Organizational dynamics of respect and elder care

Problem: Mistreatment of older people cared for in care homes is a global and persistent concern that has tended to be examined at the level of individuals. However this focus draws attention away from understandings of how and why mistreatment may arise, despite the best intentions of staff and managers of care homes.

Aim: To examine the organizational dynamics associated with abuse, neglect and/or loss of dignity of older people cared for in care homes.

Research approach: This study combined participatory research approaches with ethnographic case study. A scoping review informed collection of ethnographic data from a purposive sample of eight care homes in East and North England varying in size and provider type. Comparative case study methodology (Eisendhardt and Graebnor, 2007) was used to examine the organization of care in these homes, focusing on organizational factors, care practices and experiences of providing and receiving care.

Findings: Organizational dynamics may include external factors beyond the control of staff and residents and can lead to a) care that is inconsistent at different times or places in a home or b) entrenchment of practices in
routines, norms and organizational cultures. Both poor care and good care may remain hidden. Contrastingly interaction of organizational factors can contribute to robust systems responding positively to challenges.

Implications: Inspectors, managers and care staff need to better identify institutional abuse and quality assurance processes need to consider organizational dynamics in care homes. A resource to support the
identification of organizational dynamics within care homes is proposed.

This paper is based on a research study funded by the Department of Health and Comic Relief. The views expressed in this paper are not necessarily the views of the Department of Health or Comic Relief.