Abuse and Neglect

Abuse and Neglect

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People are not always aware that adults, as well as children, are at risk and can experience abuse and neglect.

Abuse or neglect in any form needs to be identified and responded to appropriately to make sure harm can be stopped, or managed, to reduce the likelihood of it recurring.

Everyone has a duty to respond if they are worried about abuse or neglect of an adult at risk of harm.

Abuse and neglect are very complex. Patterns of abuse vary and include:

Serial and organised abuse
Long-term abuse in the context of on-going relationships
Opportunistic abuse such as theft occurring because money is left lying around

Incidents of abuse can be one-off or multiple. Repeated incidents of poor quality of care can be described as ‘organisational abuse’. There can often be signs or indicators that abuse has taken place, even if you don't witness an event happening.

16 and 17-year-olds should be referred to child safeguarding services.

Physical abuse

This is non-accidental harm to the body. It can include hitting, pushing, punching, kicking, nipping, pulling hair, rough handling, spitting, misuse of medication or inappropriate use of restraint.

Example:

Mr Jones' support worker pinches him to stop him asking for the nurse to come and help him.

Indicators of physical abuse might include:

Finger marks
Bruising
Unexplained injuries or falls
Inconsistent explanations for injuries or accidents
Unexplained changes in a person's behaviour
A person being fearful of people around them

Domestic abuse

This is defined as an incident or pattern of incidents of controlling, coercive or threatening behaviour, violence or abuse by someone who is, or has been, an intimate partner or family member regardless of gender or sexuality.

It includes those aged under 18, and includes the following types of abuse:

Psychological (often referred to as coercing or controlling behaviour)
Physical
Sexual
Financial
Emotional
So called honour-based
Female genital mutilation
Forced marriage

Example:

At her last physiotherapy appointment Debbie states her husband hits her when he’s drunk. They have a son and daughter in their teens and the son is now mimicking his father’s behaviour.

Indicators of domestic abuse might include:

Fractures
Bruising
Absence from work
Isolation
Depression

Sexual abuse

This can include rape, sexual assault, being forced to look at sexual images or any sexual acts to which an adult has not consented or was pressured into consenting.

Example:

John feels very uncomfortable when the carer visiting him always gives him a kiss and holds him tightly when he arrives at and leaves his home.

Indicators of sexual abuse might include:

Bruising or injuries in intimate areas
Changes in a person's behaviour
Fear, withdrawal, depression, flinching from physical contact
Unusual use of sexual language or sexualised behaviour
Genital and urine infections
Disturbed sleep pattern

Psychological abuse

This can include name calling, threats of harm or abandonment, deprivation of contact, humiliation, blaming, bullying, radicalisation, treating someone like a child, shouting, verbal abuse, threats, intimidation and coercion.

Example:

Charity is told that unless she does what the ward staff tell her, the consultant will stop her family from visiting.

Indicators of psychological abuse might include:

Lack of confidence and self-esteem
Depression, withdrawal
Changes in behaviour (for example, becoming more aggressive)
Lack of trust in others
Deprivation of contact
Bullying
Verbal abuse

Organisational abuse

This can include neglect and poor care practice within an institution or specific care setting such as a hospital or care home. Poor professional practice can be the result of the structure, policies, processes and practices within an organisation.

Example:

The residents of Willow Court are not allowed anything to eat after 7pm because the kitchen is locked once the chef goes home.

Indicators of organisational abuse may include:

Complaints not being responded to
Inflexible routines
Lack of individualised care
Reluctance of staff to report on progress
Increased withdrawal, apathy or challenging behaviour from residents or individuals
Medication not administered

Modern slavery

This encompasses slavery, human trafficking, forced labour and domestic servitude. Traffickers and slave masters use whatever means they have at their disposal to coerce, deceive and force individuals into a life of abuse, servitude and inhumane treatment.

Example:

Leon is 39 years old and has a learning disability. He works on a farm, lives in a leaking caravan, is not allowed to contact his family and is paid £2.50 a week.

Indicators of modern slavery might include:

Severe weight loss
Poor skin condition
Poor hygiene
Extreme anxiety and fear
Low self-esteem
Suicide and self harm risk

Financial or material abuse

This can include theft, fraud, internet scamming, being forced to pay for other people's things, collecting loyalty points for shopping for others, not being allowed access or control of your money or being pressured in connection with your will, possessions or benefits. It can also include coercion in relation to an adult’s financial affairs or arrangements in connection with property, inheritance or financial transactions.

Example:

Mary uses a wheelchair and is dependent on her sister Sue to take her shopping, and help her wash and dress. Because of her care and support needs, Mary feels unable to complain when Sue uses Mary’s money to pay for her own shopping, including clothes, although this leaves Mary very short and unable to afford treats for herself. Sue tells Mary she’d have to ‘go into a home’ without her help.

Indicators of financial abuse might include:

Fear of making decisions
Change in living conditions
Sudden changes in finances or constant supervision by the abuser
Lack of basic items
Money or possessions going missing
Unable to account for spending, incorrect receipts
Worrying about money
Insufficient money to provide for basic need

Self-neglect

This covers a wide range of behaviours where individuals neglect to attend to their basic needs, such as personal hygiene, health or surroundings.

Example:

Deidre is a 75-year-old lady with capacity to make her own decisions, but reduced mobility. She drinks a considerable amount of alcohol each day and spends most of her day in bed, refusing to let carers help her wash and shower.

Indicators of self-neglect might include:

Unkempt appearance
Unkempt surroundings
Hoarding
Non-attendance at health appointments
Lack of engagement with health and social services

Neglect and acts of omission

This can include ignoring medical needs, not providing personal care or withholding necessities such as food, drink, medication or heating. It can also include not managing or supporting services as agreed. Neglect is not only about not providing services or ignoring an adult with care and support needs. For example, not giving medication can be a form of neglect.

Example:

Alison can't get herself a drink because of her disability. Her mum gives her a drink only three times a day so that she doesn't constantly ask to go to the toilet.

Indicators of neglect might include:

Weight loss
Pressure ulcers
Dehydration
Malnutrition
Complaints of pain or discomfort
Complaints of hunger or thirst
Reduced communication skills or independence
Reluctance by the abuser to report on health or progress

Discriminatory abuse

This includes all forms of harassment, bullying or name calling based on a person's disability, ethnic origin, sexuality or gender. In some circumstances this would be considered a hate crime. It can also include not taking account of a person's religious or cultural needs.

Example:

Yousuf is a Muslim man who used to go to mosque by himself until he became disabled. His support staff refuse to take him to mosque because they are not Muslim themselves.

Indicators of discriminatory abuse include:

Using racist or sexist descriptions or innuendos
Victimising somebody because of a disability
Failing to respect religious faiths and practices
Institutional abuse can occur whenever the regimes or routines of an organisation are insensitive to or ignore the unique needs of the service user

Influencing Factors

What are the influencing factors in relation to safeguarding adults?

Factors include:

Complex interpersonal relationships; people may fluctuate in their thinking and can be unclear or unrealistic about their personal circumstances
Unequal power relationships; this is particularly relevant in the care setting
Social isolation; this can lead to issues such as depression
Staff issues; organisational abuse can occur when staff receive inadequate support from management and are inadequately trained, poorly supervised; inappropriate staff behaviours, e.g. failure to respond to leadership, development of factions, bullying, misuse of substances
Historical relationships; the effects of past relationships and personality changes
Mental health issues; capacity to consent and make decisions

It is important to recognise and act on these factors, before, or at the same time as, identifying abuse.

Safeguarding is concerned with many forms of exploitation which you will learn more about during this training. Radicalisation of individuals is also considered a form of exploitation which is covered separately in the Preventing Radicalisation session that you can access as part of the Statutory and Mandatory programme.

Carers and Safeguarding

Circumstances in which a family friend or carer could be involved include:

A carer may witness or speak up about abuse or neglect
A carer may experience intentional or unintentional harm from the adult they are trying to support or from professionals or organisations they are in contact with
A carer may unintentionally or intentionally harm or neglect the adult they support on their own or with others

Assessment of both the carer and the adult they care for must include:

''Consideration of the well-being principle of both people. Section 1 of the Care Act includes protection from abuse and neglect as part of the definition of well-being. As such, a needs or carer’s assessment is an important opportunity to explore the individuals’ circumstances and consider whether it would be possible to provide information, or support that prevents abuse or neglect from occurring, for example, by providing training to the carer about the condition that the adult they care for has or to support them to care more safely.

The Care Act makes provision for carers to be identified as having care and support needs of their own. Carers are entitled to an assessment to explore the individual’s circumstances and consider whether it would be possible to provide information, or support that prevents abuse or neglect occurring, for example, by providing training to the carer about the condition the adult they care for has or to support them more safely.

Reporting a Safeguarding Concern

When you become aware of a concern you must share information at the earliest opportunity. Any immediate protection needs for the person concerned should be addressed.

Speak to your manager about whom you should talk to regarding a safeguarding concern in your organisation. If a crime may have been committed or an individual is in immediate danger, the police need to be contacted.

A decision is then made on the same day as to whether the situation should be referred to the multi-agency 'Safeguarding Adults' procedure. The local authority will decide whether the adult safeguarding concern meets the criteria for a Care Act section 42 Duty of Enquiry.

You need to familiarise yourself with your local organisation’s policy and procedures (including whistleblowing) on escalation if you are still worried.

Case Studies

Jakub

You, as an old friend of Jakub’s, visit every week and you have recently become concerned. You have noticed that Jakub is no longer his usual, good-humoured self, and doesn’t even seem interested in tending to his garden any more. When you speak to Jakub’s daughter, she says that this is natural for someone with dementia and you should stop poking your nose into family business.

On the previous couple of visits, Jakub was wearing clothes with old food stains on them, his hair was very greasy and he smelled strongly of urine. He also appeared to have lost weight, and when you looked through the kitchen cupboards, they were nearly empty.

You ask Jakub if his daughter is helping him and Jakub says yes, she is helping him and obtaining his pension for him. He says he doesn’t always receive all this pension.

Jakub could be experiencing abuse the two easily identified are below, however, on investigation others could become apparent.

Neglects and acts of omission
Financial or material abuse

Philip

Now let's hear Philip's story.

Philip suffered many years of abuse.

Click on the play button to watch the video and consider these three things:

What type of abuse did he suffer?

What might you have done to help him?

What positive practice did the care worker demonstrate?

Warning: This film contains strong language

People can experience more than one type of abuse.

The clip showed Philip describing physical abuse from a family member which would mean he was also experiencing domestic abuse in the home. He also described how his family controlled his money and did not allow him to make personal choices that he was able to make. The family did this without any legal powers awarded to them (financial or material abuse). He was not allowed to make choices or buy essential items and described being neglected at home, left in his room and not being given food (neglect and acts of omission).

All of the types of abuse that Philip suffered would have had a psychological impact on him. The way he described how he was treated emotionally being called names is a form of psychological abuse.

Session Summary

Key Points

The key aims of adult safeguarding are to:
- Prevent harm and reduce risk of abuse or neglect to adults with care and support needs
- Stop abuse and neglect wherever possible, and
- Address what has caused the abuse or neglect
The safeguarding principles are: empowerment, prevention, proportionality, protection, partnership and accountability
All providers' core responsibility across health and social care is to provide safe, effective and high quality care

NEXT STEPS

Continue to the Safeguarding Adults Level 1 eAssessment. This should be completed to demonstrate the required knowledge and understanding and to complete the training. Remember to also familiarise yourself with local procedures.

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