Recognising Abuse and Neglect
Scope of this chapter
Safeguarding is 'protecting an adult's right to live in safety, free from abuse and neglect'.
An important part of safeguarding is taking preventative steps to stop abuse and neglect from happening in the first place. However, there may be times when we are unable to do this, and we must all be able to recognise when abuse or neglect may be occurring.
This chapter describes the 10 categories of abuse and neglect set out in the Care Act 2014 and explains some of the potential signs and indicators to be aware of.
Relevant Regulations
Regulation 12: Safe care and treatment
Regulation 13: Safeguarding service users from abuse and improper treatment
Related Chapters and Guidance
Abuse or neglect can occur in any setting. This includes the place where a person lives, a day service, a hospital or other health setting, in the community etc.
Anyone can cause abuse and neglect. This includes a spouse or partner, a family member or friend, an informal carer, a stranger, another vulnerable adult, paid staff working in services like ours, professionals in health, social care or the police etc.
Even though there are 10 categories of abuse and neglect, these categories rarely occur in isolation. Often, there is more than one type of abuse or neglect taking place.
For example:
- Domestic violence or abuse can include physical abuse and psychological abuse;
- Organisational abuse can include psychological abuse, neglect and acts of omission and financial abuse.
This chapter explains some of the signs and indicators of the different categories of abuse and neglect. However, they may not always be present. For example:
- The person causing harm or the person experiencing it may have hidden it well;
- The person experiencing abuse will not recognise what is happening as abuse and therefore will not react as such.
The signs and indicators should therefore be used as guidance only - be curious and trust your gut feelings. If something doesn’t seem right, it probably isn’t.
There are many reasons why abuse and neglect occur. Some may be malicious where the intention was to exploit or cause harm, others may be accidental or unintentional. Regardless of the circumstances in which the abuse and neglect has happened it should be reported in line with the legal requirements of the Care Act 2014.
Sometimes the individual act of abuse or neglect taking place is also a criminal offence and should be treated as such.
For example:
- Assault;
- Rape;
- Theft;
- Hate crime.
The following 10 categories of abuse and neglect are set out in the Care Act 2014. Alongside each category of abuse in the table below you can see examples of the harmful behaviour that could take place.
|
Category of Abuse |
Examples |
|---|---|
|
Physical Abuse |
Assault, slapping, hitting, pushing, misuse of medication, restraint, inappropriate physical sanctions |
|
Domestic Violence or Abuse |
Honour based violence, all examples within the categories of sexual abuse, physical abuse, psychological abuse and financial abuse |
|
Sexual Abuse |
Rape, indecent exposure, sexual harassment, inappropriate looking or touching, sexual teasing or innuendo, sexual photography, subjection to pornography, witnessing sexual acts, indecent exposure, sexual assault, sexual acts to which the adult has not consented or was pressured into consenting to |
|
Psychological Abuse |
Emotional abuse, threats of harm or abandonment, deprivation of contact, humiliation, blaming, controlling, intimidation, coercion, harassment, verbal abuse, cyber bullying, isolation, unreasonable withdrawal of services or support networks |
|
Financial or Material Abuse |
Theft of money, property or belongings, fraud, internet scamming, coercion in relation to financial affairs or arrangements (e.g., wills, property and inheritance), the misuse or misappropriation of property, money, possessions or benefits |
|
Modern Slavery |
Slavery, human trafficking, forced labour and domestic servitude, debt bondage - being forced to work to pay off debts that will never be paid |
|
Discriminatory Abuse |
Harassment, slurs or similar treatment in relation to race, gender or gender identity, age, disability, sexual orientation or religion |
|
Organisational Abuse |
Neglect and poor practice in a care home, hospital or within an organisation providing care and support to an adult in their own home |
|
Neglect and Acts of Omission |
Ignoring or failing to provide for emotional, medical or physical care needs, failure to provide access to services (e.g., health or care and support), withholding the necessities of life (e.g., food, heating, medication) |
| Self-Neglect |
Neglecting to maintain environment, personal hygiene or health, hoarding |
- Unexplained or repeated marks, injuries or fractures such as bruising, cuts, abrasions or reddened skin, lesions, loss of hair in clumps, bald patches, burns and scalds;
- Pain that is unexplained but not due to a health condition;
- Injuries that are very unlikely to be accidental, for example grip marks, cigarette burns or strangulation marks;
- Behaviourial indicators, such as showing fear around another person, being guarded around what is said and having an aversive reaction to physical contact;
- Medication errors (see below);
- Evidence that the person is being restrained without authorisation, either by direct restraint or by being confined to a particular area;
- Evidence that the person is being made to feel uncomfortable, such as windows opened when they are cold or not being given blankets when they have requested them;
- Evidence that the person is being force-fed.
- Evidence that medication has been deliberately withheld without a valid reason;
- Evidence that medication has been used for a reason other than the one it is prescribed for;
- Evidence that medication is being used routinely to control behaviour or restrict movement;
- Evidence that there has been a deliberate attempt to harm the person;
- Accidental harm of a serious nature has been caused to the person;
- Multiple or frequent errors.
For further information about medication errors see: Information and Guidance for Specific Safeguarding Issues
- Pain or tenderness to areas of the body e.g., swelling or blister-like wounds;
- Pus-like fluid on bed linen or clothing;
- Skin infection that feels cool or hot to the touch;
- The pressure sore requires immediate medical treatment e.g., infection, cellulitis or sepsis.
For further guidance see Information and Guidance for Specific Safeguarding Issues
Domestic violence or abuse always exists alongside another category of abuse, normally either sexual, psychological, physical or financial abuse.
Domestic abuse is a criminal offence.
Research indicates that a vulnerable person is more likely to be subjected to domestic violence or abuse than the general population. There are many possible reasons for this:
- The person not being aware they are being abused;
- The person being worried that if the person abusing them leaves them, they will have no one to look after them;
- The person blaming themselves for the abuse;
- Not knowing how to alert others to the abuse, due to cognitive or communication issues.
Indicators
- Increased health needs-domestic violence or abuse can impact on physical and mental health;
- Suspicious explanations for injuries seem suspicious e.g., “I walked into the door again”;
- Signs of psychological abuse (see below);
- Signs of sexual abuse (see below);
- Signs of physical abuse (see above);
- Signs of financial abuse (see below).
For further guidance see: Adult safeguarding and domestic abuse
Honour based violence and female genital mutilation are both classified as types of domestic violence.
Psychological abuse is also called emotional abuse. It involves saying and doing things that cause a person to be so upset or afraid that they feel powerless to do anything but what the person abusing them wants.
Indicators
- Change in mood-often becoming more withdrawn;
- Unable to sleep;
- Low self-esteem;
- Weight loss/gain;
- Emotional distress-being tearful or afraid;
- Change in behaviour when a particular person is around e.g., suddenly being silent or looking to the other person for approval before saying anything.
Financial or material abuse is complex. It can be perpetrated by individuals that know the person but also by tradesmen or organisations through doorstep, postal, telephone or internet scams.
All the following are examples of financial abuse:
- Theft of money or possessions;
- Stopping someone from accessing their money;
- Applying pressure or using threats to coerce someone into making specific financial decisions e.g., to buy something/not buy something or to leave something in their will;
- Misuse of benefits, direct payments or personal allowance;
- Using someone else's bank cards or bank account;
- Exploitation of money or assets e.g., using their car or staying in their home rent free;
- Family members cancelling care to save money and maximise inheritance;
- Rogue trading e.g., charging too much for work or carrying out unnecessary work;
- Postal, telephone or internet scams e.g., romance scams, banking scams.
Indicators
- Money or possessions are missing, and the person cannot explain where they have gone;
- The person doesn’t have enough money for food, heating and other essentials;
- The person is living ‘in the red’ or borrowing money to survive;
- The person starts to experience financial difficulty after starting a new friendship/relationship;
- Family members or others show an unusual interest in finances;
- Someone is managing finances without the legal authority to do so;
- Unnecessary property repairs have been carried out;
- The person buys someone an expensive item or gifts them large amounts of money out of character;
- Those managing finances for the person do not keep receipts or records;
- Those managing finances for the person are evasive and uncooperative;
- Those managing the person’s finances are not buying the things that the person needs;
- The person signs a lasting power of attorney when they clearly do not have the mental capacity to do this.
Modern slavery is a broad term which involves slavery and human trafficking, forced labour, domestic servitude, and debt bondage. The gang or trafficker deceives or coerces the person into sexual exploitation, criminal behaviour and/ or work with no or little payment or long hours. The gang or trafficker has full control over the person's life.
Indicators
- Signs of physical abuse (see above);
- Signs of psychological abuse (see above);
- Signs of sexual abuse (see below);
- The person is kept isolated from the wider community;
- The person seems malnourished, unkempt or withdrawn;
- The person appears, “invisible”, and disappears frequently;
- The person is living in dirty, cramped or overcrowded housing;
- The person has few personal effects, including clothing and identification documents;
- The person has a fear of the police and other uniformed services.
For further guidance and information see: Modern slavery
Neglect and acts of omission occur when a person is not provided with the care and support they need. This includes support for essentials of life like food and drink, clothing, heating, personal care and access to healthcare. However, it also includes stimulation, interaction and respect for cultural needs.
Indicators
- Signs of physical abuse (see above);
- Signs of psychological abuse (see above);
- Untreated injuries or medical problems;
- Regular health issues, such as urinary tract infections or pressure sores;
- Increased falls-related injuries or number of falls;
- Poor personal hygiene, including oral hygiene and continence;
- Poor appearance e.g., hair, fingernails, clothing;
- Build-up of unused medication;
- The environment is risky e.g., unclean, trip or slip hazards;
- Complaints by family and friends about the service.
Sexual abuse means any sexual act that is non-consensual. Sexual abuse does not always involve physical contact. For example, making someone watch a sexual act, images or video when they have not consented to doing so is still abuse. Sexual abuse can also take place online through social media forums and websites.
Sexual abuse can also be historical. An adult may say that they were sexually abused as a child and wish to report it now.
Indicators
- Changes of behaviour, such as, the person does not like to be touched or is using sexualised language or behaviours;
- Signs of psychological abuse (see above);
- Itching, bleeding or bruising of the genitals, breasts, anal area, or inner thighs;
- Ripped or blood-stained undergarments;
- Difficulty or discomfort walking or sitting;
- Unexplained bodily fluids on clothing or bedding;
- Sexually transmitted infections;
- Urinary tract infections or incontinence not related to a health condition;
- Refusal of personal care;
- Self-harming and self-neglecting behaviours (see below);
- Fear of a particular individual;
- Sleep disturbance, including insomnia and nightmares;
- Pregnancy when the person lacks capacity to consent to sex.
Discriminatory abuse is when a person experiences harassment, victimisation and/or abuse due to one or more protective characteristics under the Equality Act 2010.
Protective characteristics are:
- Age;
- Race;
- Religion and belief;
- Disability;
- Gender or gender identity (including gender reassignment);
- Sexual orientation;
- Marriage and civil partnership;
- Pregnancy and maternity.
Indicators
- Anger and frustration with the service;
- Complaints from the person being supported or their family;
- Signs of psychological abuse (see above);
- Cultural needs in an individual care and support plan not being met.
Organisational abuse occurs when there is a culture of neglect and poor practice by a health or social care service.
Indicators
- Signs of neglect or acts of omission (see above);
- Increased incidents of accidents or challenging behaviour;
- Poorly maintained, unsafe or unclean premises;
- A lack of adequate procedures;
- Poor record keeping and missing documents;
- Inadequate staffing levels;
- Low levels of choice for people using the service;
- Care and support is not built around the needs of people using the service;
- Low regard for the privacy and dignity of people using the service;
- Visitors are not made to feel welcome;
- Inadequate staffing levels which seems to be a constant problem;
- Lack of manager presence and support.
For information about closed cultures and how to reduce the risk of organisational abuse in our service see: Reducing the Risk of a Closed Culture.
Self-neglect is when the person neglects their own care and support needs. This could be intentional or unintentional. Either way, it will have a detrimental effect on the person and negative consequences for their health and well-being.
Indicators
- Weight loss or gain
- Unused medication-unwillingness to take medication;
- Unclean or poorly maintained home;
- Poor appearance or hygiene e.g., dirty clothes, not washing;
- Refusing to access health or social care services, or to comply with advice or treatment;
- Spending lots of time in bed or at home;
- Withdrawing from friends and family;
- Reluctant to allow people into their home;
- Cold home due to not paying bills;
- Debts due to not paying bills;
- Hoarding behaviours.
For further guidance see: Information and Guidance for Specific Safeguarding issues.
Last Updated: September 12, 2022
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