Despite a growing interest in elder abuse and neglect (EAN) among researchers and policy-makers in recent decades, most studies have concentrated on community-dwelling elders [1]. Little is known about mistreatment within institutional settings like nursing homes (NHs). This scarcity of evidence is especially palpable in low-and middle-income countries. Estimates from the National Center on Elder Abuse revealed that out of 44% of long-term care (LTC) residents who experienced abuse, only 7% of these cases were reported [2]. Compared to those living in the community, institutionalized older adults are at higher risks of abuse as they tend to be more physically dependent, have poorer cognition, lack social support, and come from lower socioeconomic background [3, 4]. Other factors have also been attributed to abuse in NHs such as inadequate staff training, lack of research, poor working conditions, funding issues, and absence of proper guidelines and screening tools [5]. In addition, gaps in policies and weak law enforcement–2 common phenomena in low-and middle-income countries–often translate into a “deficit” in regulation and monitoring of LTC facilities [6, 7]. This renders institutional abuse largely hidden and unreported.

In Malaysia, NHs and aged care facilities are either managed by the government (publicly funded), private entities, or nongovernmental organizations (NGOs)/welfare bodies. Public NHs and those run by NGOs are generally not for profit, while private aged facilities are mostly commercial. Each type caters to a distinct group; public NHs are mainly reserved for low socioeconomic elders who lack financial and family support and admission is strictly based on pre-determined criteria (eg, partially dependent, free of communicable diseases, and lack of family support). NHs run by NGOs–also often meant for indigent elders–tend to target specific groups such as marginalized elders (eg, refugees and HIV patients) or provide services based on certain affiliations such as faith (religion) or ethnic group. Private facilities, on the other hand, are costly, thus catering largely to the urban, higher income older populations [8, 9]. Currently, there are approximately twelve public NHs (9 in Peninsular Malaysia and 2 in East Malaysia)[10], 454 NGO-based NHs, and 1,019 private facilities [11]. However, according to unofficial estimates, the total number of NHs is 1,700, with 382 being registered. This discrepancy is due to a lack of reliable data and official websites not being regularly updated.