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AbstractThis article draws on a study aimed at developing theoretical and methodological understanding of the abuse and neglect (mistreatment) of older people in long‐term care settings such as care homes and hospitals. It presents an interactionist account of mistreatment of older people in such establishments. Starting with an outline of definitional issues surrounding the topic, the allied concept of dignity is also briefly explored, and one important model described; we present dignity as the converse of mistreatment. The article argues for the potential of a positioning theory analysis of mistreatment. Positioning theory proposes that interactions are based on taking of 'positions', clusters of rights and duties to act in certain ways and impose particular meanings, which enable or prohibit access to certain storylines. It is argued that 'malignant' positioning can contribute to the creation of a climate that allows mistreatment to take place, or fails to prohibit its development. Mistreatment of people with dementia is used as an illustration, and it is argued that this is potentially generated by negative feedback loops of behaviour patterns, interpretations and malignant positioning by staff or family carers and subsequent response to these interpretations by the person with dementia. Positioning theory also allows for an explanation of the importance and impact of organizational cultures and social factors such as ageism. Individual staff members take positions, use meanings and develop storylines imbued with such factors. This understanding therefore overcomes some of the potential confusions created by concepts such as organizational or institutional abuse, removing the need to ascribe intentions and personal responsibility to such constructs. The article concludes with some suggestions for further research to develop an understanding of the kinds of cultures that allow mistreatment and consequently to inform the development of protective measures.

PurposeThe purpose of this paper is to set out and discuss findings from a developmental study, commissioned by the English Department of Health and the charity, Comic Relief, which was commissioned to clarify definitional issues and recommend ways of operationalising key concepts for a prospective survey of abuse, neglect and loss of dignity in the care of older people in residential care in the United Kingdom (UK).Design/methodology/approachAs well as drawing upon their experience and expertise, the authors conducted a review of the literature, held consultation events with a range of stakeholders and undertook in‐depth interviews with international academics and care home residents.FindingsExisting definitions and descriptions vary widely in form and content, are commonly subjective and imprecise and frequently make reference to abstract concepts which themselves need defining. Many of the concepts are also inherently evaluative, unspecific and open to interpretation. The study considered how, in this context, practical research definitions that are clear, unambiguous and widely acceptable to a range of stakeholders could be developed.Research limitations/implicationsThe study took a UK focus and the review of literature was confined to the English language. Further research might usefully extend discussion about definitions cross‐culturally. The interview samples were small and should not be considered to be representative.Originality/valueThe paper identifies key issues in defining the perpetrator. It focuses on the concepts of trust and intentionality, the responsibilities of the care home and multiple perpetrators and makes practical proposals for operationalising the "perpetrator" in research. Recommendations from the study were positively received and have directly informed the Government‐funded research programme in England.

This study examined people's perceptions and behaviours in relation to planning for their social care needs, and their values and priorities concerning how social care should be funded. Eight deliberative focus groups were conducted in May 2018 with 53 participants, aged 25-82 years, in London, Manchester and rural locations near York and Sheffield. Multiple uncertainties created barriers to planning for social care needs including not knowing how much to save, not thinking it possible for an average person to save enough to meet significant needs, reluctance to plan for something potentially unnecessary, lack of suitable and secure ways of saving, and a perception of social care policy as unsettled. Participants also had significant concerns that they would not be able to obtain good-quality care, regardless of resources. In addition, it was commonly thought unrealistic to expect families to provide more than low-intensity, supplementary care, while use of housing assets to pay for care was considered unfair, both for home-owners who could lose their assets and non-home-owners who were left reliant on the state although it was more acceptable where people were childless or had substantial assets. Participants thought any new arrangements should be inclusive, personally affordable, sustainable, transparent, good-quality and honest. They preferred to contribute regularly rather than find considerable sums of money at times of crisis, and preferred to risk-pool, with everyone obliged or heavily encouraged to contribute. Transparency was valued so those better at 'working the system' were not able to benefit unfairly and participants wanted to know that, if they contributed, they would be assured of good-quality care. Trust in Government and other institutions, however, was low. New funding arrangements should incorporate measures to increase transparency and trust, be clear about the responsibilities of individuals and the state, provide meaningful options to save, and place significant focus on improving actual ...

The Department of Health commissioned a team from the London School of Economics and Political Science and the London School of Hygiene and Tropical Medicine to consider progress in dementia care since 2009. We were asked to focus particularly on three areas: improvements in diagnosis and post-diagnostic support, changes in public attitudes, and developments in research. Two major policy documents provide the context: the National Dementia Strategy 2009, which is now finished, and the Prime Minister's Challenge on Dementia 2012, which superseded it.

User involvement in social care research has generally been the preserve of qualitative methodologies, while user involvement in quantitative research has tended to be limited by the assumed inflexibility of statistical designs and concerns that lay people may require specialist training to engage with quantitative methods. Using the example of the Care and Caring study, a survey about the direct employment of care and support workers in England commissioned and funded by Skills for Care, this paper explores the benefits and difficulties of involving service users in the development and design of survey processes and instruments.