POPULATIONS AT RISK ACROSS THE LIFESPAN:POPULATION STUDIES The Public Health Nursing Role in Elder Neglect in Assisted Living Facilities Linda R. Phillips, Ph.D., R.N., F.A.A.N. and Carolyn Ziminski, R.N., B.S. Center for the Advancement of Gerontological Nursing Science, UCLA School of Nursing, Los Angeles, California Correspondence to: Linda R. Phillips, Professor and Audrienne H. Moseley Endowed Chair in Nursing, Director, Center for the Advancement of Gerontological Nursing Science, Factor Building Room 5-133A, 700 Tiverton Avenue, Los Angeles, CA 90095. E-mail: lrphillips@sonnet.ucla.edu ABSTRACT Objective: 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 inspec- tions and narrative reports of complaint investigations written by Arizona state surveyors in 165 ALFs. Measures: Database that included citations and allegations for the selected facilities. Results: Neglect was related to numerous poor outcomes, including injury, emergency department vis- its, 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. Conclusions: Public health nurses working with older adults residing in ALFs and working in communi- ties 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. Key words: domestic violence, elderly, health policy, long-term-care. In Healthy People 2020, elder maltreatment is identified as an “emerging area” of concern in injury and violence prevention (U.S. Department of Health and Human Services, 2010). In addition, legislative bodies recognize neglect of elders in resi- dential care facilities, including assisted living facili- ties (ALFs), as an important public health problem (U.S. Government Accountability Office (GAO), April 26, (1999); US House of Representatives, July 30, 2001; US Senate Committee on Finance, June 18, 2002; US Senate Special Committee on Aging, (2011); U.S. GAO, (2004)). Public health nurses are responsible for working with other groups in moni- toring, anticipating, responding to, and developing public policy about public health programs, particu- larly those involving vulnerable groups (American Public Health Association, Nursing Section, 1996), such as older adults living in residential care settings. In addition, some public health nurses are in the unique position of being surveyors in State Health Departments, the regulatory bodies that usually license ALFs. Little research provides guid- ance to these nurses about the role of public health nurses in addressing the problem of elder neglect in ALFs. Therefore, this study was designed to begin to fill the knowledge gaps by analyzing archived data collected by state surveyors during routine inspections and complaint investigations in one Western state. ALFs are one of several types of facilities designed to provide residential long-term care (National Association of Long Term Care, 2007). ALFs were originally designed as housing alterna- tives for older adults with stable health conditions and the capability for self-care with or without supportive services (Wilson, 2007; Zimmerman & 1 Public Health Nursing 0737-1209/© 2012 Wiley Periodicals, Inc. doi: 10.1111/j.1525-1446.2012.01029.x