The problem of how to conceptualize elder mistreatment goes back several decades, and is especially important for ethnic minority populations, who may have perspectives that differ from the dominant society. This community-based participatory research study, which examined perceptions of mistreatment by family among 100 urban and rural older American Indians, permits a rare glimpse into how Native elders themselves understand this issue. Here, good treatment was conceptualized in terms of being taken care of, having one’s needs met, and being respected. We found relatively high standards for how elders should be treated —such as the belief that an elder’s needs should be anticipated and met without the elder needing to ask—in the face of widespread accounts of the mistreatment of elders within the community, largely through various acts of financial exploitation and neglect. Substance abuse and culture loss were blamed for much of the elder mistreatment occurring in contemporary Native communities.