Homicides of dependent elderly and nonelderly adults by their caregivers violate trust and have long-term consequences for families. A better understanding of the characteristics of homicide by caregivers may provide insights that can inform prevention efforts. Data collected in the National Violent Death Reporting System (NVDRS) between 2003 and 2007 are used to characterize victims, perpetrators, and caregiver roles, and circumstances that precipitated homicides by a caregiver. A total 68 incidents are categorized into either homicide by neglect ( n = 17), intentional injury of the victim only (n = 21), or homicide followed by suicide of the perpetrator (n = 30). Demographics, mechanism of injury, location of injury, and victim-suspect relationship variables are supplemented by narrative accounts of incidents. In general, findings show that adult homicide victims of a caregiver were widowed (42.6%), non-Hispanic (97.1%), White (88.2%), women (63.2%) killed in their homes (92.6%) with a firearm (35.3%) or by intentional neglect (25.0%) by a husband (30.9%) or a son (22.1%). Nearly half were aged 80 years and older (48.5%), 42.6% were aged 50 to 79 years, and 0.9% were aged 20 to 49 years. Many homicide by caregiver incidents are precipitated by physical illness of the victim or caregiver, opportunity for perpetrator financial gain, mental illness of the caregiver, substance use by the caregiver, or an impending crisis in the life of the caregiver not related to illness. Understanding the vulnerabilities of victims, the characteristics of suspects, and the multiple types of motivations is key to developing effective prevention efforts.