Through focus groups with nursing home care managers in Norway, this study explored perceptions of elder abuse and neglect, and concluded that these are overlooked patient safety issues. Most care managers interviewed were not explicitly aware of elder abuse in their daily work but when prompted with keywords describing abusive actions (e.g., hitting, threats of harm or abandonment), care mangers were able to identify harmful situations. The authors conclude that nursing home residents are at risk for abuse by co-residents, relatives and direct care staff and future research should focus on increasing awareness and knowledge of elder abuse among care mangers and developing strategies to identify and manage abuse and neglect.