The demographic change will be a challenge for organizing long term care for older people in the future. As a matter of facts, the abuse of older people in need of care is increasing and becomes a pressing social problem. The dependence of many old people caused by physical or psychological restraints makes, the situation complicated and the risk of becoming a victim of elder abuse is rising, particularly in the case of familial care settings. The article starts with a definition of the term violence against older people and gives different reasons that explain abusive behavior against people in need of care. The psychological stress or physical strain on the side of the caregiver is as well in focus as relationship conflicts between the familial caregiver and the old person in the need of care. Moreover, empirical data on elder abuse in Germany is presented. In the second half of the article, various benefits of the long term care insurance as an instrument of prevention are described with a focus on counseling and support services for the caregiver. The need to develop strategies of intervention which include the will and the interests of the old people in need of care is pointed out.