Safeguarding adults

What is adult abuse?

Abuse of adults can happen anywhere. It can happen at home, in a residential or nursing home, in a hospital, at work or in the street. There are different types of abuse, which include:

• Physical - being hurt or harmed either deliberately or through rough, careless or thoughtless behaviour.

• Emotional abuse or bullying - being humiliated or put down or made to feel anxious or frightened.

• Financial abuse or theft - someone using your money or possessions in a way that you don't want.

• Negligenza - not being given the things you need to feel safe and comfortable or not making sure you get the care or treatment you need.

• Abuso sessuale - being made to do something that you don't want to do, or being made to watch sexual activity when you don't want to.

• Discrimination - including racist, sexist or abuse about a person's disability.

• Domestic abuse - examples include psychological, physical, sexual, financial, emotional abuse or 'honour'-based violence.

• Modern slavery - includes slavery, human trafficking and forced labour.

• Organisational abuse - includes neglect and poor care within an institution or specific care setting such as a hospital or care home.

• Self-neglect - includes not caring for personal cleanliness, health or surroundings, and displaying behaviour such as hoarding.

Adult safeguarding is when professionals such as social workers take steps to protect adults from any kind of abuse. Safeguarding action might be triggered by a referral from another professional, such as a doctor or nurse, but this does not have to be the case. Anyone who is concerned that an adult may be at risk of abuse should make a referral to their local safeguarding team.

Anyone can be vulnerable to abuse at some time in their life. Those who need safeguarding help are often elderly and frail, living on their own at home, or without much family support in care homes. They may suffer from ill health.

Many other groups of people are also at increased risk of suffering harm. Examples include those with physical or learning difficulties, people with mental health needs, those with cognitive impairment (such as dementia), young adults and immigrant workers.

The person who is responsible for the abuse is often well known to the person abused. They could be:

• A paid carer or volunteer.

• A health worker, social care or other worker.

• A relative, friend or neighbour.

• An employer.

• Another resident or service user.

• An occasional visitor or someone who is providing a service.

• Someone who deliberately exploits vulnerable people.

The same principles of safeguarding, discussed below, apply to all adults. Anyone can be an adult at risk. For those who are particularly vulnerable, more care may need to be taken to understand what is happening. For example, if an adult is deaf or has communication difficulties then that will need to be taken into account; if they have a learning disability, the language used will need to be adjusted appropriately.

Abuse of vulnerable adults is common but often not reported. It is not known exactly how common it is.

At first, you might not recognise the signs of abuse. They may appear to be symptoms of dementia or signs of the elderly person's frailty.

Different forms of abuse

General signs of abuse

• Frequent arguments between the carer and the elderly person.

• Changes in personality or behaviour in the person being abused.

Abuso fisico

• Unexplained signs of injury such as bruises, burns or scars, or more serious unexplained injuries such as broken bones.

• Report of a person taking too much of their medicines or not taking their medicines regularly (a prescription has more remaining than it should).

• Broken eye glasses or frames.

• Signs of being restrained, such as bruises on the wrists.

• Staff in a care home refusing to allow you to see the elderly person alone.

Abuso emotivo

• Threatening, belittling, or controlling behaviour by the abuser.

• Behaviour from the abused person that seems like dementia, such as rocking, sucking, or mumbling to themself, when there is no diagnosis of dementia.

Abuso sessuale

• Bruises around the breasts or genitals.

• Unexplained genital infections.

• Unexplained bleeding from the vagina or from the back passage.

• Torn, stained or bloody underwear.

Neglect by caregivers or self-neglect

• Unusual weight loss because of not eating enough food or drinking enough fluids.

• Untreated physical problems, such as bedsores.

• Dirty living conditions: dirt, bugs, soiled bedding and clothes.

• Being left dirty or unbathed.

• Unsafe living conditions (no heat or running water; faulty electrical wiring, other fire hazards).

Financial exploitation

This may include:

• Significant withdrawals from the vulnerable person's bank account.

• Items or cash missing.

• Suspicious changes in wills, power of attorney, policies or other documents.

• Suspicious addition of names to the person's signature card.

• Unnecessary services, goods or subscriptions.

The six principles of adult safeguarding are as follows. These are taken from the Care Act 2014.

1. Empowerment - people are supported and encouraged to make their own decisions and give informed consent, where they understand the consequences of that consent. The information given to someone in order to help them make a decision may vary depending on their personal circumstances. An adult who has mental capacity has the right to make their own decisions.

2. Prevention - it is better to take action before harm occurs than afterwards.

3. Proportionality - the best response to any risk is the one which gives least intrusion into the person's life.

4. Protection - representation for those in greatest need is important so that they are protected.

5. Partnership - local solutions, planned with communities, are better than solutions which are imposed on communities from outside.

6. Accountability - decisions should be transparent and professionals should take responsibility for their decisions.

If you are being abused or concerned about someone else being abused, it is very important to talk about your concerns.

If you are worried that there is an immediate danger of harm then you should contact the police. If you think the person is at immediate risk of serious harm from physical violence then you should dial 999/112/911. If you have reported it to an agency and they have not taken action, but you continue to feel that the person is at risk, then you could consider escalating to someone else within that agency, or involving another agency eg, the police if you have already reported to safeguarding.

It can be difficult for the abused person to talk to someone about what is happening, especially if:

• The person abusing them is otherwise someone they love such as a family member.

• They feel guilty.

• The person abusing them is someone they depend on for care or support (personal, financial or otherwise).

• They feel frightened of what might happen if they tell someone

You can obtain help just by talking to someone you trust or by talking to:

• A GP or someone else in the primary care team such as a nurse, healthcare assistant or social prescriber.

• A doctor or nurse in hospital if you are admitted; or anyone in the hospital.

• A social worker or care manager.

• A carer.

• A community or district nurse.

• A daycare workers.