Ramsey-Klawsnik and colleagues examined the characteristics of 119 individuals alleged to have sexually assaulted an elderly resident of a healthcare facility in which the incident was reported to APS and-or other state authorities. Most of the alleged sexual abusers were either facility employees or other residents , and the rest were partners, other family members,visitors to the factors to the facility, or those who had unknown relationships to the victims. Investigation by Adult Protective Services or state regulatory staff substantiated sexual assault in only thirty-two of the 119 allegations. A statistically significant difference in substantiation rates emerged for accused for accused facility employees and residents. Only 4 % of cases of cases alleged to have been perpetrated by staff by staff were substantiated, versus 52 % of cases alleged to have been