Elder abuse Understanding the real worlds of practitioners using policy to safeguard older people from mistreatment Paper given to IFA 11 th Global Conference on Ageing, Prague, 30 May 2012 Dr Angie Ash Economic & Social Research Council grant PTA

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)

Plan 1. 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. Lipskys Street- Level Bureaucracy

Lipskys 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

Lipskys 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.xii Angie 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 dont 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 Theres 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 dont 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 youd want, then probably the answer is no. Manager Angie Ash © 2012 Real worlds?

Angie Ash © 2012 Youve got somebody broken down at home, the carer cant possibly cope anymore, you're going to make a placement, it meets regulatory standards, its acceptable, but well … thats a very real world for people. Manager You calibrate whats acceptable to what you know … you operate in that real world. Manager Real worlds?

All this activity that goes on often doesnt 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, weve had contracts with individual people there for a long time … why dont we have a full picture of what its 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 Ash ESRC Research Fellow Centre for Innovative Ageing College of Human & Health Sciences Swansea University | Swansea SA2 8PP Wales | UK Economic & Social Research Council grant PTA

References Lipsky, 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),