What if you have to physically struggle with someone in order to wash them? Or feed them? Or get them to take their medication? Or simply to get them to stop hitting you every time you come near? People with dementia can be quite combatative and persuasion and encouragement may very well not work. Anyone from the outside looking at a physical struggle would probably think "that 'carer' is abusing that poor frail elderly person!" and class it as abuse, even if the carer is doing their best to use the safest holds and so on. But if the carer opts to NOT struggle, and patient goes unwashed, unmedicated, unfed, etc, then people from the outside will view that as neglect/abuse too. There's no easy solution. Often there is more to a situation than meets the eye. Of course this doesn't excuse people who aren't making any effort to do their jobs, like the nurse mentioned by Tom who didn't know why her patient had antibiotics, and it certainly doesn't excuse people who take out their bad mood on a patient in the form of abuse or neglect.