Cognitively impaired older adults are at risk for caregiver neglect, but characteristics of these neglected older adults and their circumstances have not been well described. We quantitatively and qualitatively examined case records from an emergency department/hospital-based elder mistreatment response team, analyzing data from 146 cognitively impaired older adults experiencing caregiver neglect. Nearly half of cases involved suspicion of multiple forms of mistreatment. The neglecting caregiver was most often the patient's child. We identified nine key themes from these cases: (1) caregiver impairment, (2) conflict between caregivers, (3) sudden appearance of relative or new "friend" offering to help, (4) inadequate supervision or care, (5) unsafe physical home environment, (6) isolation from family and friends, (7) delays in seeking medical care, (8) interference with care, and (9) attempts to honor patient preferences. The wide range of situations that may lead to neglect emphasizes the need for multifaceted interventions.