There is considerable evidence to suggest that older people living in situations of mistreatment and neglect are reluctant to accept help. This is attributed to the high value that older generations place on their privacy and family integrity, and on their ability to cope and remain in charge of their lives. These values are particularly strong in rural communities. The paper explores the challenges these cultural norms pose for formal and informal helpers. The discussion is illustrated by the findings of a study of service delivery in rural Eastern Canada. The study revealed that the efforts of formal and informal helpers to accommodate older people's cultural norms, and respond to what they want, are frequently successful. However, this help is continually under threat from the centralisation and rationalisation of service delivery, as well as an increasing focus on the potential for litigation resulting from harm to clients or helpers. The implications of these findings for practice are discussed.; (abstract from http://www.ingentaconnect.com/content/routledg/cpra/2005/00000017/000000...)