Types of abuse (vulnerable adult)

Recently, we have discussed what makes someone a vulnerable adult and touched on the types of abuse we need to be vigilant about. Today, we would like to elaborate on that. 

Recently, we have discussed what makes someone a vulnerable adult and touched on the types of abuse we need to be vigilant about. Today, we would like to elaborate on that. 

Abuse has many forms, and we have to stay vigilant for the signs that this could be happening. 

Below are the types of abuse that may occur within the care sector and a breakdown of what they are and the signs and indicators to look out for (these are not listed in order of priority): ** If you do not want to read these, then please feel free to close this document now** 

Physical Abuse 

•  Types of physical abuse are assault, hitting, slapping, punching, kicking, hair-pulling, biting, pushing, rough handling, scalding and burning, physical punishments, inappropriate or unlawful use of restraint, making someone purposefully uncomfortable (e.g. opening a window and removing blankets when they are unable to recover themselves or close the window), involuntary isolation or confinement, misuse of medication (e.g. over-sedation), forcible feeding or withholding food, unauthorised restraining, restricting movement (e.g. tying someone to a chair). 
• Signs and indicators – no explanation for injuries or inconsistency with the account of what happened; injuries are inconsistent with the person’s lifestyle, bruising, cuts, welts, burns and/or marks of the body or loss of hair in clumps, frequent injuries, unexplained falls, subdued or changed behaviour in the presence of a particular person, signs of malnutrition, failure to seek medical treatment or frequent changes of GP.

Sexual violence and abuse 

• Types of sexual abuse - rape, attempted rape or sexual assault, inappropriate touch anywhere, non-consensual masturbation of either or both parties, non-consensual sexual penetration or attempted penetration of the vagina, anus or mouth, any sexual activity that the person lacks the capacity to consent to, inappropriate looking, sexual teasing or innuendo or sexual harassment, sexual photography or forced use of pornography or witnessing of sexual acts, indecent exposure. 
• Signs and indicators – bruising, particularly to the thighs, buttock and upper arms; marks on the neck; torn, stained or bloody underclothing; bleeding, pain or itching in the genital area; unusual difficulty in walking or sitting, foreign bodies in genital or rectal openings, infections, unexplained genital discharge or sexually transmitted diseases, pregnancy in a woman who is unable to consent to sexual intercourse, the uncharacteristic use of explicit sexual language or significant changes in sexual behaviour or attitude, incontinence not related to any medical diagnosis, self-harming, poor concentration, withdrawal, sleep disturbance, excessive fear/apprehension of/or withdrawal from relationships, fear of receiving help with personal care, reluctance to be alone with a particular person. 

Psychological or Emotional Abuse

•  Types of Psychological or Emotional Abuse - enforced social isolation – preventing someone from accessing services, educational and social opportunities and seeing friends, removing mobility or communication aids or intentionally leaving someone unattended when they need assistance, preventing someone from meeting their religious and cultural needs, preventing the expression of choice and opinion, failure to respect privacy, preventing stimulation, meaningful occupation or activities, intimidation, coercion. Harassment, use of threats, humiliation, bullying, searing or verbal abuse, addressing a person in a patronising or infantilising way, threats of harm or abandonment, and cyberbullying. 
• Signs and indicators – an air of silence when a particular person is present, withdrawal or change in the psychological state of the person, insomnia, low self-esteem, uncooperative and aggressive behaviour, a change of appetite, weight loss/gain, signs of distress; tearfulness or anger, apparent false claims -by someone involved with the person, to attract unnecessary treatment. 

Financial or Material Abuse 

• Types of Financial or Material Abuse - theft of money of possessions, fraud, scamming, preventing a person from accessing their own money, benefits or assets, employees taking a loan from a person using the service, undue pressure, duress, threat or undue influence put on the person in connection with loans, wills, property, inheritance or financial transactions, arranging less care than is needed to save money to maximise inheritance, denying assistant to manage/monitor financial affairs, denying assistance to access benefits, misuse of personal allowance in a care home, misuse of benefits or direct payments in family home, someone moving into a person’s home and living rent free without agreement or under duress, false representation – using another person’s bank account, cards or documents, exploitation of a person’s money or assets e.g. unauthorised use of a car, misuse of a power of attorney, deputy, appointeeship or other legal authority, rogue trading e.g. unnecessary or overpriced property repairs and failure to carry out agreed repairs or poor workmanship. 
• Signs and indicators – missing personal possessions, unexplained lack of money or inability to maintain lifestyle, unexplained withdrawal of funds from accounts, power of attorney or lasting power of attorney (LPA) being obtained after the person has ceased to have mental capacity, failure to register an LPA after the person has ceased to have mental capacity to manage their finances – so that it appears that they are continuing to do so, the person allocated to manage financial affairs is evasive or uncooperative, the family or others show unusual interest in the assets of the person, signs of financial hardship in cases where the person’s financial affairs are being managed by a court appointed deputy, attorney or LPA, recent changes in deeds or title to property, rent arrears and eviction notices, a lack of clear financial accounts held by a care home or service, failure to provide receipts for shopping or other financial transactions carried out on behalf of the person, disparity between the person’s living conditions and their financial resources e.g. insufficient food in the house, unnecessary property repairs.

Institutional or organisational abuse 

• Types of Institutional or organisational Abuse - discouraging visits or the involvement of relatives or friends, run-down or overcrowded establishment, authoritarian management or rigid regimes, lack of leadership and supervision, insufficient staff or high staff turnover resulting in poor quality care, abusive and disrespectful attitudes towards people using the service, inappropriate use of restraints, lack of respect for dignity and privacy, failure to manage residents with abusive behaviour, not providing adequate food and drink, or assistance with eating, not offering choice or promoting independence, misuse or medication, failure to provide care with dentures, spectacles or hearing aids, not taking account of individuals’ cultural, religious or ethnic needs, failure to respond to abuse appropriately, interference with personal correspondence or communication, failure to respond to complaints. 
• Signs and indicators – lack of flexibility and choice for people using the service, inadequate staffing levels, people being hungry or dehydrated, poor standards of care, lack of personal clothing, possessions and communal use of individual items, lack of adequate procedures, inadequate record-keeping and missing documents, absence of visitors, few social, recreational and educational activities, public discussion of personal matters, unnecessary exposure during bathing or using the toilet. Absence of individual care plans, lack of management overview and support. 

  Neglect and acts of omission 

• Types of Neglect and acts of omission - failure to provide or allow access to food, shelter, clothing, heating, stimulation and activity, personal or medical care, providing care in a way that the person dislikes, failure to administer medication as prescribed, refusal of access to visitors, not taking account of individuals’ cultural, religious or ethnic needs, not taking account of educational, social and recreational needs, ignoring or isolating the person, preventing the person from making their own decisions, preventing access to glasses, hearing aids, dentures etc., failure to ensure privacy and dignity.
•  Signs and indicators include a poor environment—dirty or unhygienic, poor physical condition and/or personal hygiene, pressure sores or ulcers, malnutrition or unexplained weight loss, untreated injuries and/or medical problems, inconsistent or reluctant contact with medical and social care organisations, accumulation of untaken medication, uncharacteristic failure to engage in social interaction and inappropriate or inadequate clothing.

Self-neglect  

• Types of self-neglect include lack of self-care to an extent that threatens personal health and safety, neglect of personal hygiene, health, or surroundings, inability to avoid self-harm, failure to seek help or access services to meet health and social care needs, and inability or unwillingness to manage one’s personal affairs. 
• Signs and indicators – deplorable 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. 

Unfortunately, in the world we live in, abuse can happen to anyone we know, and it is so important to look out for the warning signs and report them. There are so many different types of abuse, but we have chosen to list the ones most commonly seen within the care sector. If you would like to read about the other types of abuse you may see, please visit https://www.scie.org.uk/safeguarding/adults/introduction/types-and-indicators-of-abuse/ and learn more.