• domestic violence;
  • elderly;
  • health policy;
  • long-term-care



Assisted living facilities (ALFs) are a highly unregulated segment of health care serving a large group of vulnerable elders. The purpose of this study was to examine the scope of neglect and neglect-related outcomes in ALFs and to determine whether citations given by state inspectors for certain institutional practices and staff inadequacies were associated with neglect.

Design and Sample

Exploratory descriptive. Citations given during routine inspections and narrative reports of complaint investigations written by Arizona state surveyors in 165 ALFs.


Database that included citations and allegations for the selected facilities.


Neglect was related to numerous poor outcomes, including injury, emergency department visits, and relocation. Citations related to staff attitudes and inappropriate staffing were associated with more neglect. Data suggest that facilities with citations with enforcement actions had less neglect.


Public health nurses working with older adults residing in ALFs and working in communities that have ALFS need to be aware of the problem of neglect and its related outcomes and their role in public policy and education. Public health nurses working as facility inspectors need to be sensitive to the relationship of institutional practices and staff inadequacies and neglect.