About adult abuse

Find out about the different types of abuse, signs and symptoms, and some of the circumstances in which it may occur.

This is intended to illustrate what adult abuse is and when this should be reported as safeguarding adults concern.

Report abuse

If you suspect an adult is being abused report it to the relevant Council.

Physical abuse

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

The following could indicate physical abuse:

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 / 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
Over and under medication
Weight loss due to malnutrition or dehydration

Sexual abuse

Sexual abuse is the involvement of vulnerable adults in sexual activities, which:

They do not fully comprehend
They cannot give consent to
They object to, or
May cause them harm

The following list may indicate sexual abuse. They must be viewed in the context of the situation, taking account of other factors. Often more than one indicator may be apparent. There may be other causes for the indicators listed below but a combination of several factors is often found in sexual abuse cases:

An adult discloses that they have been sexually abused or raped, or subjected to sexual assault or sexual harassment
Sudden change in behaviour; sudden onset of confusion, or withdrawal
Incontinence
Overt sexual behaviour/language by the vulnerable adult
Self-inflicted injury and self-harm
Disturbed sleep pattern/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/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
Sexual exploitation

5% of abuse enquiries in Richmond relate to sexual abuse.

Financial

Financial or material abuse can take the form of fraud, theft or using 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.

The following could indicate financial abuse:

Sudden inability to pay bills
Sudden withdrawal of money from an account
Person lacks belongings that they can clearly afford
Person’s relatives are not receptive to necessary expenditure
Power of attorney is obtained when the person is unable to 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 that the individual does not require or use
Personal items going missing
Unreasonable or inappropriate gifts

20% of cases investigated related to financial or material abuse.

Emotional or psychological

Emotional or psychological abuse can include intimidation, humiliation, shouting, swearing, emotional blackmail and denial of basic human rights, as well as using racist language and preventing someone from enjoying activities or meeting friends.

The following may indicate emotional abuse:

Ambivalence about carer
Fearfulness, avoiding eye contact, flinching on approach
Deference
Insomnia or need for excessive sleep
Change in appetite
Unusual weight loss / gain
Tearfulness
Unexplained paranoia
Low self esteem
Confusion, 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 individuals rights
Carer does not offer personal hygiene, medical care, regular food/drinks
Use of furniture to restrict movement

14% of cases investigated last year resulted from emotional abuse.

Neglect

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

The following may indicate neglect:

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

26% of safeguarding enquiries completed during 2016/17 related to allegations of neglect.

Discriminatory

Discriminatory abuse is often on the grounds of age, gender, race, culture, religion, sexuality or disability. This type of abuse and others can be perpetrated through grooming. This can be called ‘Mate crime’ and it occurs when vulnerable adults are "befriended" with the intention to abuse.

Mencap have recently launched the "Stand by Me" campaign to eradicate Hate and Mate crime.

The following may indicate discriminatory abuse:

Derogatory, offensive and racist comments and actions, graffiti, trolling etc.
harassment and bullying due to a personal attribute
being made to move to a different resource/ service based on age
being denied medical treatment on grounds of age or mental health
not providing access

There were only two cases of discriminatory abuse reported under safeguarding adults during 2016/17. 22 Disability hate crimes were investigated in Richmond during 2016.

Organisational

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

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

The following may indicate organisational abuse:

No flexibility in bed time routine and/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
Unhomely or stark living environments
Deprived environmental conditions and lack of stimulation
Inappropriate use of medical procedures e.g. enemas, 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

Self-neglect

Self-neglect is any failure of an adult to take care of himself or herself that causes, or is reasonably likely to cause within a short period of time, serious physical, mental or emotional harm or substantial damage to or loss of assets.

Types of self-neglect

Lack of self-care to an extent that it threatens personal health and safety
Neglecting to care for one’s personal hygiene, health or surroundings
Inability to avoid self-harm
Failure to seek help or access services to meet health and social care needs
Inability or unwillingness to manage one’s personal affairs

The following may indicate self-neglect:

Very poor personal hygiene
Unkempt appearance
Lack of essential food, clothing or shelter
Malnutrition and/or dehydration
Living in squalid or unsanitary conditions
Neglecting household maintenance
Hoarding
Collecting a large number of animals in inappropriate conditions
Non-compliance with health or care services
Inability or unwillingness to take medication or treat illness or injury

Modern slavery

As a SAB we have not received or investigated modern slavery or trafficking of adults with care and support needs locally. However this does not indicate that it does not occur and in fact the SAB has taken action, through training local professionals and raising awareness locally.

Types of modern slavery

Human trafficking
Forced labour
Domestic servitude
Sexual exploitation, such as escort work, prostitution and pornography
Debt bondage – being forced to work to pay off debts that realistically they never will be able to

The following may indicate modern slavery:

Signs of physical or emotional abuse
Impingement on human rights, removal of personal ID, passport etc. and substantial control of one person by another
Appearing to be malnourished, unkempt or withdrawn
Isolation from the community, seeming under the control or influence of others
Living in dirty, cramped or overcrowded accommodation and or living and working at the same address
Lack of personal effects or identification documents
Always wearing the same clothes
Avoidance of eye contact, appearing frightened or hesitant to talk to strangers
Fear of law enforcers

The Home Office provides information on identifying and reporting modern slavery.

Domestic violence

Domestic violence and abuse includes any incident or pattern of incidents of controlling, coercive or threatening behaviour, violence or abuse between those aged 16 or over who are or have been, intimate partners or family members regardless of gender or sexuality. It also includes so called 'honour’-based violence, female genital mutilation and forced marriage.

Coercive or controlling behaviour is a core part of domestic violence. Coercive behaviour can include:

Acts of assault, threats, humiliation and intimidation
Harming, punishing, or frightening the person
Isolating the person from sources of support
Exploitation of resources or money
Preventing the person from escaping abuse
Controlling everyday behaviour

The Safeguarding Adults Board will be involved when domestic abuse involves adults with care and support needs, or has an impact on a person with care and support needs (for example when a disabled or older person is affected by domestic violence perpetrated against them or around them resulting in their harm).