Commissioning care homes: common safeguarding challenges
Underlying causes – Dehumanisation
People using care services often report the experience of being treated in a way that is 'less than human' or 'dehumanising'. Research has examined the way in which workers can distance themselves from, and fail to show empathy towards, the people they support. 'The tendency to view a patient as less than human has been identified with a need to defend oneself against the anxiety that their condition provokes' (Menzies 1977). Wardhaugh and Wilding (1993) referred to the concept as 'neutralisation of moral concerns'. This can 'place residents beyond the bounds of normal, acceptable behaviour, allowing abusive behaviours to be justified and perceived as legitimate' (Marsland et al. 2007). This issue has been closely related to the concept of 'burnout'. Workers who feel that they put more into the job than they get out are more likely to detach themselves emotionally from their work (Thomas and Rose 2009; Rai 2010).
Institutionalisation can also lead to dehumanisation as the regimes and routines of the home are placed above the needs of individuals. (Institutionalised care). Dehumanisation can be experienced in a number of different ways including being:
- discriminated against or treated differently to others
- isolated, dismissed or ignored
- disrespected, mocked or belittled
- deprived of dignity and privacy
- deprived of choice and control
- stripped of one's identity
- deprived of basic needs (e.g. food)
- abused physically, sexually or in any other way.
- Staff are respectful towards residents, treating them as individuals, promoting choice and upholding their rights.
- Staff are respected and valued.
- Residents participate in staff training and exercises that encourage empathy are included.
- The home offers person-centred care and promotes dignity for all, including those who lack capacity or have problems with communicating their needs.
- Staff are encouraged to get to know residents, their preferences and their personal histories.
- Staff work in close partnership with residents' friends and family.
- Residents are encouraged to make a 'life story book'.
- Particular effort is made to ensure that people who lack capacity or have problems with communicating are treated as individuals and every effort is made to ascertain their wishes.