be much more domestic violence as being seen for younger people, perhaps older people tends to go down the POVA* route”. Team manager
*(protection of vulnerable adults)
• Resource shortfalls – quality/quantity, people/cash
Angie Ash © 2012
Findings• Health services dealings with older people
“… the way in which nurses speak to relatives and patients. I don’t mean niceties. It might be something like ‘I told her to sit down, so sit down and shut up’”. Social worker
• ‘Barely acceptable’ care homes “The whole place is an abuse”… Social worker
“There’s been all sorts of things down to people being fed slightly roughly or disrespectfully or people not having their teeth in”. Manager
Angie Ash © 2012
“I don’t think for a minute social workers would actually walk away from a situation they thought was abusive, but I do think if you said to social workers ‘are you content with where people are placed, is this the sort of quality of care you’d want’, then probably the answer is no”. Manager
Angie Ash © 2012
Real worlds?
Angie Ash © 2012
“You’ve got somebody broken down at home, the carer can’t possibly cope anymore, you're going to make a placement, it meets regulatory standards, it’s acceptable, but well … that’s a very real world for people”. Manager
“You calibrate what’s acceptable to what you know … you operate in that real world”. Manager
Real worlds?
“All this activity that goes on often doesn’t seem to get to the heart of how people are living and being cared for.
(When a report) throws up quite serious concerns about a place we think well hang on a minute, we’ve had contracts with individual people there for a long time … why don’t we have a full picture of what it’s like to live in a place where the people are subject to abuse?”
Manager
Angie Ash © 2012
Messages• Policy-makers: contexts & cultures shape
policy delivered to older people (Lipsky 1980)
• Managers: ask – again and again – for reports from staff of poor care to older people
• Practitioners: speak out about poor care. Tell people. Keep on, and on, until something is done.
Angie Ash © 2012
Dr Angie AshESRC Research Fellow
Centre for Innovative AgeingCollege of Human & Health Sciences
Swansea University | Swansea SA2 8PPWales | UK
Economic & Social Research Council grant PTA-026-27-2617
ReferencesLipsky, M. (1980). Street-level Bureaucracy. Dilemmas of the Individual in Public Services. New York: Russell Sage Foundation.
Straka, S. M., & Montminy, L. (2006). Responding to the Needs of Older Women Experiencing Domestic Violence. Violence Against Women, 12(3), 251-267.
