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The purpose of this paper is to explore what existing literature about the care home environment for people with dementia reveals. It also evaluates the implications for practice, to show which parts of the care home environment staff feel have the most impact on the day to day lives of residents living with dementia. In turn, this paper seeks to feedback to care home management to improve practice and to contribute to research in care homes in the future.

A literature review forms the basis of this research, in addition to four semi-structured interview conducted with care home staff of different roles; allowing them to share their experiences with little restriction. Participants were recruited through informal discussions with the researcher before the research took place, as part of her job role and using purposive sampling.

Data were analysed using computer software Nvivo and identified four main categories which all participants discussed: social interaction, staff involvement, staff restrictions, staff involvement and physical elements of the environment. This research has shown the importance of staff presence in the care home environment to facilitate social interaction among residents with dementia.

The sample is very small due to staff not having the time to take part in the interview and this itself is a key finding. Interviews were able to capture feelings but not the overall experience of interaction between resident and staff, which observations would have achieved if there was more time to conduct the research.

A literature review and qualitative research signifying the importance of staff presence in the care home setting in order for the residents to socially engage in their environment. However, it has also show the lack of time that is face by staff and the impact this has on people living with dementia.

One in 14 people over 65 years suffer from dementia in the UK. Over 25 per cent are receiving antipsychotics, which cause increases in mortality and cerebrovascular events. The need for a reduction and the use of alternative supportive strategies has been advocated. Risperidone at six‐week intervals is the only antipsychotic licensed for treatment with regular review. The majority of management occurs at primary care level and in care homes. The purpose of this paper is to investigate antipsychotic prescribing practices and patient review in these settings.

In total, two surveys comprising questions addressing prescribing practices were developed and distributed electronically to all GP practices and care homes in Coventry and Warwickshire, West Midlands, England.

The majority of GPs (75 per cent) reported only “occasional” discontinuation of antipsychotics due to concerns at reducing drugs on their own, expectations of regulation from secondary care and resistance from care home staff. Poor reduction levels were reported in care homes, attributing low numbers to reluctance among GPs. History of cardiovascular risk factors did not appear to influence withdrawal. Only 40 per cent of GP practices maintained sole use of risperidone. At least six‐monthly reviews were reported by 63 per cent of GPs and 64 per cent of care homes, with very few conducting reviews at least three‐monthly. The importance of non‐pharmacological alternatives was emphasized, yet access was limited and highly resource‐dependent.

This study reveals the perspectives of staff delivering healthcare for people with dementia and behavioural and psychological symptoms of dementia (BPSD). Potentially inappropriate antipsychotic principles were reported. A lack of communication and uncertainty of roles was evident. The development of understandable guidelines for healthcare workers and care home staff managing behavioural issues in patients with dementia is necessary.

The purpose of this paper is to present findings from face-to-face interviews with three former care staff who were proven to have abused some of the older people living in the care and nursing homes in which they had once worked. The research sought to explore the intra-personal dynamics, personal characteristics and work experiences that led these staff to perpetrate abuse.

Semi-structured interviews were undertaken with three former care and nursing home staff who had committed abusive acts and the data secured subjected to thematic narrative analysis.

None of the three people interviewed had intended to become care staff and reported that the interview and induction processes they experienced did little to establish their suitability for the work they would be undertaking or to prepare them for its demands. Participants expressed their generally negative perceptions of older people, particularly those living with dementia, and told of how they also felt that they were under pressure to conform with the often abusive care home regimes that they had entered. They also recounted some specific abusive practices developed to allow them to manage the constant tension between the time available to complete all of the tasks required when “caring” for older people, and revealed their perceptions of external scrutiny of care home conduct and the behaviours developed to deflect the effectiveness of this oversight. Two interview participants also revealed their unfavourable attitudes to some of the people they were employed to care for that were based upon perceptions of ethnic differences, and of how this had contributed to the abuse they perpetrated.

Though the research draws upon the experiences of only three former care staff, the data reveal some of the intra-personal dimensions of individual staff who have engaged in abusive acts, and illuminates how the care home environment with which they interact can engender conditions under which abuse is more likely to occur.

Unusually, the paper explores the characteristics, perceptions and experiences of care staff who have actually committed abusive acts against those entrusted to their care.

In 2004, the author carried out a small scale study to find out the views of those living and working in private care homes in England about a range of issues connected to inspection, regulation and ways to better protect older people. This study reports on views from 19 managers and 19 residents about their understanding of abuse, their perceptions of the different forms of abuse and the possible action to deal with offending care staff. Although there was some consensus about the seriousness of certain types of abuse and how managers would investigate the allegation, the findings indicate that mandatory training for registered care home owners and managers is necessary to clarify their responsibilities in relation to their actions and the reporting of certain offences to relevant agencies. Residents' views also need to be taken seriously if they are to voice their opinions about life in a care home.

The purpose of this paper is to present some of the findings from an empirical, mixed methods research project that reveal the importance of the personal value frameworks held by individual staff in the prevention of abuse of older people in private sector care homes.

Semi-structured interviews were undertaken with a sample of 36 care home personnel, including proprietors, care managers and care staff.

A significant number of respondents identified the importance of personal value frameworks among staff providing care as a potential contributory factor in the prevention of abuse of older people.

Though the research draws upon the experiences of only 36 care home personnel through interviews, data suggest that the personal evaluations of staff towards those in their care is a significant contributory factor to the occurrence of abuse.

The research has identified individual staff value frameworks as a causal factor in the occurrence of abuse. The research also confirms that the perceptions of “values” among respondents directly involved in the provision of care are at odds with common understanding of “values” often cited elsewhere in connection with staff recruitment and training as a means of preventing the occurrence of abuse.

The purpose of this study is to explore the factors that influence the reporting of adverse events related to elder abuse and neglect in nursing homes from nursing home leaders' perspectives. Good leadership requires in-depth knowledge of the care and service provided and the ability to identify and address problems that can arise in clinical practice.

A qualitative explorative design with data triangulation was used. The sample consisted of 43 participants from two levels of nursing home leadership, representing six municipalities and 21 nursing homes in Norway. Focus group interviews were undertaken with 28 ward leaders and individual interviews with 15 nursing home directors. The constant comparative method was used for the analyses.

Both ward leaders and nursing home directors described formal and informal ways of obtaining information related to elder abuse and neglect. There were differences between their perceptions of the feasibility of obtaining formal reports about abuse in the nursing home. Three main categories of influencing factors emerged: (1) organisation structural factors, (2) cultural factors and (3) abuse severity factors. A main finding is that in its present form, the Norwegian adverse event reporting system is not designed to detect abuse and neglect.

This paper provides an in-depth understanding of patient safety and factors related to reporting elder abuse in nursing homes in Norway.

The purpose of this paper is to present findings from face-to-face interviews undertaken with 16 care and nursing home managers employed in homes situated in two English local authorities. The research sought to explore managers’ perceptions of the role of contract monitoring in the prevention of abuse.

Semi-structured interviews were undertaken with 16 care and nursing home managers.

Though personnel employed by the local authority who conducted contract monitoring were generally thought of positively by care home managers on a personal level, their effectiveness was perceived to be limited as a result of their lack of experience and knowledge of providing care, and the methods that they were required to use.

Though the research draws upon the experiences of only 16 care and nursing home managers in two local authorities, data suggest that current contract monitoring activity is of limited utility in determining the true nature of care and the presence of abuse.

Unusually, the paper explores care and nursing home managers’ perceptions of contract monitoring processes in terms of how they perceive their effectiveness in preventing abuse.

Through the lens afforded by two theories drawn from the discipline of social psychology, the purpose of this paper is to explain the evident continuing abuse of adults at risk living in care homes by the staff who should be looking after them.

By considering existing theories and research into the reasons why vulnerable adults are abused the paper proposes the relevance of other extant theories on the degradation of moral restraint and dehumanisation of victims, and on the social psychology of intergroup relations, to the perpetration of abuse.

The paper demonstrates how theories that explain the psychology of human behaviour in certain circumstances may be usefully applied to the inveterate social problem of the abuse of vulnerable adults living in care homes.

The paper offers the opportunity for the reader to consider how these theories of social psychology may be applied to explain and guide remedies to the persistent levels of abuse in English care homes, abuse that continues despite government oversight of care provided to adults who may be at risk by virtue of the activities of the statutory regulator and health and social care commissioners, and the interventions of safeguarding personnel.

This is a conceptual paper from which future research and theorising may arise to better understand the most fundamental causes of the abuse of older people in care homes in order to develop feasible and effective measures to overcome it.

The purpose of this paper is to explore potential differences in how nursing home residents rate care quality and to explore cluster characteristics.

A cross-sectional design was used, with one questionnaire including questions from quality from patients’ perspective and Big Five personality traits, together with questions related to socio-demographic aspects and health condition. Residents (n=103) from four Norwegian nursing homes participated (74.1 per cent response rate). Hierarchical cluster analysis identified clusters with respect to care quality perceptions. χ² tests and one-way between-groups ANOVA were performed to characterise the clusters (p<0.05).

Two clusters were identified; Cluster 1 residents (28.2 per cent) had the best care quality perceptions and Cluster 2 (67.0 per cent) had the worst perceptions. The clusters were statistically significant and characterised by personal-related conditions: gender, psychological well-being, preferences, admission, satisfaction with staying in the nursing home, emotional stability and agreeableness, and by external objective care conditions: healthcare personnel and registered nurses.

Residents assessed as having no cognitive impairments were included, thus excluding the largest group. By choosing questionnaire design and structured interviews, the number able to participate may increase.

Findings may provide healthcare personnel and managers with increased knowledge on which to develop strategies to improve specific care quality perceptions.

Cluster analysis can be an effective tool for differentiating between nursing homes residents’ care quality perceptions.

Older adults living in nursing homes may become vulnerable because of errors or incidents; it is necessary to create a positive safety culture to minimise such occurrences. However, safety culture is still a prevailing issue in Indonesian nursing homes. This study aims to examine factors related to resident safety culture in nursing homes located in Indonesia.

This study used a cross-sectional research design and involved 13 nursing homes in East Java province, Indonesia. Multistage cluster samplings were used to determine the respondents of this study. The respondents included 219 employees: managers, health care, supportive and administrative staff. The Indonesian version of the Safety Attitudes Questionnaire was used to measure safety culture.

Most of the respondents (68.5%) had a positive perspective on the nursing home’s safety culture. Staffs who had worked for six to ten years in the nursing home were 17.07 times more likely to have positive perspective on safety culture with a p-value of 0.0002. Respondents who gave direct care also had a positive perception of safety culture with a p-value of 0.008.

Broader insight into safety culture needs to be provided to all staff in the nursing home. Safety topics should be included in the orientation session for new staff.

The staff’s work experience and direct care have a significant connection to safety culture.