Abuse and neglect

What is Abuse?

This section considers the different types and patterns of abuse and neglect and the different circumstances in which they may take place.

This is not intended to be an exhaustive list but a guide as to the sort of behaviour which could give rise to a safeguarding concern.

The next sections give more details of each aspect of how the specific types of abuse can present itself.

Physical injuries can occur where there is no satisfactory explanation, definite knowledge, or a reasonable suspicion that injury was inflicted with intent, caused through lack of care by the person having custody, charge or care of that person.

The following list may be indicators of many different problems, it is important not to jump to the wrong conclusion too quickly, some of the indicators could be as follows -

History of unexplained falls
Unexplained bruising - in well protected areas or soft parts of the body
Bruising in different stages of healing
Unexplained burns - unusual location or type
Unexplained fractures to any part of the body
Unexplained lacerations or abrasions
Slap, kick, punch or finger marks
Injury shape similar to an object
Untreated medical problems
Weight loss due to malnutrition or dehydration

Sexual abuse is the involvement of vulnerable adults in sexual activities, which they do not fully comprehend, to which they are unable to give consent, to which they object or which may cause them harm.

The following list may be indicators of many different problems - it is important not to jump to conclusions too quickly, some of the indicators could be as follows -

Sudden change in behaviour
Sudden onset of confusion
Incontinence
Withdrawal
Overt sexual behaviour or language by the vulnerable adult
Self-inflicted injury
Disturbed sleep pattern or poor concentration
Difficulty in walking
Torn, stained underwear
Love bites
Pain or itching, bruising or bleeding in the genital area
Sexually transmitted disease, urinary tract or vaginal infection
Bruising to upper thighs and arms
Frequent infection
Severe upset or agitation when being bathed etc.
Pregnancy in a person unable to consent

Financial or material abuse can take the form of fraud, theft or using of the vulnerable adult's property without their permission. This could involve large sums of money or just small amounts from a pension or allowance each week.

It is important not to jump to the wrong conclusions too quickly; however the following is a list of possible indicators of financial abuse -

Sudden inability to pay bills
Sudden withdrawal of money from an account
Person lacks belongings that they can clearly afford
Lack of receptivity by the persons relatives to necessary expenditure
Power of attorney obtained when the person is unable to understand what they are signing
Extraordinary interest by family members in the vulnerable adults assets
Recent change of deeds to the house
Carer's main interest is financial with little regard for the health and welfare of the vulnerable adult
The person managing the finances is evasive and uncooperative
Reluctance to accept care services
Purchase of items that the individual does not require or use
Personal items going missing
Unreasonable or inappropriate gifts

This can include intimidation, humiliation, shouting, swearing, emotional blackmail, denial of basic human rights, using racist language, preventing someone from enjoying activities or meeting friends.

The following may be indicators of many different problems, it is important not to jump to the wrong conclusions too quickly:

Ambivalence about carer
Fearfulness, avoiding eye contact, flinching on approach
Deference
Insomnia or need for excessive sleep
Change in appetite
Unusual weight loss or gain
Tearfulness
Unexplained paranoia
Low self esteem
Confusion or agitation
Coercion
Possible violation of human and civil rights
Distress caused by being locked in a home or car etc.
Isolation - no visitors or phone calls allowed
Inappropriate clothing
Sensory deprivation
Restricted access to hygiene facilities
Lack of personal respect
Lack of recognition of individual's rights
Carer does not offer personal hygiene, medical care, regular food or drinks
Use of furniture to restrict movement

A person can suffer because their physical or psychological needs are being neglected by a carer. This could include failure to keep someone warm, clean and well nourished or neglecting to give prescribed medication.

The following list may be indications of many different problems, it is important not to jump to the wrong conclusion too quickly.

Poor environmental conditions
Inadequate heating and lighting
Poor physical condition of the vulnerable adult
Person's clothing is ill fitting, unclean and in poor condition
Malnutrition
Failure to give prescribed medication properly
Failure to provide appropriate privacy and dignity
Inconsistent or reluctant contact with health and social care agencies
Isolation - denying access to callers or visitors

Discriminatory abuse is often on the grounds of: age, gender, race, culture, religion, sexuality or disability.

It also incorporates hate crime and mate crime. Mate crime occurs when vulnerable adults are "befriended" with the intention to abuse:

derogatory comments
harassment
being made to move to a different resource or service based on age
being denied medical treatment on grounds of age or mental health
not providing access

Organisational abuse – including neglect and poor care practice within an institution or specific care setting such as a hospital or care home, for example, or in relation to care provided in one’s own home. This may range from one off incidents to on-going ill-treatment.

It can be through neglect or poor professional practice as a result of the structure, policies, processes and practices within an organisation.

The following list may be possible indicators of institutional abuse - it is important not to jump to the wrong conclusions too quickly.

No flexibility in bed time routine or deliberate waking
People left on the commode or toilet for long periods of time
Inappropriate care of possessions, clothing and living area
Lack of personal clothes and belongings
Un-homely or stark living environments
Deprived environmental conditions and lack of stimulation
Inappropriate use of medical procedures such as enemas or catheterisation
'Batch care' - lack of individual care programmes
Illegal confinement or restrictions
Inappropriate use of power or control
People referred to, or spoken to with disrespect
Inflexible services based on convenience of the provider rather than the person receiving services
Inappropriate physical intervention
Service user removed from the home or establishment without discussion with other appropriate people or agencies, because staff are unable to manage the behaviours

Reporting abuse

Information on contact details or to report abuse online can be found at https://www.kent.gov.uk/social-care-and-health/report-abuse

Last updated: 24/02/2023

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