Care of the elderly


Abuse of elderly patients will not be prevented by ‘more of the same’ : inspections, checklists, threats of prosecution (Secret filming exposes elderly being slapped and taunted, Daily Telegraph, 30 April). The management structure needs to change. Managers can’t be everywhere, still less inspectors; so while many care workers treat patients with humanity, some who see it only as a poorly paid and sometimes unpleasant job will behave as we saw in the Panorama programme on 30 April when no one is looking. We can learn from experience in Australia. Professor John Braithwaite and colleagues, as the federal government’s consultants, threw out lengthy rule books; with management and unions, after talking to residents and staff, they agreed just thirty-one outcome standards. Performance against each standard was then evaluated by a conference of the inspection team and management to which representatives of owners, staff, residents and relatives were invited. Evaluation found that this regulatory regime improved both the quality of life for residents and compliance with the law. Inspectors who treated nursing homes with trust and used praise when improvements were made achieved higher compliance with standards two years later than those who did not. This restorative approach worked better than a punitive one, and could also give better results if applied here.

Note:  The information is taken from Professor Braithwaite’s book Restorative justice and responsive regulation, OUP 2002