title: Care workers' abusive behavior to residents in care homes: a qualitative study of types of abuse, barriers, and facilitators to good care and development of an instrument for reporting of abuse anonymously.
abstract: BACKGROUND
  Elder abuse in care homes is probably common but inherently difficult to detect. We developed the first questionnaire to ask care home workers to report abuse anonymously.
  
  
  METHODS
  We held qualitative focus groups with 36 care workers from four London care homes, asking about abuse they had witnessed or perpetrated.
  
  
  RESULTS
  The participants reported that situations with potentially abusive consequences were a common occurrence, but deliberate abuse was rare. Residents waited too long for personal care, or were denied care they needed to ensure they had enough to eat, were moved safely, or were not emotionally neglected. Some care workers acted in potentially abusive ways because they did not know of a better strategy or understand the resident's illness; care workers made threats to coerce residents to accept care, or restrained them; a resident at high risk of falls was required to walk as care workers thought otherwise he would forget the skill. Most care workers said that they would be willing to report abuse anonymously. Care workers were sent the newly developed Care Home Conflict Scale to comment on but not to complete and to report whether it was acceptable and relevant to them. Several completed it and reported abusive behavior.
  
  
  CONCLUSIONS
  Lack of resources, especially care worker time and knowledge about managing challenging behavior and dementia were judged to underlie much of the abuse described. We describe the first instrument designed to measure abuse by care home workers anonymously; field-testing is the logical next step.
authors.affiliation: UCL Mental Health Sciences Unit, University College London (UCL), London W1W 7EJ, UK. c.cooper@ucl.ac.uk
authors.forename: Claudia
authors.initials: C
authors.lastname: Cooper
authors.forename: Briony
authors.initials: B
authors.lastname: Dow
authors.forename: Susan
authors.initials: S
authors.lastname: Hay
authors.forename: Deborah
authors.initials: D
authors.lastname: Livingston
authors.forename: Gill
authors.initials: G
authors.lastname: Livingston
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D017028:Caregivers / Q000523:psychology; D004552:Elder Abuse / Q000175:diagnosis* / Q000706:statistics & numerical data; D017144:Focus Groups; D006282:Health Personnel / Q000523:psychology*; D006707:Homes for the Aged / Q000458:organization & administration*; D006801:Humans; D008131:London; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes / Q000458:organization & administration*; D011594:Psychometrics; D036301:Qualitative Research; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires