Overall, the findings did not indicate that physical violence against nursing home residents was common in German long-term care institutions; however, severe incidents of the physical abuse of elderly nursing home residents do occur. Night shifts were particularly critical periods for staff mistreatment of residents. Residents' loss of control of their elimination functions was sometimes the trigger for the abuse of residents. Although there was widespread agreement among the homes' nursing staff that physical abuse of elderly residents was unacceptable, verbal aggression by nurses was often viewed as justified in gaining residents' compliance with nurses' requests or as excusable as a stress reaction or response to a resident's aggressive behavior. Nurses were generally aware of the legal requirements associated with the use of mechanical restraints. Nurses emphasized that the use of sedatives to control residents' behavior was the responsibility of residents' doctors, who controlled drug prescriptions. Psycho-social neglect was common in the institutions. Treating the residents like children was especially characteristic of less qualified staff. Inadequate staff training and education were linked to poor strategies for managing stress and engaging in abuse and neglect. Investigators, prosecutors, and researchers all reported barriers to identifying and responding appropriately to the abuse and neglect of elderly nursing home residents. A total of 251 interviews were conducted with individuals linked to 8 randomly selected nursing homes in the Federal State of Hesse in central Germany. Those interviewed included nursing home owners and administrators; staff working in the fields of health care and social work; residents and their family members, friends, and legal guardians; doctors; clergy; and State survey agencies. 5 tables and 15 references