Organizational dynamics of respect and elder care: Final report DoH Policy Research Programme 025/0054

This is a report of a study to examine the organisational dynamics associated with abuse, neglect and/or loss of dignity of older people being cared for in care homes. The report identifies the organisational factors associated with mistreatment and examines the ways in which these factors can interact to shape the provision of care and the care experiences of residents. A participative research approach was used in order to involve the people affected by the issues under study as active participants throughout the whole research process. The study draws on a quasi-systematic review of the literature and on data from a purposive sample of eight care homes in the East Anglia and North West regions of England. Among the factors underlying mistreatment in the care of older people the study highlights: the organisational infrastructure; management and procedures, including management of the workforce; inadequate skill mix, training and numbers of staff; resident population characteristics, including cognitive impairment and dementia; and combined factors, including organisational culture, isolation and changes from outside the organisation. The report also examines patterns of organisational dynamics grouped around key elements found to be important in the organisation of care. These include: team work; routines and work based norms; openness and relatives’ participation; meeting residents’ needs and skilful practice; care quality and responding to mistreatment; being resourceful; and feeling of ‘being at home’.