Physical Abuse

What is it?

Deliberately hurting an adult, causing injuries such as bruises, broken bones, burns or cuts, or otherwise causing harm. It could also be when a carer fabricates the symptoms of, or deliberately induces illness, or misuses medication.

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:

• Multiple bruising

• Fractures

• Injuries in places not normally exposed to falls or rough games

• Burns

• Bedsores

• Fear

• Depression

• Unexplained weight loss

• Assault (can be intentional or reckless)

• Failure to seek medical treatment, or a pattern of visiting different hospitals or doctors over a short period of time.

Sexual Abuse

What is it?

Sexual abuse is any sexual activity where a person has been forced or persuaded to take part or doesn't understand.

Types of Sexual Abuse:

• Rape, attempted rape or sexual assault

• Inappropriate touching anywhere on the body

• 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

• Repeated urine infections or unexplained stomach pains, soreness or bruising around the genitals, sexually transmitted infections, unplanned, concealed or denied pregnancies

• Uncharacteristic use of explicit sexual language or significant changes in sexual behaviour or attitude

• 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

Modern Slavery

What is it?

Modern Slavery is where an individual is exploited, forced to work, or sold.  It involves the recruitment and movement of individuals using threats, deception and coercion for the purpose of exploitation. Modern Slavery can take many forms:

Types of Modern Slavery:

• Forced labour

• Domestic servitude

• Sexual exploitation, such as escort work, prostitution and pornography

• Human trafficking

• Debt bondage – being forced to work to pay off debts that realistically they never will be able to

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

Modern Slavery isn't confined to history or other countries, it is a global problem and is happening right now, here in Lancashire.  It's a problem that affects all ages, genders and ethnicities, and affects people from Britain and abroad.

Emotional Abuse

What is it?

Emotional maltreatment. It is sometimes called psychological abuse and can cause serious harm. It may involve:

• Isolation from services, social opportunities or friends

• ·Removing mobility of communication aids

• Intentionally leaving someone unattended when they need assistance

• Preventing expression of choice or opinion

• Failure to respect the privacy

• Preventing stimulation, meaningful occupation or activities

• Intimidation, coercion, harassment, use of threats, humiliation, bullying, swearing or verbal abuse

• Being patronising or infantilising towards an individual

• Cyberbullying

• Preventing access to services or support.

Possible indicators of Emotional Abuse:

• An air of silence when a particular person is present

• Withdrawal or noticeable changes in mood or behaviour

• Depression, aggression, extreme anxiety

• Signs of distress, tearfulness, anger

• Obsessions, fears or phobias

• Sleep disorders, changes in appetite

• Going missing, stealing and lying

• Low self-esteem

Financial Abuse

What is it?

Financial abuse is the theft or misuse of money, property or personal belongings, taken without consent or under pressure in connection with wills, property or inheritance.

Types of Financial 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, threat or 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 or access to benefits

• Misuse of the 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

• The exploitation of a person’s money or assets, e.g. unauthorised use of a car

• Misuse of a power of attorney, deputy, appointee ship or other legal authority

• Rogue trading – e.g. unnecessary or overpriced property repairs and failure to carry out agreed repairs or poor workmanship

Possible indicators of Financial Abuse:

• Missing personal possessions

• Unexplained lack of money

• Unexplained withdrawal of funds from accounts

• The person allocated to manage financial affairs is evasive or uncooperative

• The family or others show an 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 or power of attorney

• Recent changes in deeds or title to a 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

Neglect

What is it?

Neglect is the ongoing failure to meet basic needs. The individual may be left hungry or dirty, without adequate clothing, shelter, supervision, medical/health care, and access to aids or equipment. They may not get the love, care and attention they need from their family or carers.

Types of Neglect:

• 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

Discriminatory Abuse

What is it?

Discriminatory abuse is where an individual is treated differently because of ethnicity, culture, sexuality, gender, age or disability.

Types of Discriminatory Abuse:

• 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

Organisational (Institutional) Abuse

What is it?

Organisational abuse is where poor working practices in care homes or hospitals cause mistreatment by repeated poor or inadequate care, which violates a person's dignity and human rights.

Types of Organisational Abuse:

• Discouraging visits or the involvement of relatives or friends

• Run-down or overcrowded establishment

• 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

• 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 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

Self-Neglect

What is it?

Self-neglect is the lack of self-care; lack of care for one's environment; and/or the refusal of services, to an extent that it threatens personal health and safety.

Self Neglect Framework for multi-agency partners:

The LSAB has produced a Self-Neglect Framework which provides process guidance for multi-agency partners. The framework aims to support practitioners in taking the most appropriate action and response when concerns of Self-Neglect have been identified. The framework is supported by Hoarding Guidance which is published as an appendix.

Types of Self-Neglect:

• Lack of self-care

• 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

Possible 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

Domestic Abuse

What is it?

Domestic abuse is any type of violence - or other abuse - that is present in close relationships. For example it could be between husband and wife; mother/father and their son/daughter; siblings; boyfriend and girlfriend; partner or ex-partner. It can emerge through many other types of abuse: physical, sexual, emotional or financial, and can include undermining of self-confidence and the threat of violence.

Possible indicators of Domestic Abuse:

• Low self-esteem

• Physical evidence of violence such as bruising, cuts, broken bones

• Verbal abuse and humiliation in front of others

• Fear of outside help and support

• Damage to home or property

• Isolation – not seeing friends and family

• Limited access to money