Protecting Adults at Risk

of Abuse

A Guide for Staff

 Protecting Adults at Risk of Abuse

A Guide for Staff

Introduction
Vulnerable adults should be enabled to live and receive services in an environment,
which is free from prejudice and safe from abuse.

An approach of zero tolerance will be taken to ensure that vulnerable adults are protected.

All individuals are entitled to;

• Privacy
• Being treated with dignity
• Leading an independent life and to be enabled to do so
• Being able to choose how they lead their lives
• The protection of the law
• Having their rights upheld regardless of ethnic origin, gender, sexuality,
impairment or disability, age, religious or cultural background.

Where a vulnerable adult is able to make informed choices, they must be advised of the
options available to them, and have their wishes respected, unless, exceptionally, a
statutory responsibility to intervene arises. If intervention is necessary to prevent further
risk, the staff should pursue action in a way that causes the least disruption for that
individual’s way of life.

Who is a vulnerable adult?

“Any person aged 18 or over who:

i) is or may be in need of community care services by reason or mental, physical

or learning disability, age or illness, and who:
ii) is or may be unable to take care of him or herself or unable to protect him or
herself against significant harm or serious exploitation which may be
occasioned by the actions or inactions of other people”.

“Abuse is a violation of an individual’s human and civil rights by any other person or
persons.”
(Adaption of Department of Health’s guidance called ‘No Secrets’ – March 2000)
The POVA (Protection of Vulnerable Adults) Scheme
The POVA List aims to protect vulnerable adults in care homes and their own homes by
barring people who have caused harm to a vulnerable adult from being employed in a
care position in a care home or in providing domiciliary care to those living in their own
homes.

With effect from 26th July 2004, care providers must check the POVA List before
employing someone in a position where they will have regular contact and provide
personal care to people living in their own homes. Such jobs may not be offered to people
whose names are on the POVA List.

POVA checks are made as part of CRB checks. They should also be made if someone
moves to a care position from a job (even if with the same employer) which did not
involve regular contact with vulnerable adults.

Employers must refer for inclusion on the POVA List anyone who was dismissed for
misconduct which harmed a vulnerable adult or placed a vulnerable adult at risk of being
harmed. Staff must also be referred for inclusion on the List if because of such
misconduct they were suspended, or transferred away from a care position, or they
retired, resigned or were made redundant in circumstances where they would have been
dismissed.

People may appeal against (initially) being included on the List, and may apply for
removal on the grounds that they are not unsuitable to work with vulnerable adults.

What is abuse?
It may involve:

“ A single or repeated act or omission, occurring within a personal or other close

relationship where there is an expectation of trust, which causes harm to a vulnerable
adult as defined above.” (Adapted from ‘Action on Elder Abuse’)

Physical abuse - including physical assault ranging from rough, inappropriate or

careless handling to direct physical violence, resulting in falls and injuries which may
include bruising, abrasions, burns, scalds, sores, wounds, dislocations or fractures; also
including medical mistreatment such as withholding or inappropriately altering
medication or other treatment regimes and the inappropriate use of restraint.

Sexual abuse – including physical assault, rape or coercion to engage in sexual

activity, including the threat of deprivation or neglect or physical abuse.
Psychological/emotional abuse – including any verbal or non-verbal harassment,
bullying, insulting, intimidating or threatening behaviour, including the threat of
deprivation or neglect or physical or verbal humiliation or undermining through ridicule
and contemptuous treatment and the deliberate misrepresentation of behaviour or views;
may also include threats to future security based upon property ownership or financial
support.

Financial or material abuse – including the exploitation of dependence for

personal gain, abuse of legal rights, misappropriation of funds or property, extortion or
the threat of deprivation or neglect or physical abuse to obtain money, consent or legal
powers including the right of inheritance.

Deprivation, neglect and acts of omission – including careless or deliberate

withholding or inadequate provision of food, withholding assistance to use the toilet,
keep clean, warm and comfortable and the involuntary isolation or confinement of the
individual against their will (including control of access by telephone or post); may also
include withholding of the right to independent decision making or action and the
enforcement of inappropriate, unnecessary dependence.

Discriminatory abuse – including racist, sexist, homophobic, or other discriminatory

abuse, including that related to age, illness or disability. Including harassment, slurs or
incitement of others to commit abusive acts or make abusive comments.

Where does abuse happen?

People can be abused at work in hospitals, in residential or nursing homes, in day centres,
police stations, in public places and in their own homes.

Who is abused or at risk?

Any vulnerable adult, man or woman, can experience abuse or be at risk, irrespective of
social class, status, income, age, gender, sexuality, ability, race or cultural background.
Abuse may occur in any culture but may be interpreted in different ways in difficult
cultural settings.

• People may be abused by a person they care for

• They may be abused by a person who cares for them
• Mutually abusive relationships involving two or more adults exist
• Abuse may be related to race, age, gender, disability, sexuality or culture
• It may be related to personal gain
Who abuses?
The abuser is frequently, but not always, known to the person they abuse. They may be:
• A partner, child, relative or other household member
• A friend or neighbour
• A volunteer worker
• A health or social care worker
• A member of staff in a residential or nursing home or a sheltered housing scheme
• Another customer or patient
• Any other person with access to the person concerned

Patterns of abuse
Patterns of abuse vary and reflect very different dynamics. These include:

• Serial abusing in which the perpetrator seeks out and ‘grooms’ vulnerable
individuals. Sexual abuse usually falls into this pattern as do some forms of
financial abuse

• Long term abuse in the context of an ongoing family relationship such as

domestic violence between spouses or generations

• Opportunistic abuse such as theft occurring because money has been left around

• Situational abuse which arises because pressures have built up and/or because of
difficult or challenging behaviour

• Neglect of a person’s needs because those around him or her are not able to be
responsible for his/her care, for example if the carer has difficulties attributable to
such issues as debt, alcohol or mental health problems

• Institutional abuse which features poor care standards, lack of positive responses
to complex needs, rigid routines, inadequate staffing and an insufficient
knowledge base within the service

• Unacceptable ‘treatments’ or programmes which include sanctions or punishment

such as withholding of food and drink, seclusion, unnecessary and unauthorized
use of control and restraint or over-medication
 • Failure of agencies to ensure staff receive appropriate guidance on anti-racist and
anti-discriminatory practice

• Failure to access key services such as health care, dentistry, prostheses

• Misappropriation of benefits and/or use of the person’s money by other members
of the household

• Fraud or intimidation in connection with wills, property or other assets

Why does abuse happen?

Abuse happens for many reasons and the causes are not fully understood

The risk is known to be greater when:

• The vulnerable person is socially isolated

• A pattern of family violence exists (the person who abuses may themselves have
been abused)

• Drugs or alcohol are being misused

• Relationships are placed under stress

In residential or nursing homes abuse is more likely to occur where staff are:

• Inadequately trained

• Poorly supervised

• Lacking support

• Working in isolation

As well as the known risk factors a range of other factors may increase the
likelihood of abuse where:

• The person has an illness such as Parkinson’s Disease or Alzheimer’s Disease

which may affect which may affect his or her intellect, memory or physical
functions and cause unpredictable behaviour

• The person has communication difficulties

 • The person exhibits challenging behaviour or shows major changes in personality,
repetitive or embarrassing behaviour, wandering or aggression

• The person concerned is demanding beyond the capacity of the carer to respond
• The family undergoes an unforeseen or u foreseeable change in circumstances, eg
sudden illness, unemployment

• A carer has been forced to change their lifestyle for financial or other reasons as a
result of caring

• A carer is isolated an can see no end to, or relief from, the caring task

• A carer experiences regularly disturbed nights

• There has been a reversal of role (a parent becoming dependent on their child)

• There are persistent financial problems

• Other relationships are unstable or placed under pressure by the caring task

Possible signs of abuse

A range of indicators may suggest the possibility of acute risk or abuse. None of
them means that abuse has taken place but they suggest the need to raise awareness
of the possibility that it may:

• Direct reports or admissions that abuse has occurred or expressed fears that it
might
• A vulnerable person found alone and at risk on repeated occasions without
adequate explanation
• A prolonged interval between injury or illness and presentation for medical or
other care (possibly on more than one occasion).
• Evidence of unreported injuries
• Injuries suggesting a possible non-accidental cause; eg finger mark bruising,
cigarette burns, cord or strap marks, bruising on the inside of upper arms or upper
legs
• Explanations inconsistent with injuries presented or inconsistent explanations
given
• A history of unexplained illness, infection or injury or the inappropriate use of
medication
• Abrupt or frequent changes of doctor or caring agency
• Unexplained weight loss or gain
 • Uncharacteristically unkempt appearance, regularly lacking glasses, hearing aid,
false teeth
• Repeated difficulty in gaining access or evidence of possible avoidance, including
regularly missing appointments, refusal of help etc
• Property or money going missing or bills not being paid, unexplained withdrawals
of money, disappearance of bank statements
• Person regularly and uncharacteristically withdrawn, without apparent
explanation or cause
• Evidence of alcohol or other substance misuse
• Signs of stress, eg inappropriate or misplaced anger, unexplained loss of temper,
mood changes, uncharacteristic changes in appearance or behaviour, frequent and
unusual patterns of minor illness or injury
• History of previous abuse or violence in the family
• Unexplained pain, itching or injury in the anal, genital or abdominal areas
• Difficulty in walking or sitting due to discomfort in the anal or genital areas
• Recurrent bouts of cystitis or venereal disease
• Unexplained and persistent problems with catheters
• Torn, stained or bloody underclothing without adequate explanation or cause
• Reports of concern from one or more third parties in contact with the person
concerned

Best practice for disclosure/discovery

Staff may become aware of the potential abuse of a vulnerable adult through their
own or others suspicions or by the victim or abuser disclosing the abuse to them. It
is important that staff respond to such disclosures in a way supportive to the client.

Supporting the individual

• Remain calm and try not to show any shock

• Listen very carefully to what you are being told
• Reassure the person by telling them they have done the right thing by telling you
• Explain that you are required to share information with our manager
• Let them know that steps will be taken to support and protect them and that they
will be kept informed
• Don’t promise what you can’t deliver

Information gathering
• Take care not to ask any leading questions
• Establish the views of the victim
 • Be aware of possibility of the need for forensic evidence and ensure the protection
of this evidence
• As soon as possible, record what has been said, in their own words a far as is
possible, including the sequence of events

What to do next

• Ensure the safety of the vulnerable adult and any other person at risk
• Determine the view of the vulnerable adult about what you propose to do
• Inform the person that any further investigation will be carried out sensitively and
that information will only be shared with people that need to know

The police must be involved when there is:

• An allegation from a vulnerable adult to another person of sexual abuse or there is

a suspicion that sexual abuse has occurred
• Alleged or suspected cases of physical injury. This includes violence to a
vulnerable adult constituting an assault, actual or grievous bodily harm
• An alleged or suspected case or cruelty, including ill-treatment or neglect
• An alleged or suspected case of financial abuse
Or
• Whenever a criminal offence is suspected

If you suspect that your line manager may be involved in the abuse, or you do not feel
able to discuss it with them for any reason, see the following section on Whistleblowing

Whistleblowing
A whistleblower is a person who reveals information with the intention of calling
attention to bad practice, which may include abuse or negligence, in the workplace. Staff
who work with vulnerable adults have an individual responsibility to raise concerns about
bad practice and a right to know that they will be supported by their employer if they are
acting in good faith.

The service user’s interest is paramount and the common law ‘duty of care’ requires that
each employee has a responsibility to protect the vulnerable.

Support and protection will be given to those providing information about abuse of
vulnerable adults. If staff do not feel confident about reporting to their line manager, or
other internal methods, the following organisations can offer advice:

Your Local Authority Social Services/Community Care Department

Commission for Social care Inspection – 0118 903 3230
Action on Elder Abuse – 0808 80 8141
Public Concern at Work – 0207 404 6609
The Carersline – 0808 808 7777

Organisations should promote a culture which values good practice and encourages
whistleblowing.

Investigating abuse
Reporting
Where there is any suspicion of abuse that relates to a vulnerable adult, the concern must
be reported to the Local Authority Social Services/Community Care Department.

Early referral and consultation with the police will enable them to establish whether a
criminal act has been committed, and will give them the opportunity of determining if,
and at what stage, they need to become involved.

Agencies receiving a complaint or allegation of abuse must inform other agencies

involved of the nature of the complaint or allegation and the action being taken. Social
Services should co-ordinate and monitor action and should ensure that other agencies
involved receive updates on progress made in the investigation unless it is unsafe and
inappropriate for them to do so.

Strategy meeting/discussion
A strategy meeting/telephone discussion involving the relevant statutory agencies, eg the
police, social services, health, CSCI and legal department must now be co-ordinated by
social services. There may be circumstances where the client and/or their representative
may be invited to attend part of the meeting.

More than one strategy meeting/telephone discussion may be necessary to share further
information.

The purpose of a strategy meeting is to:

• Ensure the safety of the vulnerable adult

• Allocate an investigating officer
• Define whether a joint investigation is necessary
• Exchange information across agencies
• Decide if no further action is needed
• Decide whether the internal press officer/department needs to be alerted to any
possible media interest.
A record of these meetings must be sent to all relevant agencies.

Where an allegation of abuse is made concerning a vulnerable adult person supported by

a domiciliary care agency, the Commission for Social Care Inspection (CSCI) must be
consulted and invited to any strategy meeting or case conference.

The investigation
The investigation aims to:

• Establish matters of fact

• Assess he needs of the vulnerable adult for protection, support and redress
• Make decisions with regard to what follow-up action should be taken, with regard
to the alleged perpetrator and the service, or its management, if they have been
culpable, ineffective or negligent.

Where staff are implicated in a case of abuse, immediate discussion will take place
between (where appropriate) the police, the employer, Social Services and Health.

Keeping accurate records during the investigation

Information from the initial disclosure will already have been recorded. It is important
that clear and accurate records are kept as they may be used as evidence in court
proceedings.

Your report should include

• Name, address and date of birth of the vulnerable person

• Allegation/suspicions reported, record dates and locations here known
• Previous related allegations/history of abuse
• A brief description of the vulnerable adult, including nature
disability/vulnerability, communication needs
• Social situation/family network and current services received
• Your assessment of the persons capacity to consent in relation to
allegation/suspicions, legal status
• Vulnerable person’s views, do they wish to involve the police
• A description of the investigation process and evidence gathering.
• An evaluation of the evidence
• Your assessment of the seriousness of the alleged abuse
• Risk assessment
• Recommendations for action
• Your name, organization, team, position and qualifications.
The role of the police
It will always be the responsibility of the police to preserve and gather evidence when a
criminal offence is suspected. Everybody working with vulnerable adults can play an
important part in preventing evidence being lost.

If in doubt seek advice.

Remember that police involvement will not always result in criminal prosecution, either
because of lack of evidence, because prosecution may not be in the public interest or
because the injured party may not wish to proceed.

Finally
• Be aware

• Abuse is by definition a hidden problem

• Carers can also be victims of abuse

• If in doubt contact your line manager

• If there is evidence or suspicion of a criminal offence contact the police