Beacon Hill Training

“Where knowledge meets experience”

What Causes Abuse in Care Homes?

Abuse takes many forms and may occur in any care home whether it be a home for the elderly or for those with disabilities.  The process and the cycles of escalating abuse are identical.   Here are some examples of abuse:

Physical abuse: rough handling including hitting, shaking, misuse of medication (forcing or hiding medication in food), poisoning, restraint / confinement.

Fabricated and induced illness: when the symptoms of illness are deliberately induced causing illness or physical damage.

Sexual abuse: forcing to take part in sexual activities, rape and sexual assault or sexual acts to which the vulnerable adult has not consented,

Psychological / Emotional abuse: including shouting, swearing, frightening, ridiculing, name calling, blaming, withdrawal of emotional warmth, threats of harm or abandonment, deprivation of contact, humiliation,

Financial or material abuse: including theft, fraud, exploitation

Neglect and acts of omission: including ignoring basic medical or physical care needs, such as food, clothing and heating.

Discriminatory abuse: including racism, sexism, that based on a person’s disability.

A person may abuse or neglect a client by inflicting harm, or by failing to act to prevent harm (‘failure to protect’).

How does it start?

Abuse of clients starts slowly, no one goes into a role with the intention of becoming an abuser or to cause harm.   Often job dissatisfaction, stress, and negative working environments are the primary factors that lead to abuse occurring.    A ‘toxic’ environment will impact upon anyone coming into that environment, especially if the worker does not have a firm background and history of professional positive functioning to fall back on.  I have seen young, fresh and often idealistic workers become indoctrinated into negative ways of working, thinking and behaving and eventually mirroring poor or abusive practices.  In this case the newer or less experienced a worker the more likely they are to ‘mirror’ the work place culture and ‘normal’ practices.   People tend to try to fit in as best they can, they copy peoples humor and ways of behaving, it is no wonder that abusive practices occur.  Remember, when something becomes normal or is seen as normal it becomes acceptable

Abuse in an organization is like a disease, it is contagious and symptoms that start as mild will grow worse.

Often abusive situations grow over time and are often unintentional at first.  As the normal barriers of respect and behavioral norms break down, abusive behaviors become more likely. This may apply to the abuse of children or even someone caring for an elderly relative

The cycle of abuse

Abuse and neglect are, of course, intrinsically linked and the bonds between them are often blurred.

Often abuse begins slowly in a step-by-step sequential manner typically starting with poor communication and a genuine misunderstanding of others’ needs.  The service user becomes dehumanized and only basic needs are met.  Careless neglect occurs at this point, as the service user is not seen as truly human or deserving of respectful treatment.  Deliberate abuse often follows. 

Abuse starts in small ways, in small acts of disrespect, in poor practice.  Frustration and thoughtlessness are the catalysts for abuse and also the drivers that cause abusive practices to evolve.   The client is slowly de-humanized into a source of frustration and tasks to do, or seen as simply demanding, when all they require is effective care.  How often have we heard the phrase: ‘I’m not paid enough for this?’ this typifies the starting point for abuse developing.

As we can see on the diagram above the more times a pattern of care occurs the more it leads to poor practice in the future.   The more times it occurs the worse it gets, each time a cycle is repeated it makes poor practice seem more normal, the more normal it seems the less of a jump to ever lower standards.


Non reporting of abuse is a huge factor, typically only around 10 % of people speak out against their colleagues when the witness co-workers breaking the rules or acting incompetently, this 10% are typically those who consider themselves better valued and more content in their roles. 

The key factors of abuse

  • Lack of awareness / previous positive experience
  • Overloaded staff
  • Lack of effective training
  • A ‘toxic environment’ already existing in the work place
  • The ‘normalization’ of poor practice
  • Ambivalence / dehumanizing of the service user
  • Organizational culture
  • Friendships with colleagues overriding professional responsibility
  • Fear of repercussions
  • Ineffective procedures supervision and monitoring of staff

I hope this Blog was helpful.

Comments? Questions?