Imbedded in today’s nursing home culture is a practice that has been notoriously associated with elder abuse in nursing homes. Nationwide, many nursing home residents with advanced cognitive impairment are tube fed (35% according to some studies), despite no demonstrable benefits of this intervention in this population. Studies suggest that organizational features of nursing homes are associated with this practice, but underlying reasons for these associations are poorly understood. A feeding tube in a sub-standard nursing home can be a death sentence. My Elder Advocate has been very successful in preventing this abuse from occurring in many cases, where we were called in early to advocate for clients who were losing weight in nursing homes.