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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.

The purpose of this paper is to present findings from an empirical research project designed to enhance knowledge of the current extent and nature of abuse in contemporary care homes for older people.

A self-completion, postal questionnaire was used to elicit both numerical and textual data that was subsequently subjected to both quantitative and qualitative analysis. The questionnaire was distributed to newly appointed care staff in six participating care homes providing care to older people to determine the nature of any abuse they may have witnessed in the homes in which they had previously worked.

A significant proportion of respondents described instances of predominantly psychological and physical abuse and neglect.

Though the research draws upon the experiences of only 194 anonymous questionnaire respondents, of whom 140 had witnessed abuse; data suggest that abuse continues to occur in some care homes for older people.

The research has revealed staffs’ recent experiences of a range of abusive acts and practices. Findings suggest that changes are required to current methods of external scrutiny and investigation of practices in care homes.

The purpose of this paper is to present findings from two research projects undertaken between 2015 and 2019 that reveal continued underreporting and sometimes active concealment of abuse in private sector care homes for older people in England.

An anonymously completed questionnaire was used among newly appointed staff in 11 newly opened care homes to elicit both quantitative and qualitative data relating to the reporting of occurrences of abuse within the care homes in which they had previously worked. In total, 391 questionnaires in total were returned, 285 of which indicated that respondents had witnessed the perpetration of abuse on at least one occasion.

A significant number of respondents indicated their awareness of acts of abuse that had not been reported within the care home(s) in which they had worked, or externally to the appropriate authorities. Some respondents were aware that where occurrences of abuse had been reported within care homes no subsequent action was taken, or that external authorities were not always involved in responses to abuse. A significant number of respondents described strategies that had been used to deter reports of abuse to external agencies and to conceal its occurrence from the statutory regulator and service commissioners.

Though the research draws upon the experiences of only 285 questionnaire respondents who had witnessed episodes of abuse, data suggest that a significant proportion of abuse in care homes remains unreported.

The research has revealed experiences of continued underreporting and concealment of abuse among staff in private sector care homes. Findings indicate that a strengthening of incentives and protections extended to the staff who should report abuse are essential, and that changes to current methods of external scrutiny to which care homes are subject are required.

The purpose of this paper is to present findings from a research project designed to enhance knowledge of the current extent and nature of abuse in contemporary care homes for older people.

A self-completion, postal questionnaire was used to elicit both numerical and textual data that were subsequently subjected to both quantitative and qualitative analysis. The questionnaire was distributed to newly appointed care staff in five participating care homes providing care to older people to determine the nature of any abuse they may have witnessed in the homes in which they had previously worked.

A significant proportion of respondents had witnessed numerous occurrences of primarily psychological and physical abuse and neglect, perpetrated against the older people living in the care homes in which they had previously worked.

Although the research draws upon the experiences of only 197 anonymous questionnaire respondents, of whom 180 had witnessed abuse, data suggest that abuse continues to occur in some care homes for older people.

The research has revealed staffs’ recent experiences of a range of abusive acts and practices. When combined with two previous studies using the same or a similar methodology, the research also confirms the enduring presence of abuse in care homes. Findings again suggest that changes are required to current methods of external scrutiny and investigation of practices in care homes.

The purpose of this paper is to present a review of some of the fundamental theoretical and contextual components of commissioning and regulatory processes as applied to care home services, revisiting and examining how they impact on the potential prevention of abuse.

By revisiting a number of the theoretical bases of commissioning activity, some of which may also be applied to regulatory functions, the reasons for the apparent limited impact on the prevention of the abuse that occurs in care homes by these agencies are analysed.

The paper demonstrates how the application of commissioning and regulatory theory may be applied to the oversight of care homes to inform proposed preventative strategies.

The paper offers strategies to improve the prevention of abuse in care homes for older people.

A factual and “back to basics” approach is taken to demonstrate why current strategies that should contribute to tackling abuse in care homes are of limited efficacy.

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.

The purpose of this paper is to introduce the concept of the assumption of altruism argued by the author to be a tendency among both the lay public, professionals and politicians, a generalised assumption that contributes to the long standing and obstinate presence of abuse of adults who are at risk throughout England, particularly older people living in care and nursing homes.

By examining available figures that depict the continuing abuse of vulnerable adults, and by drawing on research, the author offers a partial explanation for the longevity of abuse in English society.

The paper demonstrates how the concept of the assumption of altruism can explain to a degree the apparent enduring levels of abuse of adults who are at risk.

The paper offers the opportunity for the reader to consider some of the fundamental, higher order reasons for the persistent levels of abuse in England, abuse that endures despite the oversight by government of care provided to adults who maybe at risk by virtue of the activities of the statutory regulator and health and social care commissioners.

By presenting the incontrovertible evidence of enduring abuse, the paper introduces the concept of the assumption of altruism as a partial explanation for its continuing occurrence despite decades of policy and practice guidance designed to overcome it.

The purpose of this paper is to discuss the relevance and importance of developing and making use of robust theory to explain and counter the tenacious social anomaly of the abuse of older people who live in care homes.

The activities of theorising and conducting research to gain revised theoretical comprehension of why abuse occurs in care homes, along with the enduring over reliance of those with an interest in safeguarding on existing theories borrowed from other fields to guide their activities are considered and discussed.

There is a pressing need for theory based understandings of the continuing abuse of older people and it is apparent that the development of such theory will be more productive if theorising and theory development are specific to certain types of abuse perpetrated in delineated settings.

The paper offers the opportunity for the reader to consider the significance of theorising and developing new theory in order to improve of the protection of potentially vulnerable adults by virtue of the guidance it can provide to the activities of policy makers, managers and practitioners.

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

Strategic socio-political views are notably scarce among contemporary discourses on the causes of abuse of vulnerable older people in care and nursing homes. This paper aims to catalyse higher order consideration and discussion of one socio-political characteristic that has relevance to the issue of abuse, that is, the market-like environment in which care and nursing homes in England operate. In doing so, the paper argues that the now firmly established but imbalanced “quasi-market” of care that has developed over many years fosters conditions under which both poor care and abuse are more likely to occur. The evidence presented in the paper focusses primarily on the rise to dominance of for-profit care home provision and the contraction of public sector provision. The paper does not examine in detail the characteristics and market presence of the not-for-profit sector because it has not held a numerically significant market share either historically or contemporarily.

Outcomes of the marketisation of the care home sector that has its origins in the political landscape prevailing in 1979 and thereafter, along with the concurrent development of its regulation and oversight, are narrated and analysed. From this, a mythos of the motives behind the transition to a market-like economy that has taken place over four decades is developed and used to explain how prevailing market conditions contribute to the perpetuation of poor care and abuse.

In the opinion of the author, there are identifiable consequences arising from the evolution of the current care economy that dispel the beliefs that providing care by means of current market-like arrangements is advantageous, that the independent regulation and monitoring of such a market is unproblematic and effective, and that the “consumers” in this market are exercising personal choice, in accord with classical economic theory.

The paper offers the opportunity for the reader to consider how the development of a “quasi” market of care and nursing home services that has come to be dominated by for-profit private providers, and that is subject to ineffective oversight, may have contributed to conditions where abuse is more likely to occur and endure.

This is a conceptual paper that explores the consequences of the creation of the market-like economy of care in which care and nursing homes now operate and suggests that it is time for prevailing market conditions to be re-visited and subjected to remedial strategic intervention.

The purpose of this paper is to present findings from a research project designed to determine the qualifications held by those staff who had perpetrated abuse in private sector care and nursing homes for older people during a 12-month period.

A self-completion, postal questionnaire was issued to the safeguarding teams of all local authorities in England with adult social care responsibilities to determine the qualifications held by staff who were proven to have perpetrated abuse in these facilities.

Though findings with respect to qualified nurses who had perpetrated abuse when considered in isolation were inconclusive in numerical terms, the proportion of all nursing and care staff who had perpetrated abuse, and who held either a professional or vocational qualification was high.

Responses to the postal questionnaire represented 21.8 per cent of local authorities with social services responsibilities, yet the data secured suggests that care providing staff who have received recognised training are disproportionately represented among those proven to have perpetrated abuse.

Findings indicate that recognised training for those who provide care in care and nursing homes is of limited efficacy in the prevention of abuse.