Abuse and neglect of adults with care and support needs - Print version

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Types of abuse/neglect

Safeguarding means protecting the health and wellbeing of adults at risk and enabling them to live safely, free from abuse and neglect. It is about people and organisations working together to prevent and reduce both the risks and experience of abuse or neglect.

An adult is anyone over the age of 18. Abuse of adults who need care and support is where someone hurts, harms or causes them distress. Abuse is unacceptable; everyone has the right to be treated with dignity and respect and to live free of abuse or mistreatment, whether they live on their own, live with others, live in a care/nursing care home, attend a day centre or are in hospital.

What is an adult at risk?

Adults at risk could include:

  • Those with learning/physical disabilities, mental health needs including dementia, long-term illness/condition and those lacking the mental capacity to make decisions
  • Older people who are frail due to ill health or disability

The adults may be perceived as an easy target and may be less likely to identify abuse themselves or to report it. People with communication difficulties can be particularly at risk because they may not be able to alert others. Sometimes people may not even be aware that they are being abused and abusers may try to prevent access to the person they abuse.

See our introductory guide [https://www.coventry.gov.uk/downloads/file/32627/one_minute_guide_-_safeguarding_adults] aimed at volunteers and members of our communities.

What to do if you want to share a concern

If you see/are told something or it doesn’t seem right, report it to Adult Social Care on:

024 7683 3003 or email ascdirect@coventry.gov.uk [mailto:ascdirect@coventry.gov.uk]
Out of office hours: Emergency Duty Team on 024 7683 2222
In an emergency always call the emergency services on 999

Find out more about the work of Adult Social Care in Coventry. [http://www.coventry.gov.uk/info/158/safeguarding_adults/404/worried_that_someone_you_know_is_being_harmed_or_neglected/2]

Adult Social Care Direct

Speech impairment, deaf or hard of hearing? You can call using Next Generation Text (also known as Text Relay and TypeTalk): Call 18001 024 7683 3003

Address: Coventry City Council
PO Box 7097
Coventry
CV6 9SL

Telephone: 024 7683 3003 [tel:02476833003]

Physical abuse

There are different types of adult abuse, some of which are also criminal offences. See below for more information about adult abuse, however please also note that evidence of one indicator should not be taken on it’s own as proof that abuse is happening. The list of indicators is not exhaustive, there are other indicators that do not appear here and individuals may be subject to more than one type of abuse at the same time.

Types of physical abuse

  • 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)
  • Involuntary isolation or confinement
  • Misuse of medication (e.g. over-sedation)
  • Forcible feeding or withholding food
  • Unauthorised restraint, restricting movement (e.g. tying someone to a chair)

Possible indicators of physical abuse

  • 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 on 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

Real life example of physical abuse

In 2014 in Coventry local adult Coral Millerchip carried out what was described as a “sickening attack” on a pensioner. Ms Millerchip punched 80-year-old Joginder Singh to the ground in the city centre, before kicking him and spitting on him. The attack was completely unprovoked.

The attack, which left the pensioner with cuts to his face and a black eye, was filmed on a mobile phone by a bystander. His family said he was ‘never the same’ after the brutal assault which left him afraid to leave the house. Ms Millerchip is said to have assaulted Mr Singh after he touched her in a non-sexual manner as they passed in the street.  Mr Singh, who had a form of dementia was afterwards admitted to hospital with a pre-known illness, and died three months later.

Coventry Police said, "Despite the fact we could not show the assault and his death were connected, the close proximity of events is something we have explored in great detail and recognise the family's trauma."

Psychological abuse

There are different types of adult abuse, some of which are also criminal offences. See below for more information about adult abuse, however please also note that evidence of one indicator should not be taken on its own as proof that abuse is happening. The list of indicators is not exhaustive, there are other indicators that do not appear here, and individuals may be subject to more than one type of abuse at the same time.

Types of psychological or emotional abuse

  • Enforced social isolation – preventing someone 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, swearing or verbal abuse
  • Addressing a person in a patronising or infantilising way
  • Threats of harm or abandonment
  • Cyber bullying

Possible indicators of psychological or emotional abuse

  • 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, anger
  • Apparent false claims, by someone involved with the person, to attract unnecessary treatment

Example of psychological abuse

In a relationship

The relationship begins with a combination of flattery and extravagant gestures, leaving the victim feeling overwhelmed but loved. This gradually develops into possessive and obsessive behaviour, with the flattery and poetic language being replaced with the giving and removing of affection which produces insecurity and anxiety. The victim’s mental health suffers and friends and family often notice a distinct change in someone’s happiness and ability to cope. Psychological abuse in a relationship can include:

  • telling lies or exaggerating
  • denying they said things that you both know they did
  • their actions not matching their words
  • putting you down and then praising you
  • eliciting insecurity and anxiety when you bring up their conflicting actions
  • convincing you it is your mental health causing confusion after directly causing it with their actions
  • it all culminating in a co-dependent relationship caused by the fear and vulnerability that the abuser created.

In adults, emotional and psychological abuse may be the most common and pervasive type of abuse. Unfortunately, it is also the most difficult to track and often goes unreported, so experts are not sure how many individuals suffer from it or how often it is experienced.

Unlike elder sexual abuse or financial exploitation, acts of psychological abuse are not always obviously criminal in nature. Unlike physical abuse, emotional/psychological abuse does not leave physical markings or evidence. This type of abuse often can be invisible meaning that professionals and other people may have no idea it is occurring if they do not witness it first hand.

If you are taking care of a person, you must always be mindful and careful so as not to inflict emotional or psychological abuse. Pay attention to the person and how they are feeling and reacting to your care. You should also be mindful of your own emotions and stress levels, and prevent your personal feelings from affecting how you treat your family member or patient.

Sexual abuse

There are different types of adult abuse, some of which are also criminal offences. See below for more information about adult abuse, however please also note that evidence of one indicator should not be taken on its own as proof that abuse is happening. The list of indicators is not exhaustive, there are other indicators that do not appear here, and individuals may be subject to more than one type of abuse at the same time.

Types of sexual abuse

  • Rape, attempted rape or sexual assault
  • Inappropriate touch anywhere
  • Non- consensual masturbation of either or both persons
  • 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

Possible indicators of sexual abuse

  • Bruising, particularly to the thighs, buttocks and upper arms and 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

Real life example of sexual abuse

Last October, in Scotland a 51 year old man pretended to be a Good Samaritan to a woman with learning difficulties, helping her to decorate her flat. He later returned to her home and raped her. He is currently undergoing trial and the court heard the accused turned up at the victim’s flat and walked in when she answered the door. The woman, who was in pyjamas, walked to her bedroom and the accused followed her there. The prosecutor said the woman felt scared but did not say anything when he touched her inappropriately as she was too frightened. The accused then undressed himself and raped the terrified woman while she repeatedly told him to stop. After he left, the victim sent a text to her support worker which read: "I'm so frightened. Don't want to stay in this flat anymore." Police were called and the accused arrested.

In 2015 the BBC Victoria Derbyshire programme submitted Freedom of Information requests to 152 councils with adult social services responsibilities in England, asking how many reports of sexual abuse of disabled clients they had recorded over the financial years 2013-14 and 2014-15, up to 16 February 2015. Data received from 106 of the 152 councils showed that 63% of the 4,748 reported cases were against those with learning disabilities, and 37% against those with physical disabilities.

Adults with care and support needs are people aged over 18 who are in need of care and support, ie could or do receive a service from the local council to meet their support needs. Dependent on their type of need, this group of adults can be more likely to be victims of sexual abuse as they are less likely to tell anyone about the abuse or may not be able to, they may be physically unable to defend themselves, or may not understand that what is happening to them is abusive.

Further Support

Sexual Assault Referral Centre (SARC)

You can turn access Coventry's sexual assault referral centre for 24/7 medical, emotional or practical support.

Call 0800 970 0370 or visit the Blue Sky Website [https://blueskycentre.org.uk/].

Financial abuse

There are different types of adult abuse, some of which are also criminal offences. See below for more information about adult abuse, however please also note that evidence of one indicator should not be taken on its own as proof that abuse is happening. The list of indicators is not exhaustive, there are other indicators that do not appear here, and individuals may be subject to more than one type of abuse at the same time.

Types of financial or material abuse

  • Theft of money or 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 assistance 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 a 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 – eg. unnecessary or overpriced property repairs and failure to carry out agreed repairs or poor workmanship

Possible indicators of financial or material abuse

  • 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

Real life example of financial abuse

Actor Mickey Rooney was a victim of elder abuse at the hands of his own stepchildren and was granted a Restraining Order to keep them away from him. The 90-year-old actor was granted court protection from his stepson and stepdaughter after he filed a case against them charging verbal, emotional and financial abuse, and for denying him such basic necessities as food and medicine.

The court documents say that both perpetrators have been keeping Rooney as "effectively a prisoner in his own home" through the use of threats, intimidation and harassment. The stepson was also accused of taking control over Rooney's finances, blocking access to his mail and forcing the actor into performances he does not wish to do.

Mr Rooney sought and was granted temporary protection for not only himself but for his wife and his stepson, both of whom lived with him. Mr Rooney was reported to fear for his safety, and was worried the perpetrators might retaliate in a physically abusive way, or try to kidnap him after the case was filed.

A temporary conservator of Mr Rooney’s estate was appointed to ensure the financial abuse ends immediately, and a permanent conservator was later appointed by the courts.

Domestic abuse

There are different types of adult abuse, some of which are also criminal offences. See below for more information about adult abuse, however please also note that evidence of one indicator should not be taken on its own as proof that abuse is happening. The list of indicators is not exhaustive, there are other indicators that do not appear here, and individuals may be subject to more than one type of abuse at the same time.

Types of domestic violence or abuse

Domestic violence or abuse can be characterised by any of the indicators of abuse outlined previously relating to:

  • psychological
  • physical
  • sexual
  • financial

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
  • regulating everyday behaviour.

For more information please watch our short video on domestic abuse here [https://www.youtube.com/watch?v=kui0G-njqyw].

Possible indicators of domestic violence or abuse

  • Low self-esteem
  • Feeling that the abuse is their fault when it is not
  • Physical evidence of violence such as bruising, cuts, broken bones
  • Verbal abuse and humiliation in front of others
  • Fear of outside intervention
  • Damage to home or property
  • Isolation – not seeing friends and family
  • Limited access to money

Real life example of domestic abuse

In 2011 Malcolm Beardon, aged 79 killed his wife Margaret who was suffering from dementia. Mr Beardon was reported to have ‘snapped’ after caring for his wife for many years. Mr Beardon was said to have ’lost control’ and was supported by his family throughout his trial.

In 2009 Kenneth Mann, 81, killed his wife Doreen with 2 knives and a hammer – he was reported to be suffering with depression after struggling to adapt to retirement. Mr Mann was being treated for clinical depression and Mrs Mann had said to others that she feared he may harm her – but despite being urged did not leave the relationship. After attacking his wife, who died from her injuries, Mr Mann drowned himself in the bath. The bodies were found by a psychiatric worker who alerted police after being unable to get a reply at the front door for 2 days. The deaths were described by professionals as a “double tragedy” and Mr Mann’s mind as “having a disturbed balance at the time of his death”.

Domestic abuse in older people is often characterised as ‘out of character’ or ‘sudden’, and often framed in the context of illness or caring for another. However, research around domestic abuse across all generations shows that a victim is abused on average 37 times before they tell anyone, meaning the sudden loss of control theory is unlikely to be the truth.
The director of Women’s Aid says "The abuse, whether physical or psychological, is often very long-term, perhaps throughout a 40-year marriage. The abuser can often present as very frail: if the woman has a disability or is in failing health it can add to her vulnerability. Older women often tell us that they don't think they will be believed when they go to agencies for help."

Very few Domestic Violence cases in older people go to court because of the age of those involved, and very few are reported as in an older relationship the victim is likely to have experienced years of psychological abuse and coercive control, making abuse normalised.

Further support

Safe to Talk, Coventry City Council's domestic abuse website [https://www.safetotalk.org.uk/]

See our collection of posters for further information:

Discriminatory abuse

There are different types of adult abuse, some of which are also criminal offences. See below for more information about adult abuse, however please also note that evidence of one indicator should not be taken on its own as proof that abuse is happening. The list of indicators is not exhaustive, there are other indicators that do not appear here, and individuals may be subject to more than one type of abuse at the same time.

Types of discriminatory abuse

Unequal treatment based on age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion and belief, sex or sexual orientation (known as ‘protected characteristics’ under the Equality Act 2010 [http://www.legislation.gov.uk/ukpga/2010/15/section/4])

  • Verbal abuse, derogatory remarks or inappropriate use of language related to a protected characteristic
  • Denying access to communication aids, not allowing access to an interpreter, signer or lip-reader
  • Harassment or deliberate exclusion on the grounds of a protected characteristic
  • Denying basic rights to healthcare, education, employment and criminal justice relating to a protected characteristic
  • Substandard service provision relating to a protected characteristic

Possible indicators of discriminatory abuse

  • The person appears withdrawn and isolated
  • Expressions of anger, frustration, fear or anxiety
  • The support on offer does not take account of the person’s individual needs in terms of a protected characteristic

Real life example of discriminatory abuse

In Coventry recently, an adult woman was targeted, verbally abused in the street and verbally abused whenever she went outside her home. Her home was broken into and vandalised more than once. The cause of the abuse was the woman's mental health difficulties. and the abusers were both adults and children from the surrounding area.

The woman did not feel safe in her own home and wished to move out of the area to a perceived place of safety.

Professionals became involved and the woman now has regular managed contact with the police and the abusers have been spoken to by the police. She now feels safe.

Modern day slavery

Modern slavery is an umbrella term encompassing activities where one person obtains or holds another human in compelled service. Modern slavery includes (but is not restricted to) servitude, slavery, forced labour and human trafficking. The following definitions are held within the term 'modern slavery' for the purposes of the Modern Slavery Act 2015.

These are:

  • 'slavery' is where ownership is exercised over a person
  • servitude' involves the obligation to provide services imposed by coercion
  • 'forced or compulsory labour' involves work or service extracted from any person under the menace of a penalty and for which the person has not offered himself voluntarily
  • 'human trafficking' concerns arranging or facilitating the travel of another with a view to exploiting them.

Read more about the Modern Slavery Act 2015 [https://www.legislation.gov.uk/ukpga/2015/30/contents/enacted].

Types of Modern Slavery

There is no typical victim of modern slavery, victims can be male or female, from any and all backgrounds, countries and communities. Although it’s impossible to know exactly how many people are victims, Modern Slavery is on the increase. Some victims have been trafficked from overseas and some are British victims who have existing vulnerabilities. Despite their individual circumstances, all are susceptible to the promises of well-paid work and good accommodation, which turns out to be a deception.

Vulnerable adults may experience multiple types of exploitation and may not disclose all forms of exploitation to professionals. Please find below examples of some forms of exploitation, but note there are many more not listed here:

  • Labour exploitation (nail bars, car washes, catering, agricultural work, factory work)
  • Forced criminal activity (cannabis cultivation, pick-pocketing, cashpoint/credit card theft, drug dealing)
  • Sexual Exploitation (rape, sexual assault, being forced, tricked or manipulated into performing a sexual act, escort work, prostitution and pornography)
  • Domestic Servitude (excessive levels of household work, including childcare)
  • Benefit Fraud (including pregnant women exploited for maternity benefits)
  • Forced marriage
  • Bonded labour/debt bondage – being forced to work to pay off debts that realistically they never will be able to
  • Organ harvesting
  • Human Trafficking

Victims can often face more than one type of abuse and slavery for example if they are sold to different traffickers or are forced into several forms of exploitation (prostitution, domestic servitude or involvement in criminal activity).

Possible indicators of modern slavery

  • Signs of physical or emotional abuse
  • 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

Real life example of modern slavery

In 2014 a Filipino woman named Elvira arrived in the UK to start her new job as a domestic worker – via an agency. Elvira was taken to a luxury flat in Kensington, where her boss, a woman, made her work 20 hours a day, allowing her only one piece of bread and no wages. She was trapped in a life of servitude, while metres away central London bustled with shoppers. Elvira said “I had to work all the time, without a day off, and I slept on the floor by her bed. She’d shout at me, saying I was stupid or calling me a “dog” in Arabic. I was rarely allowed outside the house, and only with her. I was given just a piece of bread and cup of tea for the whole day. I became emaciated. I felt like a slave, like I was in prison. I wanted to run away, but they had my passport.” Eventually Elvira managed to make her escape, waiting until her “employer” was taking a nap before running to a nearby church for sanctuary. She is still waiting for justice.

Statistics show that approximately 41 million people are trapped in slavery across the world today, and the estimate is that in the UK a minimum of 13,000 people are modern slaves.

The industries identified as most at risk from using modern slaves in the UK are:

  • Construction
  • Agriculture
  • Hotel and restaurants
  • Care homes
  • Car washes
  • Nail bars

In 2019, the Modern Slavery Helpline received 493 reports of potential cases of labour exploitation in hand car washes across the country with 2,170 potential victims. Of these referrals, only one case led to an arrest. Albanians were the largest group of adult victims, followed by China, Vietnam, Romania and then the UK. Most Albanian victims were women who had been sexually exploited. Adult victims from other countries were most likely to have faced forced labour or other forms of labour exploitation.

Report modern slavery

If you are concerned about a potential victim, or suspicious about a situation that is potentially exploitative, you can call the Modern Slavery Helpline  [https://www.modernslaveryhelpline.org/]on 08000 121 700 or submit a modern slavery report online [https://www.modernslaveryhelpline.org/]. The helpline is operated by Unseen, open 24/7 and entirely confidential. They also operate the Unseen Mobile App

If you believe a person is being trafficked and is in immediate danger, you should call 999 straight away.

You can also report suspicions of trafficking by calling 101 or visiting your local police station.

The National Referral Mechanism [https://www.modernslaveryhelpline.org/learn-more/frontline-professionals/nrm-overview-and-form] is a framework for identifying victims of human trafficking or modern slavery and ensuring they receive the appropriate support.

Further resources

Adult Social Care Direct

Speech impairment, deaf or hard of hearing? You can call using Next Generation Text (also known as Text Relay and TypeTalk): Call 18001 024 7683 3003

Address: Coventry City Council
PO Box 7097
Coventry
CV6 9SL

Telephone: 024 7683 3003 [tel:02476833003]

Organisational abuse

There are different types of adult abuse, some of which are also criminal offences. See below for more information about adult abuse, however please also note that evidence of one indicator should not be taken on its own as proof that abuse is happening. The list of indicators is not exhaustive, there are other indicators that do not appear here, and individuals may be subject to more than one type of abuse at the same time.

Types of organisational or institutional 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 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 of 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

Possible indicators of organisational or institutional abuse

  • 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 and possessions and communal use of personal items
  • Lack of adequate procedures
  • Poor 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

Real life example of organisational abuse

In June this year, in the UK two carers appeared in court accused of abusing an elderly Alzheimer’s patient resident in a care home. The workers were only brought to justice after the family were concerned about their mother’s constant crying and unexplained bruises on their mother’s wrists, and installed a secret camera in her bedroom. Carers were filmed dragging the frail and terrified, 71 year old victim out of bed by her wrists, refusing the diabetic OAP food and drink and ignoring her pleas to use the toilet.

In 2016 the BBC programme Panorama aired an expose of care home abuse after footage was recorded by three reporters - one posed as a resident, the other two got jobs there. The Panorama undercover filming shows one nurse saying she will give morphine to a resident "to shut her up" - an event described by an independent expert as "horrifying". The care home was immediately closed but the programme exposed the organisational abuse individuals may be subject to by abusive staff.

Neglect and acts of omission

There are different types of adult abuse, some of which are also criminal offences. See below for more information about adult abuse, however please also note that evidence of one indicator should not be taken on its own as proof that abuse is happening. The list of indicators is not exhaustive, there are other indicators that do not appear here, and individuals may be subject to more than one type of abuse at the same time.

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

Possible indicators of neglect and acts of omission

  • Poor environment – dirty or unhygienic
  • Poor physical condition and/or personal hygiene
  • Pressure sores or ulcers
  • Malnutrition or unexplained weight loss
  • Untreated injuries and medical problems
  • Inconsistent or reluctant contact with medical and social care organisations
  • Accumulation of untaken medication
  • Uncharacteristic failure to engage in social interaction
  • Inappropriate or inadequate clothing

Real life example of neglect and acts of omission

Nursing home abuse implies that the caregiver intends to harm the elderly person, whilst nursing home neglect is a form of substandard care, or a breach of duty that causes harm to the person.
In early 2018 Dunmurry, a care home for older people in Northern Ireland was exposed for a catalogue of abuse and neglect against residents.

Neglectful behaviour included:

  • Residents found in a wet bed
  • Residents kept in the dark for long periods of time
  • Residents found besides plates of uneaten food (unable to feed themselves or food not edible)
  • Clothing being worn by residents including underwear, socks and shoes found soaked in urine
  • Residents being found overly warm or very cold

Resident, Annie, aged 89 complained to her family that she was not being fed and they could see she was losing weight. It transpired that there would be occasions where staff would just go past her and not give her any food. Annie wasn't being looked after with regards to her personal care and the family reported having to go over to do it themselves. Annie’s personal hygiene started to slip and there were times where family would go over on an October evening and she would be sitting without a blanket in her nightclothes next to an open window.

Annie’s family complained to the manager and received excuses (Annie didn’t like being washed) and assurances of change. Eventually Annie’s family visited to find her with vomit across her face, and on taking her to hospital the doctor diagnosed pneumonia and failing kidneys. The care home eventually admitted Annie had been in a high backed chair in this state of health for at least 12 hours. 

Signs of neglect in nursing homes can be:

  • Sudden weight loss – this can indicate dehydration or malnutrition
  • Bedsores
  • Discontent expressed by the resident
  • Isolation
  • An unclean environment
  • Bruises that don’t have a reasonable cause, or repeated bruises in odd areas such as around wrists or on shoulders
  • Depression and/or anxiety
  • Lack of attention from staff, or delayed care
  • Any sign that a basic need (such as timely and appropriate toilet visits) are not being met

Self neglect

There are different types of adult abuse, some of which are also criminal offences. See below for more information about adult abuse, however please also note that evidence of one indicator should not be taken on its own as proof that abuse is happening. The list of indicators is not exhaustive, there are other indicators that do not appear here, and individuals may be subject to more than one type of abuse at the same time.

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

Indicators of 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

Real life example of self neglect

A famous UK example of self neglect was Mr Edmund Trebus, a Polish war veteran who shot to fame on the BBC series ‘A Life of Grime’ because of his hoarding. Mr Trebus had spent years cramming his five-bedroom villa and garden in north London, with old fridges, rotting clothes, window panes, boxes of broken biscuits, items he had scavenged from local tips - and far, far worse; his home had no running water, working lavatory or electricity.

After complaints from the neighbours about the filthiness of his property, and specifically about the number of rats living there, the council obtained a court order to have the property cleared. But Mr Trebus refused to comply and a long-running feud developed.  He refused to acknowledge the rows of dead rats which suggested that his living arrangements presented a serious risk to health.

After a titanic battle of wills, the council eventually succeeded in clearing Mr Trebus's garden of 515 cubic yards of rubbish; it took six men 30 days using five large trucks and 11 skips, and cost more than £30,000. A few years later, however, the television cameras returned for a Life of Grime Special, to find that not only had Mr Trebus filled his garden up again but large cracks in his house suggested it was on the verge of collapse.

In 2001 he was finally persuaded to move into a residential care home, where he was obliged to spend the final year of his life in clean, comfortable surroundings.

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