Abuse of vulnerable adults

Within the care sector there are many individuals who rely and depend on the help and support of others such as nurses, social workers and support workers. When this level of trust and responsibility exists it is important that these individuals are able to feel safe and confident and not at risk to abuse. It is therefore our responsibility as carers to ensure there are safeguarding procedures in place to protect all individuals from any form of abuse at all times. In order to effectively safeguard against abuse within health and social care settings it is first important to identify types of abuse so as to see how the risk of abuse can be restricted and also ensure staff are able to identify any typical signs of abuse as quickly as possible.

Types of Abuse
Abuse can be categorised in one of seven ways
Physical
Sexual
Financial/Exploitation
Psychological/Emotional
Neglect
Discriminatory
Institutional

Physical Abuse
Physical Abuse is typically interpreted as a physical attack (punching, kicking) but can also include other acts of physical harm such as shaking, burns or force-feeding. Indications of physical abuse will be found as bruising, scratches and injuries (more frequent or uncharacteristic injuries if an individual is prone to injuries for other reasons). Physical abuse may also include medication being withheld from an individual causing them to appear more agitated or in pain; conversely medication could be overused making an individual appear perhaps tired/drowsy.

Sexual Abuse
Sexual abuse can include rape or the involvement of a vulnerable adult in any form of sexual contact without consent; this can include coercing individuals into masturbation or the viewing of pornographic material. Signs of sexual abuse may be physical such as bruising or bleeding on/around the genitals, the contraction of sexually transmitted infections or even unexplained pregnancies. Other signs will become apparent in the individuals behaviour which may be more inappropriate. Victims of sexual abuse will often feel ‘dirty’ and adopt an obsession with personal hygiene as well as appearing more depressed and withdrawn. Financial Abuse/Exploitation

Examples of exploitation or financial abuse include theft, fraudulent behaviour and any incident in which possessions, finance or even property are mishandled or taken by manipulating or exploiting an individual’s vulnerabilities. This abuse may present itself with an individual having less money than usual or, if possessions are targeted rather than finance, items of value such as Jewellery, ornamental pieces or electrical goods may have disappeared. This form of abuse may also concern miss-management of finance such as a situation where an abusive carer/nurse withholds money allocated for luxury or personal items. Logs and records of purchases may not match the belongings of an individual indicating abuse could have taken place. Another sign of financial abuse could be an unusual or inappropriate interest in assets of a vulnerable individual and so it is important to maintain a professional level of confidentiality whilst handling financial information. Psychological Abuse

Abuse that is considered psychological includes verbal abuse, threatening/intimidating a vulnerable adult, or deliberate isolation of an individual so as to restrict sociability or communications unfairly. Psychological abuse leaves no direct signs that allow easy detection but may be reflected in an individual’s behaviour. Those who have been victim of abuse may display dislike or ignore certain other individuals and even fear them due to verbal threats or the possibility of further abuse. To safeguard against psychological abuse it is important that staff develop an understanding and familiarity with individuals they work with so as to detect changes in regular behaviour/routines. Neglect and Acts of Omission

Neglect occurs when proper care is not provided for an individual where by a vulnerable persons needs are not fulfilled or are overlooked. This could be an individual missing meals or medication because staff fail to realise these needs have not been met. In situations where staffing levels are insufficient this type of abuse is more likely to arise as staff may be unable to cover the work load depriving individuals of care or support. It is also essential to maintain high levels of staff communication to ensure information such as medicinal requirements or hygiene routines are carried out, particularly with individuals who may have communication difficulties or are non-verbal. If an individual is displaying signs of poor hygiene, dirty clothes or other visual indications that they are not being properly supported it is important to investigate why and ensure this is not due to staff negligence. Discriminatory

Discriminatory abuse can be any form of abuse that has arisen from prejudice towards a person’s beliefs, race, sexuality, gender, disability, age etc. This is a very personal form of abuse and can be avoided by staff working as a team and being aware of any personal problems/differences or conflicts of interest. It is important to identify if abuse has occurred in a discriminatory manner as this can help identify if abuse is likely to occur again. Some individuals may have religious beliefs that require support or may restrict diet therefore it is important for staff to be aware of any individuals’ requirements. Institutional

This form of abuse can perhaps be more difficult to identify as it may occur when care practices have not been adjusted to suit the needs of more vulnerable individual or alternatively an institution may be restrictive or over-bearing to an individual who is in less need of support. This form of abuse can also manifest from staff refusing to listen to individuals because they are set in routine or let their own opinions and feelings influence their work. Staff can also easily become victims of institutional abuse if a work environment exists that does not promote communication and instead creates an environment that puts pressure on an individual who would report abuse preventing them from doing so.

What makes an individual more vulnerable to abuse?
Within health & social care there are many individuals who are considered vulnerable to abuse – essentially anybody who has a dependency on others – and it is important to help these to feel as safe and able as possible. An individual may have less understanding of finance and may not understand the value of money, requiring a support worker to manage their finance for them ensuring they do not overspend. This is but one example but shows that an individual’s mental capacity can make them more vulnerable. A person’s communicative abilities can increase vulnerability; physical disability can also leave individuals more vulnerable to certain forms of abuse making it essential that a standard of care is maintained to allow such individuals to feel safe, and that protocols are in place to prevent and detect abuse as early as possible.

What to do if abuse is suspected or disclosed
In the event that abuse is suspected it is important to record this in an incident report immediately so this can be passed on to the appropriate line manager. This in turn will be passed up through the appropriate channels. All suspicions of abuse must and will be taken very seriously regardless of whether it is reported by a staff member, service user or somebody else on behalf of an individual who may be victim of abuse. When abuse is alleged to a member of staff it is important that information is given is accepted and never immediately dismissed. This must then be recorded using a complaint form, noting all relevant factual information. A unit manager will then also be responsible for recording any additional details of substance to the complaint. In the event that immediate action is required this will be the responsibility of the unit manager.

In the event of sexual abuse where to not act immediately could hide evidence of the abuse it is important that the most senior member of staff available informs the police. The need to maintain evidence is paramount and so the scene of alleged abuse should be kept clear and undisturbed as much as possible. The individual must be supported and protected but should also be encouraged not to wash or change clothes until swabs can be taken for DNA and other forensic evidence, moreover if the individual wants to clean themselves or change staff must explain to them the complications of doing so, advising them not to. It is however still the individuals decision and in the event they decide to clean themselves it should be recorded that this was against staff recommendation. When physical abuse has been suspected or discovered the individual should be seen by their GP as soon as possible to discover the extent of abuse and also ensure the health and safety of the victim.

Reporting Abuse
As soon as abuse is suspected or discovered it should be reported to any of the following: House Manager
Line Manager
Complaints Officer (confidential helpline – 01824792102 or 01824792119) External confidential whistle blowing line (08000665778)
The manager will then be responsible for making sure the information is passed on to the necessary authorities including CSSIW (Care and Social Services Inspectorate Wales), HIW (Healthcare Inspectorate Wales), CQC (Care Quality Commission) as well as the service users Purchasing Authority. POVA (protection of vulnerable adults) procedures will be invoked. Any family members of the individual should be informed only with consent.

How to reduce the risk of Abuse
The DBS (Disclosure and Barring Service) has been in effect since 2012 having replaced the ISA (Independent safeguarding Authority) and CRB (Criminal Records Bureau) maintaining a record of people who have been deemed unfit to work with children and/or vulnerable adults. This helps employers ensure they do not hire staff unfit to work in a care environment, and also maintaining records of any criminal or abusive history to safeguard against repeat offenses. There are other legal frameworks that are to be followed including: Lasting Power of Attorney (LPA) 2007

Safeguarding Vulnerable Groups Act 2006
The Mental Capacity Act 2005 – amended in 2007
No Secrets DH 2000
Health & Social Care Act 2008
Care Standards Act 2000
The Human Rights Act 1998
The Disability Discrimination Act 1995 – amended in 2005
The Mental Health Act 1983

By maintaining awareness and understanding staff are able to be vigilant and capable in identifying as well as preventing abuse. Any staff working in care will receive regular (at least annually) training regarding POVA to ensure proper care. It is also important to make sure vulnerable individuals are protected from abuse by those outside of the care home and ensuring adequate security. Therefore staff will wear name badges to identify themselves whilst any visitors to the homes must sign in and not be granted access until they identity can be confirmed.

Person Centred Planning
Person centred planning (PCP) is an approach to care that can help safeguard against abuse but also help to focus care in a way that is most beneficial and appropriate to the individual and promote independence. The primary objective in PCP is to shift away from ‘Service centred’ care that would prioritise the needs, values and also the limitations of the service providing care and generalises the individuals who require support. By prioritising the needs of the individual care can be provided in a specific way that maximises the involvement and quality of life for those involved. To achieve this it is necessary to identify person-centred values such as individuality, rights, choice, privacy, independence, dignity, respect and partnership.

The individual is encouraged to participate in the construction of their own care to promote independence and increase confidence which in turn can help to reduce vulnerability. Active Participation should always be encouraged and to a great an extent as can be safely achieved. This could be something as simple as participating in the house shopping or something more independent such as involvement in a social or sports group. This also helps to breed confidence and self esteem and by doing so reduces vulnerability and the opportunity for abuse. Moreover it is important to include variety and choice for the individual so that they can have as much control in their own lives as possible, by being allowed to choose what activity they would like to do for instance or what meals they would like on a menu (in the instance where a weekly menu may be created).

Additionally there should be a complaints procedure in place that is accessible for the individual so that they are able to easily and safely report any failings, problems or abuse themselves, in a method that suits the needs of the individual and has made clearly available. If the process appears too difficult for a service user it may prevent them or make them unwilling to report abuse. In certain circumstances it may be that an individual is unable to read, may have difficulties communicating through speech or may be non-verbal.

Therefore to facilitate the needs of the individual staff may be required to use other forms of communication such as pictures or Makaton (form of sign language). When talking to an individual information should be shared in a ‘normal’ way, free of Jargon if this makes it easier to understand. When working with person-centred values it is always important to see the person first, rather than the disability and helping the person to achieve as much independence and freedom as possible rather than simply the approach of treating impairment.

Previous Safeguarding Failings
In the past there have been failings in safeguarding against the abuse of vulnerable adults. Flaws in previous institutions have led to the continued development of safeguarding practices and it is important to identify what allowed previous mistakes to occur and how can we avoid this in the future and create a care service that eliminates vulnerability to abuse. Previous high profile examples of failings within health and social care include the winterbourne view abuse in 2011; the Harold Shipman patient murders; and the Soham murders in 2002, each of which has led to review and reform in care within the UK. In September 2000, shortly after Dr Shipman was found guilty, the Shipman Inquiry was launched to look into the failings of the current systems surrounding medical practitioners and the laws surrounding health and social care.

The inquiry highlighted many issues surrounding health care and in a series of reports made recommendations to improve safeguarding within care leading to professionals being registered all allegations and evidence of possible abuse being explored and investigated quickly and thoroughly. The law surrounding controlled medical drugs was also changed substantially. By 2002 the Criminal records Bureau (CRB) had been set up to allow employers to check potential employees for any record of criminal history so as to eliminate the chance of giving offenders access to vulnerable adults and children. Following the 2007 Soham murders the corresponding Bichard Inquiry led to the formation of the Independent Safeguarding Authority (ISA) which operated alongside the CRB in vetting and barring any high risk personnel that were deemed unfit to work within health and social care. In 2012 both the CRB and the ISA were merged to form a new body, the Disclosure and Barring Service (DBS). This allows for greater transparency and communication between the governing bodies and presents a stronger more informed level of national safeguarding authority.