THE PROBLEM: Most physical and emotional abuse is committed by spouses and adult children, who may be caregivers, and victims are reluctant to report it.

SAFETY NET GAPS: Family, neighbors and others often treat suspected abuse as a private matter and don't act. Health-care providers, social services and the justice system aren't able to find and help many hidden, frightened or reluctant victims.

WHAT ADVOCATES WANT:

• Raise awareness so more people will report elder abuse.

• Ensure health-care providers screen for abuse, offer options and report.

• Add training in the criminal justice system, require domestic violence arrests, and fund specialized prosecution units.

WHAT OTHER STATES DO:

• California and others — Teams of professionals look for signs of abuse in elder deaths.

• Illinois — Created statewide elder abuse police unit in 2005.

NEGLECT

THE PROBLEM: So-called "self-neglect" is the most common form of abuse, often resulting from health problems. Symptoms include poor nutrition, not taking medicine, inadequate shelter and hoarding. Many cases require professional intervention.

SAFETY NET GAPS: No comprehensive system to find and help seniors unable to care for themselves.

WHAT ADVOCATES WANT:

• More money so counties can extend outreach, intervention and help.

• More state emergency money for treatment, in-home services and temporary shelter.

• More access to therapy, medication and socialization, and a special fund to clean homes.

WHAT OTHER PLACES DO:

• In Florida — Trained volunteer "senior companions."

• In New York — On Grand Island, firefighters volunteer to visit seniors who live alone.

FINANCIAL EXPLOITATION

THE PROBLEM: Financial abuse is growing rapidly, with thieves using many techniques.

SAFETY NET GAPS: Financial institutions aren't required to report suspected theft. The justice system often lacks adequate time or training to prosecute complicated cases.

WHAT ADVOCATES WANT:

• Better training for bank personnel and increased or required reporting of abuse.

• Tighter state rules for power of attorney, land transfers and wills.

• More law-enforcement training, more prosecution.

• More restrictions and oversight of "senior investment specialists" and the sale of investments, insurance and annuities.

WHAT OTHER STATES DO:

• California, Nevada and others — Make banks report suspected abuse.

• Maine — Easier to reverse shady land transfers.

LONG-TERM CARE

THE PROBLEM: Inadequate staff and training cause poor care.

SAFETY NET GAPS: State standards for staffing fall below the national average, and some training requirements are at the national minimum. The number of state inspectors has decreased.

WHAT ADVOCATES WANT:

• More staffing, training and inspections.

• Tougher penalties for poor performers.

• More fines collected and proceeds used to improve the system.

• Make the state Division of Quality Assurance Web site easier to navigate for those evaluating long-term care.

• Boost Medicaid payments for patient care.

WHAT OTHER STATES DO:

• California — Easy-to-understand ratings for nursing homes.

• Michigan and others — Enforce specific staffing ratios, and require more specialized training.

• New Mexico — Families can install and monitor "granny cams" in nursing home rooms.

INDIVIDUAL CAREGIVING

THE PROBLEM: Elders often don't report abuse due to family ties or fear. Soon, fewer professionals for a fast-growing elder population.

SAFETY NET GAPS: No national system for background checks. Inadequate caregiver training and respite.

WHAT ADVOCATES WANT:

• Decent pay and benefits for professionals, support for volunteers. More training.

• A national background check system.

WHAT OTHER STATES DO:

• Michigan — Task force recommendation would make it harder for caregivers to profit by changing financial documents.