assisted living facilities (Hawes et al., 1999). Among people age 85 and over, 21 percent were in nursing homes in 1995 and 49 percent were community residents with long-term care needs (Alecxih et al., 1997).
The nursing home population tends to be older and more severely disabled than elders residing elsewhere, with about half of the residents being 85 or older and about half having five ADL limitations, in 1996 (Stone, 2000); still, four out of five elderly persons with ADL or IADL impairments lived in the community setting (Alecxih et al., 1997). Approximately 17 percent of these community-dwelling older persons are considered severely disabled, with limitations in three or more ADLs. Of those ADL-impaired elderly people living in community settings, 37 percent report that they need help but do not receive it or receive less help than is needed (Stone, 2000).
Most long-term care for community-dwelling elders is provided in a traditional home setting, either in an older person’s own home, with or without a spouse, or in the home of a close relative. The 1994 National Long Term Care Survey indicated that more than 7 million Americans, mainly family members, provided 120 million hours of care to elders with functional disabilities living in the community. However, the nature and character of the informal networks now providing long-term care services may change (Stone, 2000). The potential pool of adult children who can serve as caregivers is already decreasing, as a result of a variety of demographic trends, including divorce, smaller families, and increased workforce participation (Himes et al., 1996). These factors increase the pressures on families caring for their elderly relatives and also are likely to increase the demand for institutional care.
These trends highlight the growing challenge of ensuring the safety and protecting the other interests of elderly people in the diverse settings in which long-term care is provided. No matter where they reside, older people are vulnerable not only to the infirmities and suffering associated with disease and disability, but also to neglect, victimization, and exploitation by others, including their caregivers. In this respect, protecting older people from mistreatment is an important element of the broad challenge of ensuring quality services in long-term care.
While elder mistreatment has attracted sustained efforts from practitioners and some interest from policy makers over the past two decades, it has not received concomitant attention from researchers or from the agencies that provide research funding. No major foundation has identified this field as one of its priorities, and the federal investment has been modest at best. For example, fewer than 15 studies on elder mistreatment have been funded by the National Institute on Aging (NIA) since 1990, and support from other agencies has been even less substantial. As a result, elder mistreatment research has thus far been confined to a small community of