Resident Safety in Aged Care: The Case for Fair Non-Punitive Blame

A common theme in patient safety literature is the call to move beyond a culture of blame and toward a safety culture that considers (many) adverse events in terms of systemic shortcomings. Recent scholarship extends this call to institutional aged care facilities, driven by evidence that adverse events in such settings commonly stem from structural factors. I challenge the general presumption against blaming in such calls. While this presumption may be warranted for punitive blame, it should not be extended to all forms. Drawing on T. M. Scanlon's account of blame, I argue for accommodating certain blaming practices by those directly affected (such as residents, family members, or advocates), where blame serves to communicate and demand backward-looking accountability. I also argue that to distribute the burdens of blame and accountability more fairly, the focus should be on broader care plans involving second-order roles such as care managers and coordinators.