Many questions and contradictions pervade both the understanding of what has come to be known as ‘elder abuse and neglect’ and attempts to address it. Four major competing constructions reflecting four differing needs discourses can be discerned in legislation, programmes and services, and in the actions of individuals. In this paper these constructions are introduced, examined and situated, with reference to the social and historical antecedents that have contributed to the emergence of elder abuse and neglect as a social problem. The article considers how these constructions are manifest in public and private responses to elder abuse and neglect, through discussion of the Canadian experience of service delivery to older people in situations of mistreatment and neglect, in non-institutional settings. It is concluded that deeply embedded value conflicts in Canadian society and in its political economy, compound the problem of resolving issues of mistreatment through public policy.