International Psychogeriatrics

Research Article

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

Claudia Coopera1 c1, Briony Dowa2, Susan Haya3, Deborah Livingstona1 and Gill Livingstona1

a1 UCL Mental Health Sciences Unit, University College London (UCL), London W1W 7EJ, UK

a2 National Aging Research Institute, Royal Melbourne Hospital, and Departments of Psychiatry and Social Work, University of Melbourne, Victoria, Australia

a3 Department of Psychiatry, Barnet, Haringey and Enfield Mental Health Trust, St. Anns Hospital, London N15 3TH, UK


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.

Method: 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.

Conclusion: 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.

(Received October 16 2012)

(Reviewed November 09 2012)

(Revised November 28 2012)

(Accepted November 30 2012)

(Online publication January 07 2013)

Key words:

  • dementia;
  • care home;
  • qualitative;
  • elder abuse;
  • instrument


c1 Correspondence should be addressed to: Claudia Cooper, Senior Clinical Lecturer in Old Age Psychiatry, Department of Mental Health Sciences, UCL, 67-73 Riding House Street, 2nd Floor, Charles Bell House, London W1W 7EJ, UK. Phone: +020 7288 4351; Fax: +020 7288 3411. Email: