Purpose: To describe the care relationships between caregivers and elderly people in Uruguayan nursing homes. Design: A qualitative study with an ethnographic approach conducted at nine nursing homes for elderly people located in four Uruguayan departments. Twenty-three purposively and theoretically selected participants were interviewed and observed between January 2011 and January 2012. Results: Study of relationships among caregivers, managers, and residents revealed a number of issues: perception and experience of elder abuse, suffering when faced with death, and existential pain. Conclusion: A cultural context of discrimination against the elderly and other factors converge to perpetuate elder abuse and suffering in care homes: the lack of adequate regulations covering safety and quality of care, lack of a care model and regular inspections, absence of minimum training requirements for caregivers, and lack of support in situations that have psychic and spiritual repercussions. The inclusion of nurses could promote the development of educational interventions to modify abusive conduct. Nursing home managers need knowledge, skills, and communication strategies to identify and manage inappropriate behavior. An urgent review of nursing home regulations is required to protect elderly people’s rights.