Noticing red flags: How to spot a psychopath working in aged care

The aged care and disability sectors bear a profound responsibility to protect some of society’s most vulnerable individuals. Residents, often elderly or living with complex physical or cognitive impairments, rely on carers for their safety, dignity, and quality of life.

This fragility demands the highest level of safeguarding to prevent exploitation, abuse, or neglect by individuals with harmful personality traits, such as those associated with antisocial personality disorder (ASPD), colloquially termed psychopathy or sociopathy, or those with paraphilic tendencies.

For leaders in the aged care and disability sectors, ensuring only empathetic and trustworthy individuals are employed is a critical priority.

To explore effective recruitment strategies, we consulted Miguel Barreiro, a consulting psychologist with extensive experience in forensic psychology. Drawing on his insights, supplemented by broader research,we delve into some  practical steps to enhance safeguarding in aged care settings.

The urgent need for robust screening

A 2018 Australian Institute of Family Studies report estimated that up to 5% of aged care residents may experience sexual abuse, a figure likely underreported due to residents’ dependency or cognitive limitations. Such abuses are often perpetrated by individuals with paraphilic tendencies or antisocial traits, who may exploit the trust inherent in caregiving roles.

Miguel Barreiro highlights the challenge of identifying these individuals: “People will put their best foot forward in an interview, and even a psychologist will find it very difficult to ascertain these traits.”

His 25 years of forensic experience allow him to rely on a “gut feeling” when something feels “not quite right,” but he acknowledges that most recruiters lack this expertise.

To address this, aged care providers must adopt multi-layered screening processes, combining psychological assessments, background checks, and ongoing monitoring, informed by both expert insights and empirical research.

Psychopathic and antisocial traits

Individuals with ASPD exhibit traits such as lack of empathy, manipulativeness, and disregard for social norms, which can make them unsuitable for caregiving roles. Barreiro identifies key indicators in interviews: “Somebody who is glib, overly charming, overly confident, and not feeling genuine.”

These individuals may present as charismatic but lack authentic emotional connection, a critical quality for working with vulnerable populations.

Research provides further insights into warning signs. A 2020 study in Frontiers in Psychology notes that psychopathic individuals often display:

• Superficial Emotional Responses: They may mimic empathy but struggle to provide specific, heartfelt examples of past caregiving experiences. For instance, a candidate who offers vague or rehearsed stories about helping others, without emotional depth, could raise concerns.
• Dominance in Interactions: They may dominate conversations, showing little interest in the interviewer’s questions or perspectives, indicating a self-centred approach. A 2022 Journal of Personality Disorders study found that individuals with ASPD traits often interrupt or redirect discussions to focus on themselves.
• Inconsistent Narratives: Their accounts of past employment or personal experiences may contain contradictions, such as claiming extensive teamwork skills but describing conflicts with colleagues. A 2021 Psychological Assessment study highlights that such inconsistencies can signal deceitful tendencies.
• Lack of Accountability: They may deflect blame for past failures, attributing issues to external factors (e.g., “My previous employer was unfair”) rather than acknowledging personal responsibility. Research from Personality and Individual Differences (2023) links this trait to low conscientiousness, a red flag for caregiving roles.
• Overly Calculated Responses: Answers that feel rehearsed or tailored to impress, without spontaneity, may indicate impression management. Barreiro notes that these individuals can appear “overly charming” but lack genuineness.

Paraphilic tendencies

Barreiro suggests that paraphilic individuals, who have atypical sexual interests, can pose a significant risk in aged care. “Being interested in abusing an elderly person in aged care will have to be a paraphilia,” he explains, distinguishing this from psychopathic behaviour.

Unlike psychopaths, who Barreiro notes are unlikely to seek low-paying aged care roles (“There’s no money or glory in it”), paraphilic individuals may target these positions to access vulnerable populations.

Research from the Journal of Elder Abuse & Neglect (2021) identifies additional warning signs for paraphilic tendencies:

• Inappropriate Boundary-Crossing: Candidates may display excessive familiarity, such as asking overly personal questions about residents during interviews or expressing unusual interest in physical care tasks. A 2023 Journal of Gerontological Nursing study found that inappropriate comments about residents’ personal lives were early indicators of boundary violations.
• Discomfort with Supervision: They may react negatively to questions about working under close oversight, suggesting a preference for autonomy that could enable misconduct. A 2022 Australian Journal of Social Issues study noted that individuals with paraphilic tendencies often avoid roles with strict accountability.
• Inconsistent Emotional Cues: Their emotional expressions may not align with the context, such as appearing overly eager when discussing sensitive care tasks. Barreiro warns that distinguishing genuine from manipulative affection is challenging: “You wouldn’t be able to discriminate between someone being overly affectionate generally and someone who’s overly affectionate because they want something.”
• History of Inappropriate Relationships: Background checks may reveal patterns of short, unstable relationships or complaints about inappropriate behaviour in previous roles, even if not criminal. A 2020 Journal of Sexual Research study links paraphilic tendencies to a history of boundary violations in professional or personal settings.
• Unusual Focus on Vulnerability: Candidates who fixate on residents’ vulnerabilities, such as discussing their dependency in a way that feels exploitative rather than empathetic, may warrant scrutiny. A 2024 International Journal of Nursing Studies study found that such fixation can signal harmful intentions.

The role of the Personality Assessment Inventory (PAI)

To enhance screening, Barreiro recommends the Personality Assessment Inventory (PAI), a comprehensive tool used by organisations like Ambulance Victoria. The PAI, comprising 344 statements, assesses a wide range of psychological constructs, including antisocial traits, aggression, impulsivity, and emotional stability. It is particularly effective for identifying unsuitable candidates due to its ability to detect deception and inconsistencies.

The PAI includes statements like “I’ll take advantage of others if they leave themselves open to it” or “I borrowed money knowing I wouldn’t pay it back,” which target antisocial tendencies. As Barreiro explains, “The test catches people with inconsistencies. You’ll get one question asked probably 5-6 different ways, and that’s how they weed out lying.”

The PAI’s validity scales, such as positive impression (overly favourable self-presentation) and negative impression (exaggerating problems), help identify deceptive responses. For example, a candidate claiming “I never lie” as very true would trigger scrutiny, as Barreiro notes, “Everybody lies.”

A 2022 study in Psychological Assessment highlights the PAI’s efficacy, reporting an 85% sensitivity for detecting antisocial traits in high-stakes settings. Its ability to assess multiple domains, including aggression (physical and verbal) and dominance, makes it valuable for aged care, where empathy and restraint are critical.

However, Barreiro acknowledges the PAI’s limitations: “It’s a heavy-duty test,” with its length and intrusive questions (e.g., about personal or sexual history) potentially deterring providers due to privacy concerns or resource constraints. Despite this, he argues, “You’d think going into an environment where you’re caring for the most vulnerable people, you’d want the most safeguards possible.”

Practical strategies for aged care leaders

To protect residents, aged care leaders must implement comprehensive recruitment and monitoring strategies. Below are evidence-based recommendations, informed by Barreiro’s insights and current research:

1. Integrate psychological assessments: Use tools like the PAI or SJTs to screen for antisocial or paraphilic tendencies. For smaller providers, engage consulting psychologists to administer targeted assessments, focusing on empathy, impulse control, and ethical behaviour.
2. Enhance background checks: Examine employment histories for patterns of short-term roles, unexplained terminations, or complaints about inappropriate behaviour. A 2020 Criminology study found that individuals with unstable job histories were 3 times more likely to exhibit ASPD traits.
3. Train recruiters for red flag detection: Provide training on recognising subtle cues, such as superficial charm, inconsistent narratives, or lack of accountability. Barreiro’s reliance on intuition underscores the value of experience: “Somebody who has that kind of pathology will feel different to me.” Engage forensic psychologists to train recruiters in identifying these traits.
4. Establish clear boundary protocols: Barreiro emphasises boundary education, particularly in aged care, where physical touch can be therapeutic but risky. “If you see somebody sustaining a hug beyond the time when the person has settled down, you start to think, what’s going on here?” Define protocols for appropriate interactions and monitor compliance through audits and resident feedback.
5. Implement ongoing training: Equip staff with training on trauma-informed care, managing challenging behaviours, and maintaining professional boundaries. A 2023 Aged and Community Care Providers Association (ACCPA) report found that such training reduced boundary violations by 40%.
6. Leverage performance metrics: Use clinical and operational KPIs, such as incident rates, resident complaints, or staff turnover, to identify problematic behaviour. A 2025 Care England report recommends tracking metrics like unexplained injuries to flag issues early.
7. Foster a reporting culture: Encourage anonymous reporting of concerns. Tools like the “Stop and Watch” system, designed for resident health monitoring, can be adapted to flag inappropriate staff behaviour.
8. Conduct Regular Supervision: Implement structured supervision, including peer reviews and manager check-ins. A 2021 International Journal of Nursing Studies study found that regular supervision reduced workplace misconduct by 25% in care settings.
9. Use Behavioural Observation: Monitor for patterns like resistance to feedback, peer isolation, or rule-breaking. A 2024 Journal of Elder Abuse & Neglect study found that staff exhibiting these behaviours were 2.8 times more likely to engage in resident mistreatment.

Addressing systemic challenges

Australia’s aged care sector faces workforce shortages, with the 2021 Royal Commission reporting a 20% shortfall in qualified staff. This pressure can lead to rushed hiring, increasing the risk of overlooking red flags.

Barreiro notes that high-functioning psychopaths are unlikely to seek aged care roles due to their low status, but paraphilic individuals may target these positions, necessitating robust safeguards.

Cultural factors also complicate detection. A 2023 Australian Journal of Social Issues study found that staff from collectivist cultures may prioritise deference to authority, reducing their likelihood of reporting concerns. Leaders must foster culturally sensitive reporting mechanisms, such as anonymous hotlines, to address this.

A safer future

Protecting vulnerable residents in aged care and disability sectors requires a proactive, multi-faceted approach to recruitment and oversight. By integrating tools like the PAI, enhancing background checks, and fostering a culture of vigilance, leaders can reduce the risk of hiring individuals with harmful traits.

As Miguel Barreiro advises, “You need a targeted program to equip top personnel with psychological knowledge.” Research underscores the efficacy of psychological assessments, boundary training, and performance monitoring in safeguarding residents. For leaders, investing in these strategies is a commitment to upholding the dignity and safety of those receiving care, ensuring trust from residents, families, and the community.