Ever wondered what listening to your favourite radio station has to do with the abuse of vulnerable adults?

When you think of the abuse of vulnerable adults what comes to mind? For many people it’s the deliberate mistreatment of elderly or “at risk” individuals. Most of us think vulnerable adult abuse happens when a vulnerable adult or older person is hurt, bullied, mistreated, exploited or neglected. The abuse can come from anyone who has contact with the person, including practitioners, professionals, private carers or even family or friends.

“The government has ordered a review of the Care Quality Commission’s (CQC) failure to investigate a whistleblower’s account of the systematic abuse that left vulnerable people to face months of physical and verbal abuse at a Bristol care home. Paul Burstow, the social care minister, has asked the regulator to investigate similar services to the Winterbourne View unit, in Hambrook, near Bristol, where a culture of abuse prevailed despite tip-offs from staff and repeated inspections – the role of the CQC, which is the sector regulator, and the local authority.”


With recent events including the Panorama programme on the Winterbourne View Unit, the report on the care of older people in NHS hospitals, Southern Cross and the CQC the abuse and neglect of vulnerable adults has, at last, become a topic of major concern.

These investigations have rightly shocked and appalled us, as they give a rare glimpse into what happens “behind closed doors” in some places where vulnerable adults are supposed to be safe and cared for. Many of us were horrified at the conduct of some of the staff who were responsible for caring for the most defenceless in our society.

But how does a care establishment become like Winterbourne View, where a culture has developed that acquiesces in poor standards of care, and where the pecking order of staff determines whether or not anyone feels able to speak out against the abuse that they see?

How does a staff team operate when there is only contempt for the people who are in effect their customers?

Institutional abuse needs certain conditions in which to become established practice.  It is sometimes easy to forget that not all cases of abuse are intentional. Abuse can happen because the people looking after a vulnerable adult don’t have the appropriate training or knowledge. For example, a friend or family member may, while trying to help a vulnerable adult, bruise them because they haven’t been shown how to help them up from a chair.  Or a member of staff may be unaware that Alzheimer’s disease can often lead to dehydration because sufferers simply forget to drink enough water each day, and should have their fluid intake monitored.

Vulnerable adults may need more time to walk from one room to another, or may have fixed ideas about when they want to eat and what food they would like. Anyone who has contact with a vulnerable adult may unintentionally cause distress by not allowing them enough time to complete a task or by not finding out about their likes and dislikes.

“A huge increase in drug prescriptions supports fears that thousands of people in nursing and residential homes are being sedated for no medical reason.  A report claims as many as 88,000 pensioners are being kept under a ‘chemical cosh’ ., . . .  and stripped of their dignity simply to make life easier for their carers.  Drawn up by MP Paul Burstow, the report cites research suggesting that 10 per cent of residents in care homes have psychotic symptoms, such as hallucinations and paranoia, yet around 30 per cent are regularly given medication for them.  It says: ‘Projecting from research in the UK and abroad, it can be shown that over 35,000 elderly people in nursing homes and up to 53,000 in residential homes are being given anti-psychotics inappropriately.”


Institutional Abuse

Institutional abuse is repeated instances of poor care of individuals or groups of individuals. It can be through neglect or poor professional practice as a result of structures, policies, processes and practices within an organisation.

It can occur in any setting where one or more service users receive a service, whether on a daily or residential basis, for example a care home, a day services centre, a hospital ward or a person’s own home. The service may not meet the necessary professional standards or there is a need for further training or the development of a more caring and person centred approach.

It is essential that individual staff within an organisation take responsibility for recognising and dealing with institutional abuse and do not accept poor standards as something that cannot be challenged or changed.

Possible personal indicators of institutional abuse

  • Inappropriate approaches to continence issues such as toileting ‘by the clock’ as opposed to when a person wishes to go to the toilet
  • Set times for refreshments with no opportunity to have a snack, or to make alternative arrangements outside these hours
  • No evidence of care plans that focus on an individual’s needs
  • Staff not following care plans when they are in place
  • Lack of privacy, for example a failure to close doors when attending to a person’s personal care needs
  • Failure to knock on a door before entering, for example a bedroom or bathroom
  • No access to personal possessions or personal allowance
  • Failure to promote or support a person’s spiritual or cultural beliefs
  • A culture of treating ‘everyone the same’ which is different from treating everyone ‘equally’
  • A couple being prevented from living together
  • Abuse of medication
  • Dehumanising language
  • Infantilising older people – speaking to or treating them like a child
  • Locking people in their rooms


Possible cultural and management indicators of institutional abuse

There are ways in which an organisation can be run that lead to practices which, if left unaddressed, can contribute to an environment where abuse is tolerated. These indicators may be contributory factors of institutional abuse in a care setting but do not always lead to abuse.

  • The absence of a clear complaints process
  • The absence of an Equal Opportunities policy
  • Failure to promote advocacy when it is locally available
  • Inadequate staff training and supervision
  • Premises that are regularly understaffed
  • Inflexible visiting procedures
  • A culture of interaction between staff that habitually runs counter to recognised best practice
  • High staff turnover
  • Low staff morale

Institutional abuse can begin with simply “taking over” a resident’s personal space and choice by listening to a radio or TV programme that is more enjoyable for you, makes the shift go faster, and takes the focus away from the fact that you are in someone else’s home doing a job.

Institutional abuse can begin with giving a resident who needs assistance with feeding cold or lukewarm food because you can’t be bothered to warm it in the microwave to make it palatable.

Institutional abuse can begin with putting residents in their pyjamas after tea so that your jobs are done and you can focus on going home at the end of the shift.

Institutional abuse can begin by assuming that a vulnerable adult doesn’t need to have regular dental check ups.

Institutional abuse can begin with assuming that vulnerable adults cannot hear or understand when you chat with colleagues whilst carrying out care duties.

Institutional abuse can begin with low staff motivation and morale.

Institutional abuse can begin with simply switching the radio from Radio Two to Radio One. Or the TV from Coronation Street to Eastenders.

What will your staff be listening to tonight?

[cta]The Athena Programme is a team of experienced professionals specialising in safeguarding with care and creativity.  Our goal is to help people protect children, young people and vulnerable adults and to make organisations, staff and working environments safer by providing training and consultancy that is dynamic, inclusive and relevant.

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