Abuse and neglect

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 

Physical injuries can happen when there's no clear explanation or when there's a suspicion that someone caused the injury on purpose or didn't take proper care of the 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, especially in well-protected areas or soft parts of the body
• Bruising in different stages of healing
• Unexplained burns, especially in unusual locations or types
• Unexplained fractures to any part of the body
• Unexplained cuts or scrapes
• Marks from slaps, kicks, punches, or fingers
• Injuries that look like they were caused by an object
• Untreated medical problems
• Weight loss due to malnutrition or dehydration

 

Sexual 

Sexual abuse is when vulnerable adults are involved in sexual activities that they don't fully understand, can't consent to, object to, or that may harm them.

The following list may indicate various problems, so it's important not to jump to conclusions too quickly. Some indicators could be:

• 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
• Pregnancy in a person unable to consent

 

Financial

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

It's important not to jump to conclusions too quickly, but here are some possible indicators of financial abuse:

• Sudden inability to pay bills
• Sudden withdrawal of money from an account
• Person lacks belongings they can clearly afford
• Relatives are not receptive to necessary expenditure
• Power of attorney obtained when the person doesn't understand what they are signing
• Extraordinary interest by family members in the vulnerable adult's 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 the individual doesn't need or use
• Personal items going missing
• Unreasonable or inappropriate gifts

 

Emotional or Psychological 

This can include things like intimidation, humiliation, shouting, swearing, emotional blackmail, denying basic human rights, using racist language, and stopping someone from enjoying activities or meeting friends.

The following signs may indicate various problems, so it's important not to jump to 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

 

Neglect 

A person can suffer if their physical or psychological needs are neglected by a carer. This could include not keeping someone warm, clean, and well-nourished, or not giving prescribed medication.

The following signs may indicate various problems, so it's important not to jump to conclusions too quickly:

• Poor environmental conditions
• Inadequate heating and lighting
• Poor physical condition of the vulnerable adult
• Ill-fitting, unclean, and poor-condition clothing
• Malnutrition
• Not giving prescribed medication properly
• Lack of appropriate privacy and dignity
• Inconsistent or reluctant contact with health and social care agencies
• Isolation - denying access to callers or visitors

 

Discriminatory

Discriminatory abuse happens when someone is treated unfairly because of their age, gender, race, culture, religion, sexuality, or disability.

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

Some signs of discriminatory abuse include:

• Derogatory comments
• Harassment
• Being made to move to a different resource or service based on age
• Being denied medical treatment because of age or mental health
• Not providing access to necessary services

 

Organisational

Organisational abuse includes neglect and poor care practices within institutions like hospitals or care homes, or in care provided at home. This can range from one-off incidents to ongoing mistreatment.

It can happen due to neglect or poor professional practices caused by the structure, policies, processes, and practices within an organisation.

The following signs may indicate organisational abuse, but it's important not to jump to conclusions too quickly:

• No flexibility in bedtime routines or deliberate waking
• People left on the commode or toilet for long periods
• Inappropriate care of possessions, clothing, and living areas
• Lack of personal clothes and belongings
• Un-homely or stark living environments
• Poor environmental conditions and lack of stimulation
• Inappropriate use of medical procedures like 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 the provider's convenience rather than the person's needs
• Inappropriate physical intervention
• Service users removed from the home or establishment without proper discussion because staff can't manage behaviours

More information and how to report abuse online can be found on the Kent County Council Website report abuse page.

NHS Website

Abuse and neglect of adults at risk (safeguarding) - Social care and support guide - NHS

Hourglass

Hourglass have a hotline to provide information and support to an older person or anyone concerned about an older person who is at risk of, experiencing or recovering from any form of abuse or neglect. 

• Hourglass website
• Call their hotline: 0808 808 8141 (available 24 hours a day, seven days a week)
• Text their hotline: 07860052906
• Email: helpline@wearehourglass.org