potential years of productive life lost. This strategy virtually ignores health issues for elders over age 65. For example, there are only ten reservation-based nursing homes in the United States, and they currently house 435 residents (Manson, 1989). A National Indian Council on Aging (1981) report indicated that 46 percent of older tribal members are assisted by extended family members to accomplish one or more activities of daily living.

Data regarding long-term care of the minority population are particularly lacking in respect to Hispanic elderly people, especially given the fact that Hispanics make up about 4 percent of the elderly population in the United States (AARP, 1985a) and are the fastest growing subgroup of the elderly (Lopez-Aqueres et al., 1984). More than 600,000 Hispanics are over the age of 65 (AARP, 1985b). What data do exist show that Hispanic populations report greater utilization of informal support systems than of professional health care providers (Greene and Monohan, 1984). As with Asians and Pacific Islanders in the United States, elder Hispanics face hypertension, tuberculosis, and cancers as their major health concerns. These elderly are less likely to use formal health care services, including nursing homes, due to lack of knowledge of available services (Holmes et al., 1983), cultural and language differences, and reliance on traditional medicine (Espino et al., 1988; AARP Minority Affairs, 1990).

In a study of nine nursing homes in San Antonio, Texas, Chiodo and colleagues (1994) found strong evidence that Mexican American nursing home residents are more cognitively and functionally impaired, after controlling for age and education, than non-Hispanic white residents. They also were significantly more likely to be funded by Medicaid, and they were more likely to have lived with relatives prior to institutionalization.

Major differences between Puerto Rican Hispanics and non-Hispanics admitted to nursing homes were identified in a study by Espino and coworkers (1988). The Puerto Rican Hispanics were significantly younger and functionally more impaired, both physically and mentally, than their non-Hispanic counterparts and more similar to chronologically older non-Hispanic nursing home residents.

Some research documents the need for nurses to be aware of the implications of ethnicity in caring for the elderly. In a study of immigrant, Canadian-born, and Anglo-born elderly in long-term-care facilities, Jones and Van Amelsvoort Jones (1986) found significant differences in the observed interactions among the groups. Although the elderly as a whole had minimal verbal interaction directed to them during morning and evening care, overall, male residents were spoken to less than female residents, and ethnic females had the least number of commands, the fewest statements, and the least number of questions spoken to them by staff.

Violence, Abuse, and Conflict

"Granny battering" and "slow euthanasia" are heard about quite often by



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