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Adult Safeguarding

Anyone can become vulnerable at some point in their life and require some level of help and support. Sometimes this might be a temporary situation because of something that has happened or sometimes that support may be more complex and will need to be addressed by numerous agencies coming together to help.

Who is a person at risk of harm?

  • Someone who has needs for care and support
  • Is experiencing, or at a risk of, abuse or neglect: and
  • As a result of those care and support needs is unable to protect themselves from either the risk of, or the experience of abuse or neglect
  • Previously known as a vulnerable adult

The ten categories/types of abuse include:

Physical Abuse

Physical abuse includes assault, hitting, slapping, pushing, kicking, misuse of medication, being locked in a room, inappropriate sanctions or force-feeding, inappropriate methods of restraint, and unlawfully depriving a person of their liberty.

Possible indicators

  • Unexplained or inappropriately explained injuries
  • Adult exhibiting untypical self-harm
  • Unexplained cuts or scratches to mouth, lips, gums, eyes or external genitalia
  • Unexplained bruising to the face, torso, arms, back, buttocks, thighs, in various stages of healing. Collections of bruises that form regular patterns which correspond to the shape of an object or which appear on several areas of the body
  • Unexplained burns on unlikely areas of the body (e.g. soles of the feet, palms of the hands, back), immersion burns (from scalding in hot water/liquid), rope burns, burns from an electrical appliance
  • Unexplained or inappropriately explained fractures at various stages of healing to any part of the body
  • Medical problems that go unattended; Sudden and unexplained urinary and/or faecal incontinence. Evidence of over/under-medication
  • Adult flinches at physical contact; Adult appears frightened or subdued in the presence of particular people
  • Adult asks not to be hurt; Adult may repeat what the person causing harm has said (e.g. 'Shut up or I'll hit you')
  • Reluctance to undress or uncover parts of the body
  • Person wears clothes that cover all parts of their body or specific parts of their body
  • An adult without capacity not being allowed to go out of a care home when they ask to
  • An adult without capacity not being allowed to be discharged at the request of an unpaid carer/family member.

Sexual Abuse

Sexual abuse including rape, indecent exposure, sexual harassment, inappropriate looking or touching, sexual teasing or innuendo, sexual photography, subjection to pornography or witnessing sexual acts, indecent exposure and sexual assault or sexual acts to which the adult has not consented or was pressured into consenting. Any sexual relationship that develops between adults where one is in a position of trust, power or authority in relation to the other (e.g. day centre worker/social worker/residential worker/health worker etc.) may also constitute sexual abuse

Possible indicators

  • Adult has urinary tract infections, vaginal infections or sexually transmitted diseases that are not otherwise explained
  • Adult appears unusually subdued, withdrawn or has poor concentration
  • Adult exhibits significant changes in sexual behaviour or outlook
  • Adult experiences pain, itching or bleeding in the genital/anal area
  • Adult's underclothing is torn, stained or bloody
  • A woman who lacks the mental capacity to consent to sexual intercourse becomes pregnant;

Sexual exploitation

The sexual exploitation of adults with care and support needs involves exploitative situations, contexts and relationships where adults with care and support needs (or a third person or persons) receive 'something' (e.g. food, accommodation, drugs, alcohol, cigarettes, affection, gifts, money) as a result of performing sexual activities, and/or others performing sexual activities on them.

Sexual exploitation can occur through the use of technology without the person's immediate recognition. This can include being persuaded to post sexual images or videos on the internet or a mobile phone with no immediate payment or gain, or being sent such an image by the person alleged to be causing harm.

In all cases those exploiting the adult have power over them by virtue of their age, gender, intellect, physical strength, and/or economic or other resources.

Psychological Abuse

Psychological abuse includes 'emotional abuse' and takes the form of threats of harm or abandonment, deprivation of contact, humiliation, rejection, blaming, controlling, intimidation, coercion, indifference, harassment, verbal abuse (including shouting or swearing), cyber bullying, isolation or withdrawal from services or support networks.

Psychological abuse is the denial of a person's human and civil rights including choice and opinion, privacy and dignity and being able to follow one's own spiritual and cultural beliefs or sexual orientation. It includes preventing the adult from using services that would otherwise support them and enhance their lives. It also includes the intentional and/or unintentional withholding of information (e.g. information not being available in different formats/languages etc.).

Possible indicators

  • Untypical ambivalence, deference, passivity, resignation
  • Adult appears anxious or withdrawn, especially in the presence of the alleged abuser
  • Exhibits low self-esteem
  • Untypical changes in behaviour (e.g. continence problems, sleep disturbance)
  • Adult is not allowed visitors/phone calls
  • Adult is locked in a room/in their home
  • Adult is denied access to aids or equipment, (e.g. glasses, dentures, hearing aid,
  • crutches, etc.)
  • Adult's access to personal hygiene and toilet is restricted
  • Adult's movement is restricted by use of furniture or other equipment
  • Bullying via social networking internet sites and persistent texting.

Financial or Material Abuse

This includes theft, fraud, internet scamming, coercion in relation to an adult's financial affairs or arrangements, including in connection with wills, property, inheritance or financial transactions, or the misuse or misappropriation of property, possessions or benefits.

Possible indicators

  • Lack of heating, clothing or food
  • Inability to pay bills/unexplained shortage of money
  • Lack of money, especially after benefit day
  • Inadequately explained withdrawals from accounts
  • Unexplained loss/misplacement of financial documents
  • The recent addition of authorised signatories on an adult's accounts or cards
  • Disparity between assets/income and living conditions
  • Power of attorney obtained when the adult lacks the capacity to make this decision
  • Recent changes of deeds/title of house or will
  • Recent acquaintances expressing sudden or disproportionate interest in the adult and their money
  • Service user not in control of their direct payment or individualised budget
  • Mis-selling/selling by door-to-door traders/cold calling;
  • Illegal money-lending.

Modern Slavery

Modern Slavery encompasses slavery, human trafficking, forced and compulsory labour and domestic servitude.

Someone is in slavery if they are: 

  • forced to work - through mental or physical threat; owned or controlled by an 'employer', usually through mental or physical abuse
  • or the threat of abuse; dehumanised, treated as a commodity or bought and sold as 'property'; physically constrained or has restrictions placed on his/her freedom of movement.

Human Trafficking

Human trafficking involves an act of recruiting, transporting, transferring, harbouring or receiving a person through a use of force, coercion or other means, for the purpose of exploiting them. If an identified victim of human trafficking is also an adult with care and support needs, the response will be co-ordinated under the adult safeguarding process. The police are the lead agency in managing responses to adults who are the victims of human trafficking. There is a national framework to assist in the formal identification and help to coordinate the referral of victims to appropriate services, known as the National Referral Mechanism.  

Possible Indicators:

Signs of various types of slavery and exploitation are often hidden, making it hard to recognise potential victims. Victims can be any age, gender or ethnicity or nationality. Whilst by no means exhaustive, this is a list of some common signs:

  • Adult is not in possession of their legal documents (passport, identification and bank account details) and they are being held by someone else
  • The adult has old or serious untreated injuries and they are vague, reluctant or inconsistent in explaining how the injury occurred
  • The adult looks malnourished, unkempt, or appears withdrawn
  • They have few personal possessions and often wear the same clothes
  • What clothes they do wear may not be suitable for their work.

The adult is withdrawn or appears frightened, unable to answer questions directed at them or speak for themselves and/or an accompanying third party speaks for them.  If they do speak, they are inconsistent in the information they provide, including basic facts such as the address where they live

They appear under the control/influence of others, rarely interact or appear unfamiliar with their neighbourhood or where they work. Many victims will not be able to speak English, have fear of authorities or the adult perceives themselves to be in debt to someone else or in a situation of dependence.

Discriminatory Abuse

This includes discrimination on the grounds of race, faith or religion, age, disability, gender, sexual orientation and political views, along with racist, sexist, homophobic or ageist comments or jokes, or comments and jokes based on a person's disability or any other form of harassment, slur or similar treatment.

Hate crime can be viewed as a form of discriminatory abuse, although will often involve other types of abuse as well. It also includes not responding to dietary needs and not providing appropriate spiritual support. Excluding a person from activities on the basis they are 'not liked' is also discriminatory abuse.

Possible indicators

Indicators for discriminatory abuse may not always be obvious and may also be linked to acts of physical abuse and assault, sexual abuse and assault, financial abuse, neglect, psychological abuse and harassment, so all the indicators listed above may apply to discriminatory abuse. An adult may reject their own cultural background and/or racial origin or other personal beliefs, sexual practices or lifestyle choices. An adult making complaints about the service not meeting their needs.

Organisational Abuse

Including neglect and poor care practice within an institution or specific care setting such as a hospital or care home, or where care is provided within their own home. This may range from one off incidents to on-going ill-treatment. It can be through neglect or poor professional practice as a result of the structure, policies, processes and practices within an organisation.

Organisational abuse is the mistreatment, abuse or neglect of an adult by a regime or individuals in a setting or service where the adult lives or that they use. Such abuse violates the person's dignity and represents a lack of respect for their human rights.

Organisational abuse occurs when the routines, systems and regimes of an institution result in poor or inadequate standards of care and poor practice which affect the whole setting and deny, restrict or curtail the dignity, privacy, choice, independence or fulfilment of adults with care and support needs.

Organisational abuse can occur in any setting providing health or social care. A number of inquiries into care in residential settings have highlighted that organisational abuse is most likely to occur when staff: receive little support from management; are inadequately trained; are poorly supervised and poorly supported in their work; receive inadequate guidance; or where these is:

  • Unnecessary or inappropriate rules and regulations
  • Lack of stimulation or the development of individual interests
  • Inappropriate staff behaviour, such as the development of factions, misuse of drugs or alcohol, failure to respond to leadership
  • Restriction of external contacts or opportunities to socialise.

Neglect and Acts of Omission

These include ignoring medical, emotional or physical care needs, failure to provide access to appropriate health, social care or educational services, and the withholding of the necessities of life such as medication, adequate nutrition and heating.

Neglect also includes a failure to intervene in situations that are dangerous to the person concerned or to others, particularly when the person lacks the mental capacity to assess risk for themselves. Neglect and poor professional practice may take the form of isolated incidents or pervasive ill treatment and gross misconduct. Neglect of this type may happen within an adult's own home or in an institution. Repeated instances of poor care may be an indication of more serious problems. Neglect can be intentional or unintentional.

Possible indicators

  • Adult has inadequate heating and/or lighting;
  • Adult's physical condition/appearance is poor (e.g. ulcers, pressure sores, soiled or wet clothing);
  • Adult is malnourished, has sudden or continuous weight loss and/or is dehydrated;
  • Adult cannot access appropriate medication or medical care;
  • Adult is not afforded appropriate privacy or dignity;
  • Adult and/or a carer has inconsistent or reluctant contact with health and social services;
  • Callers/visitors are refused access to the person;
  • Person is exposed to unacceptable risk.

Self-Neglect

Self-neglect covers a wide range of behaviour, neglecting to care for one's personal hygiene, health or surroundings and includes behaviour such as hoarding. 

Self-neglect is also defined as the inability (intentional or non-intentional) to maintain a socially and culturally accepted standard of self-care with the potential for serious consequences to the health and well-being of the individual and sometimes to their community.

Indicators of self-neglect may be:

  • living in very unclean, sometimes verminous, circumstances
  • poor self-care leading to a decline in personal hygiene
  • poor nutrition
  • poor healing/sores
  • poorly maintained clothing
  • long toenails
  • isolation
  • failure to take medication
  • hoarding large numbers of pets
  • neglecting household maintenance
  • portraying eccentric behaviour/lifestyles.

NOTE: Poor environments and personal hygiene may be a matter of personal or lifestyle choice or other issues such as insufficient income.

Who may need safeguarding?

Adult safeguarding focuses on those adults who have care and support needs that are experiencing, or at risk of abuse, neglect or exploitation (made to do things they don't want to in return for money, accommodation, 'love' and presents for example).

Adults with care and support needs may:

  • Be elderly and frail because of ill-health, disability or condition such as dementia
  • Have a learning disability
  • Have a physical disability or be blind or deaf
  • Have mental health needs including dementia or personality disorders
  • Have a long term illness or condition
  • Be a carer of a family member or friend and is being abused
  • Not have capacity to make some decisions and is need of care and support

Where does abuse occur?

It can happen in many different settings, some of which include:

  • Someone's home
  • In a care home
  • In a hospital
  • In a day centre
  • In a public place

Who is the abuser?

  • Abuse is carried out by many different people, but it's usually someone who is known and trusted. It may be:
  • A family member
  • A neighbour
  • A care worker or volunteer
  • A friend
  • Anyone with access to the person

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