Sullivan, 1983; Douglass et al., 1980; Fontana, 1978; Gubrium, 1975; Jacobs, 1969; Kayser-Jones, 1990; Monk et al., 1984; Stannard, 1973; U.S. House of Representatives, Select Committee on Aging, 1990). Such conditions were major factors in the passage of the nursing home reforms contained in the Omnibus Budget Reconciliation Act (OBRA) of 1987 (OBRA, 1987).4 The OBRA 1987 reforms, the most sweeping set of legislative changes to the way nursing homes were regulated since the passage of Medicaid and Medicare, addressed multiple areas of resident care and quality of life. They also specified that residents had the right to be free from verbal, sexual, physical, and mental abuse, including corporal punishment and involuntary seclusion, and limited the use of physical restraints and inappropriate use of psychotropic medications (Hawes, 1990; Elon and Pawlson, 1992).
Despite this federal law and reports over the preceding decades that raised the possibility of widespread and serious abuse, there has never been a systematic study of the prevalence of abuse in nursing homes. Indeed, it is important to note that none of the studies discussed below involving interviews with residents or with facility staff were designed with the intention of producing generalizable estimates to the nation as a whole. Nevertheless, the disparate evidence that is available and discussed below suggests the existence of a serious problem that warrants further study.
Several studies have examined the characteristics of individuals living in community settings (e.g., their own home or that of others) in an attempt to identify factors that place an older person at greater risk for being abused or neglected. Such studies found that persons suffering abuse or neglect were more likely to be old and nonwhite and to have greater limitations in physical and cognitive functioning, although there has been some disagreement about whether functional impairment in the activities of daily living (ADL) is a risk factor for abuse (Bristowe and Collins, 1989; Johnson, 1991; Lachs et al., 1994; Lachs et al., 1996, 1997; Pillemer and Finkelhor, 1988; Podnieks, 1992). However, there is strong evidence that the presence of cognitive impairment or dementia is associated with higher risk for being abused (Coyne et al., 1993; Dyer et al., 2000; Homer and Gilleard, 1990; O’Malley et al., 1983; Paveza et al., 1992; Pillemer and Finkelhor, 1988; Pillemer and Suitor, 1992; Wolf and Pillemer, 1989).
Studies of individual risk factors for elderly living in residential long-term care facilities are more limited but generally suggest the existence of