such reporting may lead to retaliation or otherwise negatively affect their lives (Hayley et al., 1996). Thus, as Shapira (2000) noted, “The elderly in skilled nursing facilities are among the most vulnerable members of our society. They are dependent on the . . . nursing facility operator for their food, medicine, medical care, dental care, and a bed; a roof over their heads; for assistance with virtually every daily activity.”

On any given day, approximately 1.6 million people live in approximately 17,000 licensed nursing homes, and another estimated 900,000 to 1 million live in an estimated 45,000 residential care facilities, variously known as personal care homes, adult congregate living facilities, domiciliary care homes, adult care homes, homes for the aged, and assisted living facilities (Strahan, 1997; Hawes, et al., 1999, 1995a). Research suggests that the 2.5 million vulnerable individuals in these settings are at much higher risk for abuse and neglect than older persons who live at home, as discussed below. Moreover, these figures may underestimate the number of persons who are actually at risk for abuse or neglect in a nursing home. Based on data from the National Mortality Followback Survey, researchers estimate that more than two-fifths (43 percent) of all persons who turned 65 in 1990 or later will enter a nursing home at some time before they die (Kemper and Murtaugh, 1991; Murtaugh et al., 1990). Moreover, of those who enter a nursing home, more than half (55 percent) will have a total lifetime use of at least one year. The probability of use increases dramatically with age, rising from 17 percent for those aged 65 to 74 to 60 percent for persons aged 85 to 94. Because women live longer than men, their relative risk of lifetime use of a nursing home is higher (i.e., 52 percent versus 33 percent). In addition, because the most rapidly growing segment of the population is those aged 85 and older, the proportion of persons estimated at risk for nursing home use at some time in their lives is expected to increase over time. Thus, while only 2.5 million elders living in a residential long-term care facility on any given day may be at risk for abuse, over their lives many elderly may be at risk during a period of long-term care facility use.

The general goals of this paper are to present the available evidence about the nature and scope of abuse and neglect in nursing homes and other residential care facilities and the causes, as well as to suggest a research agenda. To accomplish these goals, the paper is organized as follows:

  • Section 2 presents definitions of abuse and neglect;

  • Section 3 provides the available evidence about the nature and scope of abuse and neglect in nursing homes;

  • Section 4 presents the available evidence about the nature and scope of abuse and neglect in residential care facilities;

  • Section 5 explains the limitations of these estimates;



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