Elder Crimes of the Law Abiding: Backwards Dresses, Covered Up Messes, and Nursing Homes

status within the walls of facilities (Miller, 2017). This article uses data from 75 biographies, autobiographies, and research monographs to explore law abiding crime in care homes. It gives a brief history of elder care in the UK and US, followed by a review of structural ritualization theory (SRT). Findings concentrate on how bureaucratic dynamics worsen care in nursing homes and specifically how they influence a standard that physical maltreatment is an accepted, typical part of organizational life. ABSTRACT This article uses data from 75 biographies, autobiographies, and research monographs on nursing homes to explore physical neglect and abuse. Linked to crimes of the law abiding concepts, it implies employees see maltreat ment as “normal.” It extends lines of research examining bureaucratic forces and their influence on nursing homes. It also provides a history of elder care in the UK and US and a review of structural ritualization theory. Findings concentrate on how rituals involving hierarchical structure, work efficiency, documentation, and rules adversely influence care homes. This includes physical maltreatment involving employee neglect of personal needs of residents, failing to provide medical help, bodily harm, and not maintaining quality living spaces.


INTRODUCTION
One in three US nursing home residents experience elder abuse, and in the UK, 44 percent of senior maltreatment cases occur in care homes (BBC, 2013;Castle, Ferguson-Rome, and Teresi, 2013). Recently, New Yorker Cherrylee Young punched a resident causing him to fall on a piece of metal, which killed him (NBC, 2014). Karen Pedley of Carharrack, Cornwall, set a 96-year-old resident on fire (BBC, 2016). These cases are atypical. Most institutional abuse involves taken-for-granted work rituals that facilitate "crimes of everyday life" (Karstedt andFarrall, 2006:1011). Around 40 percent of nursing home employees have observed pushing, grabbing, shoving, kicking, and inappropriate feeding (Hillier and Barrow, 2015). Add other cases employees know of, and the number is 93 percent (Payne and Gainey, 2005). Weber (1921Weber ( /1968) predicted organizational dominance a century ago. He expressed concern with bureaucracy's impersonal interaction, rules, documentation, and hierarchy. Modern research reflects his trepidation (Griffin and Spillane, 2016;Linstead, Marechal, and Griffin, 2014;Ritzer, 2015;Vaughn, 1999). Everyday crimes of the law abiding relate (Karstedt and Farrall, 2006). These are morally dubious actions not always formally illegal, committed by people in traditionally reputable careers. Nursing home maltreatment applies. It is widespread, underreported, and often fails to carry deviant status within the walls of facilities (Miller, 2017). This article uses data from 75 biographies, autobiographies, and research monographs to explore law abiding crime in care homes. It gives a brief history of elder care in the UK and US, followed by a review of structural ritualization theory (SRT). Findings concentrate on how bureaucratic dynamics worsen care in nursing homes and specifically how they influence a standard that physical maltreatment is an accepted, typical part of organizational life. and personal actions with symbolic meaning. They can involve non-criminal and criminal practices (Knottnerus, 1997).
Repetitiveness, salience, homologousness, and resources are pertinent. Repetitiveness is "relative frequency with which a RSP is performed" (Knottnerus, 1997:262). Consider variation by setting -home versus work setting or that some rituals occur multiple times per day. Salience is the "degree to which a RSP is perceived to be central to an act, action sequence, or bundle of interrelated acts" (Knottnerus, 1997:262). Homologousness is "perceived similarity among different RSPs" (Knottnerus, 1997:263). Different RSPs exist, but if similar they fortify each other. Resources are "materials needed to engage in RSPs which are available to actors" (Knottnerus, 1997:264). With certain resources, higher likelihood of RSP involvement exists. Resources involve time, clothing, money, or any other physical items, but also traits like intellect or physical ability (Knottnerus, 2011). Rank concerns "standing of a RSP in terms of its dominance" (Knottnerus, 1997:266). High rank, and a bigger impact, exists when a RSP has repetition, is important, similar to other RSPs, and actors have resources to engage in it (Knottnerus, 2011). Consider Enron.
As a corporation, Enron created an "invisible foundation" of moral standards (Karstedt andFarrall, 2006:1013). In reality, rituals involving risk, personal gratification, excessive pride, and the use of fictional imagery, along with unethical actions, characterized it. These RSPs happened often, were similar, and overlapped. Acknowledging intelligence as a key resource, employees regularly lied to customers. They received monetary benefits for it and tricked themselves into believing failure was impossible. Framing their actions in terms of fictional anti-heroes helped them normalize illicit behavior .
Lanier and DeVall (2017) believe certain RSPs elevate success in drug treatment programs. Ricciardelli and Memarpour (2016) argue prison inmates create RSPs to manage objectification (see also Bottoms, 1999). Correctional officers do too. Pressured to follow bureaucratic standards, they self objectify and subsequently engage in policy violations to manage work stress (Memarpour and Ricciardelli, 2015). Ulsperger and Knottnerus (2009;2011) suggest elder care employees participate in emotional and verbal abuse due to bureaucracy. This article adds to these studies with a "crimes of the law abiding" perspective.

RESEARCH METHODS
Studying organizational criminal behavior is problematic. Distrust of outsiders and observation effects alter behavior. In turn, qualitative researchers analyze documents reflecting actor experiences with techniques such as literary ethnography (Copes, 2012). A literary ethnography involves systematic, intensive reading of literary texts for a composite portrait of social phenomena. It involves six stages. Researchers identify a scope of multiple sources, read and interpret them, identify themes, classify themes, develop applicable analytic constructs, and finally reread sources for confirmation (Van de Poel- Knottnerus and Knottnerus, 1994). Researchers can examine novels, short stories, plays, fictionalized autobiographies, biographies, autobiographies, memoirs, and diaries. Analysis of meeting records and community reports is possible. Logbooks and conversation records are other options (see Lowenthal, 1989). Content analysis parallels exist, but there are differences. Literary ethnography has required steps and emphasizes sources such as biographies. Moreover, content analysis is a broad label for communication examination. Literary ethnographies focus on written works (Hodder, 1994). Literary ethnographies are also different from meta-analysis ethnographies, which start with a focus on specific issues (Noblit and Hare, 1988). Literary ethnographies start with documents generally related to a topic, and subsequently streamline focus. They are also distinct because they move beyond surface level quantification and provide multiple interpretations of reality (Reid, 2016).

Analyzing Bureaucracy
Building on previous literature (see Ulsperger and Knottnerus, 2011), we found autobiographies, biographies, and research monographs ranging from 1963 to 2017 (n = 75). Fifty six percent came before the year 2000, and 44 percent after (see Appendix). Sources included works like Shield's (1988) Uneasy Endings and Diamond's (1995) Making Gray Gold. More recent materials like Sheard's (2016) Caring proved beneficial. We analyzed UK sources like Kayser-Jones' (1981) classic Old, Alone, and Neglected, with contemporary works like 'It Makes Me Feel that I'm Still Relevant' (Hall et al., 2012).
After initially adjusting to the materials by reading samples, discussions occurred on coding. Each researcher then deeply read sources independently while coding content. Considering Weber's (1921Weber's ( /1968) work and SRT, we grouped and applied the themes loosely at first. Each researcher made typed notes. This provided the ability to easily back up files and search for themes. This led to broad themes involving general social dynamics, work patterns, and maltreatment. We then coded specific themes to subdivisions with the aforementioned constructs of bureaucracy and SRTsee Table 1.
Bureaucratic RSPs were any aspect of the social environment and its processes involving staff separation and hierarchy, rules, documentation, and efficiency. Staff separation and hierarchy involved ritual dividing lines between employees. Rituals of rules involved references to official regulation on completing tasks. Documentation concerned recording aspects of care home life in written form. Efficiency involved demands for effective quickness. We used an open subdivision of "other" for late emerging themes. To rank bureaucratic RSPs, we focused on repetitiveness and salience. We used paragraphs and larger grammatical recording units, like book chapter portions. With our enumeration, each unit represented a RSP. We counted occurrences of RSPs to measure frequency. Not all units carried the same weight, so we also considered stated intensity to gauge salience. grouped the themes and methodically tracked them -see Table 2. We included any act of personal negligence, medical dereliction, bodily harm, or environmental negligence. Personal negligence concerned staff not providing resident upkeep, including clothing and personal hygiene. Medical dereliction involved not delivering medicine and services. This included using pharmaceuticals primarily to control a resident. Bodily harm incorporated actual physical abuse by staff toward residents and excessive restraint use. Environmental negligence related to employees not maintaining living areas, recreational rooms, kitchens, and facility grounds. We again tracked an "other" subdivision.

Intercoder Reliability
Again, early on researchers read large samples and collectively discussed categorization. We started with three researchers reading and interpreting sources. We then decided to have two researchers identify and classify themes, which gave the ability to develop a Cohen's kappa for agreement levels (Armstrong et al., 1997;McHugh, 2012). This value is easy to acquire when classifying objective, nominal data. However, literary ethnography focuses on latent, complex meaning. This was not conducive to Cohen's kappa (see Paul and Birzer, 2017). Avoiding circuitousness, we shifted to percentage agreement (Lombard, Snyder-Duch, and Bracken, 2002). Two researchers continued to read and code until an acceptable average of agreement existed. With disagreements, discussions with the third researcher produced case placement. We checked for intercoder reliability again during the final contextual confirmation. This involved rereading data samples for inconsistencies. To aid in trustworthiness, we discussed findings with others interested in nursing home issues, including resident's family members. This ensured the findings gelled with non-scholarly perceptions (for more see Ulsperger, 2009).

Limitations
An inability to test causal relationships quantitatively existed. In addition, we relied on prerecorded information and did not have the ability to follow up with people. The researchers' interpretive process may not reflect the totality of circumstances. As implied earlier, focusing on themes and constructs, some predefined, can also bias findings (Berg and Lune, 2017).

RESULTS AND DISCUSSION Bureaucratization
We found 2,699 references to bureaucracy. Sources discuss RSPs of staff separation and hierarchy 974 times (36.1 percent), rule-based RSPs 647 times (23.9 percent), and documentation 575 times (21.3 percent). They reference efficiency rituals 326 times (12.1 percent). The "other" subdivision has 177 references (6.6 percent). RSPs of staff separation have high repetitiveness and salience. Shield (1988) and McLean (2007) (Gaffney, 2012), but also have boundaries. With one source, residents looked forward to coffee. The activity director served it. Avoiding the area where the activity director served it, some residents stayed in their rooms and asked aides to bring them coffee. Aides, believing it was not their responsibility, would not serve it (Kayser-Jones, 1981). Similarly, prescribing medications is a physician's duty while nurses administer them. Aides sometimes question the drugs given, but nurses often dismiss concerns believing aides lack adequate knowledge (Dwyer et al., 2010). An aide notes in one source that she knows residents are getting the wrong drugs, but "if you've got no training you cannot interfere" (Hantikainen andKappeli, 2000:1201).
We found a lower frequency of rule-related RSPs compared to staff separation. The quantity discovered still reflects a substantial amount and reveals salience. In one source, an aide indicates the abundance of rules leads to goal displacement arguing that rules become more important than providing benevolent care (Gass, 2004). In one source, residents even complain about "too many rules, regulations and routines" (Brandburg et al., 2013). In another, a resident states with so many regulations, "I feel so strangled here" (Howsden, 1981:144). Moreover, more rules always emerge. Foner (1994:68) points out, "A seemingly endless onslaught of new rules affected even the smallest details of work life. One day aides could wear jewelry to work; the next, after a memo went out, only watches, engagement and wedding rings." Rules not part of official policy are a result of wider organizational regulations (Bresser and Millonig, 2003). This occurs for a variety of reasons, including practicality. Karstedt andFarrall (2006:1017) argue, "Too many rules and regulations decrease the legitimacy of norms and moral obligations, and create incentives for all to circumvent such obligations. To get things done citizens revert to illegal practices to cut red tape, which they deem justified…" In nursing homes, employees have unofficial decrees (Sandvoll, Kristofffersen, and Hauge, 2012). Gass (2004:57-58) points out that to move a resident a three employee requirement exists, but: We are routinely in violation of what we are told we must do… To get three aides together I must search for my partner, if I have one that day, and then walk a hundred feet or so over to another hall to recruit a willing and available aide. Now multiply this by the number of times each day that Bud may need to be toileted, changed, or bathed… While all of this is happening, someone on my hall is sitting in excrement, clamoring for a bath, or fighting against a bath…. You can see why I cheat.
With Sheard (2016:11), an aide discusses a resident call light going off above a DON and an administrator: It is a rule of the facility that you cannot leave the food cart unattended. At the same time, the resident needed to go to the bathroom… The administrator asked me if I saw the call light going off. I turned to him and said yes, but I can't leave the food cart unattended… When you are in orientation, what you hear is not what they really put into practice. Informal rules can carry a menacing tone. An aide comments on an employee giving a scalding bath in one source. The problem was that the person should have known that "crazy patients are not punished for cursing aides," with hot baths, only ones with suitable mental capacity (Stannard, 1973:338).
The amount of RSPs related to documentation is similar to the rules subdivision, so substantial repetitiveness exists. With salience, employees state, "there is so much of it there is little time left to do anything else" (Farmer, 1996:20). Diamond (1995: 160) elaborates: Staff continually cursed at being overwhelmed with paperwork… They were a formality with forcemade of forms, and forming the contours of the job, both in doing the prescribed work and in certifying that it had been done. Sometimes they formed the way we spoke. A nursing assistant once approached a charge nurse about a resident who had been at the home for two months and was crying out loudly in her room. "Is there anything I can do for her?" asked the nursing assistant. "Oh," said the nurse, immersed in the medications checklist, "don't worry about it, it's nothing physical, just emotional."

Randwick International of Social Sciences Journal
Consider top-level workers. In one source, an aide points out "Sometimes the doctors come in and write in the chart, but they don't go see the patient" (Kayser-Jones, 2002:15). A resident with decades of experience in nursing homes comments "required assessments and paperwork" are more important than residents (Gaffney, 2012:73). Documentation dehumanizes and creates an objectification that increases victimization (see Sgarzi and McDevitt, 2003). Gass (2004: 34) states: Harold is still in his right mind, but… we make all his choices for him… We count his heartbeats… We monitor and measure all sorts of body partsthe kinds of things state inspectors can check easilybut we cannot measure the man. So despite our best intentions, we leave Harold the person off the charts… We can make him do whatever we want. He's at our mercy. Efficiency-based RSPs carry less quantitative weight than other subdivisions. This implies less influence, but many sources highlight their significant impact. Stress emerges for employees due to time (Nakrem, 2015). If low staff numbers exist, doing quick work is problematic, especially with reduced breaks for not completing assignments or refusals to pay overtime (Vinsnes et al., 2012). Staff feel they cannot "be in several places at the same time" (Hantikainen andKappeli, 2000:1202). Fontana (1978:130) elaborates: There was usually a minimal number of aides on the ward, and in order to meet Administrative demands the aides would accomplish their daily assignments as quickly as possible… In the rushed meal hour, food was shoved down open mouths or splattered on closed mouths as the aides carried on without missing a beat. The aides broke the rules concerning good care, but it mattered little to them since the goal of efficiency was seemingly more important. Employees sometimes prefer residents who are on feeding tubes due to the disruptions feeding creates (McLean, 2007;Pasman et al., 2003). Foner (1994:60) states: [Ms. James] had no tolerance for patients' resistance, which slowed her down… I overheard her explain, indeed justify, her approach… "Schmidt eats for me, but if anyone hears me they're gonna get me for patient abuse…" She once told a resident, "You eat… if you don't eat, I'm gonna…" Themes of ritualized meetings surfaced late in the project. We classified them into an "other" subdivision. References imply that formal engagements involving facility staff and/or family members during work hours overload already busy schedules.

Physical Maltreatment
We found 835 references to physical maltreatment. Sources discuss RSPs of personal negligence 242 times (29.0 percent). They mention medical dereliction 208 times (24.9 percent), and bodily harm 132 times (15.8 percent). They reference RSPs of environmental negligence 122 times (14.6 percent). The "other" subdivision has 131 references (15.7 percent). RSPs of abuse and neglect stood alone in the sources, but as reflected with the subsequent information, they had connections to bureaucracy.
Personal negligence RSPs are highly repetitive. Sources also point to their centrality. Busy aides fail to clean or clothe residents. Laird (1979)  Mrs. White… had to wear a bathrobe tied backwards around her waist to simulate a skirt… Robes often are put on this way, staff informed me, to decrease the amount of work involved in changing an incontinent patient and to decrease the amount of laundry. If robes are put on backwards and not tucked under, they are not soiled when patients are incontinent. Oosterveld-Vlug et al. (2013) discuss staff leaving residents partially naked for quickness (see also Duncan and Morgan, 1994).

Randwick International of Social Sciences Journal
Decent physical appearance of residents is a sign of well-being and poor hygienic care, along with neglected clothing, is routine (Gubrium, 1975;Vinsnes et al. 2012). Circling back to informal rules, Shield explains that if a resident is too demanding with personal needs, "In subtle and not so subtle ways, staff members neglect… doing things" (1988:159). Personal negligence can transition into medical dereliction. Gass (2004:26) describes finding residents lying in "soupy diarrhea." Acid from feces making burning patches into their skin. Mclean (2007) discusses a physician recommended bonnet to keep water out of a resident's ears. Aides kept it off. It slowed bathing. She also describes aides having personal conversations while feeding. "Inattentive to the fact she was spitting it out" the aide continued to "stuff food into her mouth" (McLean, 2007:194).
A lower frequency of RSPs involving medical dereliction exists, however the quantity is notable since it is slightly lower than RSPs of personal negligence. Moreover, medical dereliction appears a centralized practice. Kayser-Jones (1981:76) explains a nurse suggested glasses and a hearing aid for a resident and the doctor rejected her stating, "Oh well, she's old…" Nurses are at fault too. One admitted to Lopez (2007) that she did not give required medications to a suffering resident merely because a daughter did not want her to have them. Alternatively, providing too much is also problematic. Overmedication occurs with residents who engage in bothersome screaming related to psychological problems (Bourbonnais and Ducharme, 2010). These vocalizations inadvertently create medical abandonment for residents yelling legitimately. Gaffney (2012) discusses an insect in her bed biting her repeatedly. After extended yelling, staff came and explained they thought it was someone yelling for help who did not need it.
Nurses also medicate disruptive residents when aides recommend it. Gubrium (1975: 148-149) explains residents "Do not necessarily enter the Manor with physician's orders for tranquilizers. However, when aides define them as troublemakers, they get tranquilizers shortly after" and if "the nurses forget to sedate… concerned aides repeatedly remind them." Fontana (1978:128) explains the attribution of overmedication to other causes: The goal of the [facility]… was to provide a smooth-running schedule and flow of work, minimizing disturbances and avoiding trouble… Therefore if Maria, a wiry old patient, fell heavily to the ground after having been pumped full of Thorazine, the incident was dismissed as the result of an obfuscated mind and deteriorated body. This type of aide is referenced as "real rough" in an interview with Tappan (2016:4). Sources also suggest that staff tie residents down for personal safety, but also when they disrupt schedules or need to save on expenses (Hantikaine, 2001;Henry, 1963). Paterniti (2000:106) explains: Out of frustration and a perceived need to keep Scott restrained, aides frequently tied a square knot in [his] nylon vest restraint… Some even remarked, "If you're a mechanic, let's see you get yourself out of this one!" On one occasion, an aide locked Scott, tied to a chair, in the janitors' closet. The aide entertained himself by keeping records of how long it took Scott to work his way out of the restraints… When he was working as an aide, a resident told Diamond (1995) she did not need restraints. An LPN responded it was necessary because she did not have the money to pay additional aides.
More direct bodily harm examples exist. In a conversation with Tisdale (1987: 09), an employee says "Some are kind, some are cruel… They kick me, I kick them." Stannard (1973) explains, hierarchy keeps residents far removed from administrative workers. They may hear about physical harm, but they seldom actually see criminal forms of maltreatment firsthand. This creates a barrier to the normality of abuse. It also generates situations where employees sometimes let residents fight amongst themselves for amusement. An aide tells Sheard (2016: 40) that she was watching residents in a recreation area when a woman started hitting another. The aide says she just let them fight until things got so out of control someone called the police. Interestingly, family members do not always feel they can intervene without consequence. Kayser-Jones (2002:14) explains: A 93-year-old woman was admitted to the nursing home with ovarian cancer. The daughter found bruises on her mother's arms. At first, she did not want to ask the nurses about them because she feared retaliation. Later, she decided to report it… Now, she said: "They [i.e., nurses] don't talk to me; they never crack a smile; they never come in to say hello." RSPs of environmental negligence appear in the sources at a similar percentage as bodily harm. Carrying a lower rank, references in the data did not emphasize environmental negligence, but did mention it in passing. Henry (1963) contends, in addition to violating health codes, it sends a message to residents that they are not worthy. Gubrium (1993:170) notes a state surveyor's comment, "I think that cleanliness is a problem. I think here roaches are a problem… This place has probably got as good roaches as I have ever run into…" Nakrem (2015:515) comments on areas that do not simply smell like urine, but "contaminated urine." Vinsnes et al. (2012:248) discuss "dirty floors" and "soiled chairs." This does not have to be the norm. Comparing nursing homes she lived in, Gaffney (2012) argues in some facilities, barrels of soiled laundry left around contribute to repugnant smells. In others, unpleasant smells are rare because employees take the time to store dirty linens in designated areas.
The "other" category of physical maltreatment includes limited supplies and inappropriate architecture. Examples involve unlawful behavior connected to facility safety. We do not believe they are applicable to the current analysis as RSPs. However, they are worthy of future study.

CONCLUSION
Not every nursing home employee engages in "law abiding" crime, but many accept abuse and neglect as a normal part of care (Hillier and Barrow, 2015;Payne and Gainey, 2005). This is concerning since more citizens need long-term care services now than ever (Lueddeke, 2016). As revealed with policy decisions during the COVID-19 pandemic, it is also problematic when governmental leaders push for policies that elevate the likelihood of geriatric deaths in total institutions (King, 2021). SRT shows that care home employees operate in a milieu where bureaucratic rituals saturate daily life and inadvertently promote poor care. The highest-ranking aspect of bureaucratization involves staff separation and hierarchy, then rules, documentation, and efficiency. With hierarchy, employees perform duties only when they are their precise responsibility. Administrators and frontline workers develop different norms. Lower level employees sometimes accept neglect and abuse, and even view it as an appropriate punishment for work disruptions. Administrators may see maltreatment as wrong but avoid dealing with it because it does not cross their everyday paths. Cohesion created by staff separation leads aides to cover up maltreatment carried out by one of their own. Rule-based RSPs put burdens on workers, but they ignore rules of care and even create their own for practical purposes, even if they lead to unethical treatment. Documentation promotes victimization through objectification. It turns personal acts into statistical measurements. Moreover, demands for efficiency create an environment where fast labor trumps quality care. Bureaucratization relates to physical maltreatment. Physical neglect RSPs rank highest, then medical dereliction, bodily harm, and environmental negligence. Employees fail to provide physical upkeep of residents for many reasons, including efficiency. Staff members administer medical care inappropriately due to hierarchical disagreements or desires to control workflow. Similar bodily harm themes exist. Finally, employees fail to maintain living environments, possibly due to bureaucratic constraints.
Future research should revisit our source data. Reanalyzing RSPs by country would be interesting. Reanalysis of bureaucracy and maltreatment by year, employee gender, resident gender, race, and size of facility would also be good. A deeper analysis from an interactionist perspective would be fruitful, as would pre versus post COVID-19 pandemic examinations. What do employees think about avoiding labels associated with poor care? Can we find out more about what is happening with people in power who are distributing care labels? Moreover, if bureaucracy is truly producing crimes in nursing homes, what can we do to stop it?
Culture change models imply we can limit maltreatment with alternative RSPs involving staff empowerment and person-centered activities (see Berridge, Tyler, and Miller, 2016). However, some believe alternative RSPs do little to impede depersonalization (see Kao, 2013). Perhaps Weber (1921Weber ( /1968) was right. Once bureaucratization takes hold, there is limited ability to stop the negative consequences. From a law abiding crime perspective, Karstedt andFarrall (2006:1029) believe people "hit back" when widespread victimization occurs. Research confirms this has occurred with care home maltreatment (see Ulsperger, 2002). However, stories about illicit behavior in nursing homes are becoming less common (Miller, Livingstone, and Ronneberg, 2016). It is possible people working in these institutions have normalized horrific acts against the aged, but now the general citizenry has as well.