Safeguarding vulnerable adults
Thinking the unthinkable
‘It could never happen here’
Vulnerable Adult
‘A person over 18 years of age….who is or
may be in need of community care
services by reason of mental or other
disability, age or illness; and who is or may
be unable to take care of him or herself, or
unable to protect him or herself against
significant harm or exploitation.’
Lord Chancellor’s Department, 1997:69
Definition of Adult Abuse
‘Abuse is a violation of an individual’s
human and civil rights by any other person
or persons’.
P9, Department of Health (2000) No Secrets London: HMSO
‘Abuse may consist of a single act or repeated
acts.
It may be physical, verbal or psychological, it may
be an act of neglect or an omission to act, or it
may occur when a vulnerable person is
persuaded to enter into a financial or sexual
transaction to which he or she has not
consented, or cannot consent.’
Ibid
‘Abuse can occur in any relationship and
may result in significant harm to, or
exploitation of, the person subjected to it.’
Ibid
Significant harm
‘….not only ill treatment (including sexual
abuse and forms of ill treatment which are
not physical), but also the impairment of,
or an avoidable deterioration in, physical
or mental health; and the impairment of
physical, intellectual, emotional, social or
behavioural development.’
P 68, Lord Chancellor’s Department (1997) Who Decides? Making Decisions on
Behalf of Mentally Incapacitated Adults London: The Stationery Office
Types of abuse
Physical abuse
 Sexual abuse
 Psychological/emotional abuse
 Financial/material abuse
 Neglect
 Discriminatory abuse
 Institutional abuse
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Examples of physical abuse
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Slapping
Hitting
Pushing
Pulling
Rough handling
Kicking
Misuse of medication
Unreasonable physical restraint
Isolation or confinement
Poor application of manual handling techniques
Indicators of physical abuse
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Any injury not fully explained by the history given
Unexplained bruises and welts on face, lips, mouth, body, arms, back,
buttocks, thighs
Bruises in various stages of healing or in shape of article or finger marks
Unexplained burns, especially on soles, palms and back; immersion scalds,
rope burns, electric appliance, cigarette or carpet burns
Unexplained fractures to any part of the body
Unexplained lacerations or abrasions to mouth, lips, gums, eyes, external
genitalia
Malnutrition – rapid or continuous change in weight, dehydration, indications
of force-feeding
Stench or signs of urinary/faecal incontinence
Use of furniture and other equipment to restrict movement
Examples of sexual abuse
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Inappropriate touching
Masturbation
Oral contact
Genital contact
Digital penetration (vagina or anus)
Rape (vagina or anus)
Penetration with objects
Attempted penetration
Examples of sexual abuse
Voyeurism
 Pornography
 Indecent exposure
 Teasing
 Innuendo
 Harassment
 Exploitation
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Indicators of sexual abuse
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Full or partial disclosure or hints of sexual abuse
Genital or urinary irritation or infection
Sexually transmitted disease
Love bites, bruises or finger marks on inner thighs or arms
Pain or bleeding in the genital area
Unusual difficulty in sitting or walking
Unexplained onset of faecal or urinary incontinence
Significant change in sexual behaviour, language or outlook
Pregnancy in a person who is not able to consent
Severe agitation when person is bathed, undresses or medically
examined
Examples of psychological abuse
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Threats of punishment, harm or abandonment
Humiliation, ridicule and insults
Isolation or withdrawal from services or
supportive networks
Overriding/denial of basic human and civil rights
such as choice, privacy, dignity and selfexpression
Bullying and harassment
Blaming
Examples of psychological abuse
Overprotection
 Deprivation of contact and/or freedom
 Intimidation and coercion
 Controlling
 Verbal abuse/swearing
 Treating someone inappropriately for their
age and/or cultural/ religious background
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Indicators of psychological abuse
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Fearfulness , avoids looking at caregiver, flinching on approach
Sleep disturbance – insomnia or excessive sleep
Low self-esteem
Unexplained fear, defensiveness, paranoia
Deference, resignation, passivity
Emotional withdrawal
Unusual bouts of sobbing or weepiness
Punitive approach to bodily functions or incontinence
Few visitors/ phone calls/outings
Locking the person in the home or in a car
Threats to abandon the person or “put them away”
Ambivalent feelings between victim and caregiver
Examples of financial/material
abuse
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Theft
Fraud
Exploitation
Pressure in connection with wills, property,
inheritance or money
Misuse or misappropriation of property,
possessions or benefits
Preventing access to money
Indicators of financial/material
abuse
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Unusual or inappropriate account activity
Person lacks belongings or services which they can
clearly afford
Power of Attorney obtained when person lacks capacity
and is unable to comprehend
Recent change of deeds or title of house
Person managing financial affairs is evasive or
uncooperative
Disproportionate interest or affection for person with
money or property
Examples of neglect
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Ignoring medical or physical care needs
Failure to provide access to appropriate health,
social care, educational or housing services
Withholding the necessities of life (nutrition,
medication, heating)
Failure to recognise and acknowledge religious
and cultural needs
Failure to acknowledge a person’s right to
choice, dignity, privacy and independence
Indicators of neglect
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Person has inadequate heating and/or lighting
Poor physical condition or appearance (ulcers, pressure
sores, soiled or wet clothing)
Malnourished, dehydrated, sudden or continuous weight
loss
Cannot access appropriate medication or medical care
Person and/or carer has inconsistent or reluctant contact
with health and social care agencies
Callers/visitors are refused access to the person
Person exposed to unacceptable risk
Discriminatory abuse
Discriminatory abuse exists when values,
beliefs or culture result in a misuse of
power that denies mainstream
opportunities to some individuals or
groups in society.
Discrimination can take place on
the grounds of:
Race
 Gender
 Sexuality
 Age
 Disability
 Ethnicity, religion or culture
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Discriminatory actions include:
Unequal treatment
 Verbal abuse
 Inappropriate use of language
 Slurs
 Harassment
 Deliberate exclusion
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Institutionalisation
Block treatment
 Rigid routine
 Staff/patient division
 One place and authority
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Risks: De-personalisation
De-humanisation
Role of alerter
If you know or suspect that abuse is happening,
you must report it formally and in writing, usually
to your manager (unless they are potentially
involved in the abuse).
If no action is taken, go higher/to professional or
inspection body/to relevant localauthority/to
police
If you do not do so, you become part of the
abusive situation.
Safeguarding trumps confidentiality
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If the potential victim is a vulnerable adult,
you must report even if they ask you not to
do so.
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Good practice to tell them this, unless to
do so will put them or you at risk
Emergency services
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Is urgent medical attention needed?
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Does the person have somewgere safe to
go?
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Is there a need to protect physical/verbal
evidence?
What to record
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The identity of the person reporting the incident
and any other person present at the time
Description of the scene of the incident
State and behaviour of the victim, including
anything said
Details of any obvious injuries, on a body map if
possible
Date and time of incident and sign the record
Responding to disclosures
Reassure
 Take seriously
 Avoid leading questions or helping to finish
sentences
 Record the exact words used
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Factors increasing risk of abuse
 Individual
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Sensory impairment
Does not communicate verbally,
Support needed with intimate personal care
Lack of understanding
 Experience
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Learned compliance
Abused before and thinks it is acceptable
Factors increasing risk of abuse
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Relationships
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Dependent, over-protected, devalued, lacking choice and control
Mental or physical ill-health of carer
History of alcohol or drug misuse
Debt or poor housing,
Changes in role
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Environment
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Social /geographical isolation
Rigid routines
Poorly trained/supported staff
Low morale, low status of work
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Safeguarding Vulnerable Groups
Act 2006
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identifies two sets of activities in relation to
children and vulnerable adults
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sets out the requirements for vetting and
barring people for these activities.
Regulated activities
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Contact with children or vulnerable adults (paid or
unpaid) of a specified nature (teaching, training, care,
advice, treatment, transport) or in a specified place
(school, children’s home, hospital, juvenile detention,
adult care homes) where the contact is frequent (once a
month or more), intensive (3 or more occasions in a
period of 30 days) or overnight (between 2am and 6am).
Foster care
Defined office holders (eg Directors of Children’s
Services, trustees of children’s charities, school
governors)
Controlled activities
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Frequent or intensive support work in general health
settings, NHS and further education settings
Frequent access to sensitive records about children and
vulnerable adults
Support work in adult social care settings
It is mandatory to check the ISA status of an applicant for
these roles but a barred person may be employed
provided safeguards are in place.
Independent Safeguarding Agency
Administers two lists:
 Vetted for work with children/vulnerable adults
 Barred from such work (criminal offence for them
to apply or to knowingly employ them to carry
out regulated activity)
Information on lists can be accessed only by police
and ISA case workers. Potential employers can
check status through enhanced CRB check.
Service users can be helped to
prevent abuse by:
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Access to user groups, advocacy schemes and
independent feedback
Being listened to
Being given clear and accessible information
about rights and services
Shared decision making and person centred
planning
Well publicised and accessible Complaints
Procedure
Staff can help to prevent abuse by:
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Following guidance re: personal care, behaviour issues
and sexuality
Acknowledging ‘it could happen here’
Being alert to signs of distress or intimidation
Reporting concerns at earliest opportunity and keep
reporting until action – line management, other
professions, CSCI
Requesting and attending training and development
events
Asking for help
Managers can help to prevent
abuse by:
Ensuring adequate staffing levels
 Recruitment procedures and checks
 Supervision and training
 Keeping communication channels open
 Clear polices which promote good practice
 Sound recording systems
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Further Reading
Working with Adult Abuse (e-book)
by Jacki Pritchard
Brown, K (2006) Vulnerable Adults and Community Care
Exeter: Learning Matters
www.isa-gov.org.uk
‘Lessons from the murder of Stephen Hoskins’ (audio-visual)
www.scie-socialcareonline.org.uk under ‘Safeguarding Adults’