The mistreatment of elders by their adult children, spouses, or other caregivers is a problem of increasing magnitude. We have few laws and even fewer policies to help caregivers identify and prevent abuse, partly because it has no common pattern, and partly because it so often goes unreported. Abuse can be intentional or unintentional, and as often results from failing to act, as from acts of anger or cruelty. Therefore, we must do a better job of enforcing mandatory reporting and educating and supporting our caregivers to prevent stress and burnout. Above all, we must seek an ethical course of action, knowing that there are legal, personal, and professional ethical ideals and standards that can guide us, whether the elderly are being cared for in their own home or in nursing homes.