Perspectives on Mistreated Homebound Older Adults Living in Geographically Isolated Communities

The mistreatment of homebound older adults living in geographically isolated rural communities remains an underexplored public health and social justice concern in the United States. Although national efforts to prevent elder mistreatment (EM) have expanded, limited attention has been given to older adults who are geographically isolated. This study explored the perspectives of practitioners who work directly with this population, focusing on how they perceive, experience, and respond to EM within rural contexts characterized by distance, resource scarcity, and strong cultural norms of independence. Guided by the Contextual Theory of Elder Abuse and Role Strain Theory, this study employed a phenomenological approach to capture the lived realities of practitioners in three rural counties (Montgomery, Pulaski, Floyd), within Virginia’s Planning and Service Area (PSA) 4. Seven practitioners (i.e., Adult Protective Services staff, public health nurse, long-term care ombudsman, Cooperative Extension agent, faith leader, social services supervisor) participated in semi-structured interviews conducted via Zoom. Data were analyzed using reflexive thematic analysis, yielding five major themes: neglect and isolation as overlapping conditions that heighten vulnerability, financial exploitation as interpersonal and technologically mediated, systemic and structural barriers that hinder timely intervention, cultural norms of privacy and dignity that shape reporting and response, and community-driven solutions grounded in trust and collaboration. The findings reveal that EM in rural, homebound settings cannot be separated from the broader ecological realities of place, culture, and care. Practitioners described navigating ethical and emotional strain while balancing respect for autonomy with the urgency of protection and emphasized that effective interventions depend not only on policy and law but also on local trust, relationships, and context-sensitive outreach. This study contributes to gerontological and rural aging scholarship by illuminating the voices of frontline professionals serving invisible populations. It underscores the need for multilevel, relationship-centered strategies that integrate community networks, enhance caregiver support, and expand rural infrastructure to ensure safety and dignity for homebound older adults.