Presentation on theme: "Safeguarding vulnerable adults"— Presentation transcript:
1 Safeguarding vulnerable adults Thinking the unthinkable‘It could never happen here’
2 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
3 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
4 ‘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
5 ‘Abuse can occur in any relationship and may result in significant harm to, or exploitation of, the person subjected to it.’Ibid
6 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
7 Types of abuse Physical abuse Sexual abuse Psychological/emotional abuseFinancial/material abuseNeglectDiscriminatory abuseInstitutional abuse
8 Examples of physical abuse SlappingHittingPushingPullingRough handlingKickingMisuse of medicationUnreasonable physical restraintIsolation or confinementPoor application of manual handling techniques
9 Indicators of physical abuse Any injury not fully explained by the history givenUnexplained bruises and welts on face, lips, mouth, body, arms, back, buttocks, thighsBruises in various stages of healing or in shape of article or finger marksUnexplained burns, especially on soles, palms and back; immersion scalds, rope burns, electric appliance, cigarette or carpet burnsUnexplained fractures to any part of the bodyUnexplained lacerations or abrasions to mouth, lips, gums, eyes, external genitaliaMalnutrition – rapid or continuous change in weight, dehydration, indications of force-feedingStench or signs of urinary/faecal incontinenceUse of furniture and other equipment to restrict movement
10 Examples of sexual abuse Inappropriate touchingMasturbationOral contactGenital contactDigital penetration (vagina or anus)Rape (vagina or anus)Penetration with objectsAttempted penetration
11 Examples of sexual abuse VoyeurismPornographyIndecent exposureTeasingInnuendoHarassmentExploitation
12 Indicators of sexual abuse Full or partial disclosure or hints of sexual abuseGenital or urinary irritation or infectionSexually transmitted diseaseLove bites, bruises or finger marks on inner thighs or armsPain or bleeding in the genital areaUnusual difficulty in sitting or walkingUnexplained onset of faecal or urinary incontinenceSignificant change in sexual behaviour, language or outlookPregnancy in a person who is not able to consentSevere agitation when person is bathed, undresses or medically examined
13 Examples of psychological abuse Threats of punishment, harm or abandonmentHumiliation, ridicule and insultsIsolation or withdrawal from services or supportive networksOverriding/denial of basic human and civil rights such as choice, privacy, dignity and self-expressionBullying and harassmentBlaming
14 Examples of psychological abuse OverprotectionDeprivation of contact and/or freedomIntimidation and coercionControllingVerbal abuse/swearingTreating someone inappropriately for their age and/or cultural/ religious background
15 Indicators of psychological abuse Fearfulness , avoids looking at caregiver, flinching on approachSleep disturbance – insomnia or excessive sleepLow self-esteemUnexplained fear, defensiveness, paranoiaDeference, resignation, passivityEmotional withdrawalUnusual bouts of sobbing or weepinessPunitive approach to bodily functions or incontinenceFew visitors/ phone calls/outingsLocking the person in the home or in a carThreats to abandon the person or “put them away”Ambivalent feelings between victim and caregiver
16 Examples of financial/material abuse TheftFraudExploitationPressure in connection with wills, property, inheritance or moneyMisuse or misappropriation of property, possessions or benefitsPreventing access to money
17 Indicators of financial/material abuse Unusual or inappropriate account activityPerson lacks belongings or services which they can clearly affordPower of Attorney obtained when person lacks capacity and is unable to comprehendRecent change of deeds or title of housePerson managing financial affairs is evasive or uncooperativeDisproportionate interest or affection for person with money or property
18 Examples of neglect Ignoring medical or physical care needs Failure to provide access to appropriate health, social care, educational or housing servicesWithholding the necessities of life (nutrition, medication, heating)Failure to recognise and acknowledge religious and cultural needsFailure to acknowledge a person’s right to choice, dignity, privacy and independence
19 Indicators of neglect 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 lossCannot access appropriate medication or medical carePerson and/or carer has inconsistent or reluctant contact with health and social care agenciesCallers/visitors are refused access to the personPerson exposed to unacceptable risk
20 Discriminatory abuseDiscriminatory abuse exists when values, beliefs or culture result in a misuse of power that denies mainstream opportunities to some individuals or groups in society.
21 Discrimination can take place on the grounds of: RaceGenderSexualityAgeDisabilityEthnicity, religion or culture
22 Discriminatory actions include: Unequal treatmentVerbal abuseInappropriate use of languageSlursHarassmentDeliberate exclusion
23 Institutionalisation Block treatmentRigid routineStaff/patient divisionOne place and authorityRisks: De-personalisationDe-humanisation
24 Role of alerterIf 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 policeIf you do not do so, you become part of the abusive situation.
25 Safeguarding trumps confidentiality If the potential victim is a vulnerable adult, you must report even if they ask you not to do so.Good practice to tell them this, unless to do so will put them or you at risk
26 Emergency services Is urgent medical attention needed? Does the person have somewgere safe to go?Is there a need to protect physical/verbal evidence?
27 What to recordThe identity of the person reporting the incident and any other person present at the timeDescription of the scene of the incidentState and behaviour of the victim, including anything saidDetails of any obvious injuries, on a body map if possibleDate and time of incident and sign the record
28 Responding to disclosures ReassureTake seriouslyAvoid leading questions or helping to finish sentencesRecord the exact words used
29 Factors increasing risk of abuse IndividualSensory impairmentDoes not communicate verbally,Support needed with intimate personal careLack of understandingExperienceLearned complianceAbused before and thinks it is acceptable
30 Factors increasing risk of abuse RelationshipsDependent, over-protected, devalued, lacking choice and controlMental or physical ill-health of carerHistory of alcohol or drug misuseDebt or poor housing,Changes in roleEnvironmentSocial /geographical isolationRigid routinesPoorly trained/supported staffLow morale, low status of work
31 Safeguarding Vulnerable Groups Act 2006 identifies two sets of activities in relation to children and vulnerable adultssets out the requirements for vetting and barring people for these activities.
32 Regulated activitiesContact 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 careDefined office holders (eg Directors of Children’s Services, trustees of children’s charities, school governors)
33 Controlled activities Frequent or intensive support work in general health settings, NHS and further education settingsFrequent access to sensitive records about children and vulnerable adultsSupport work in adult social care settingsIt 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.
34 Independent Safeguarding Agency Administers two lists:Vetted for work with children/vulnerable adultsBarred 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.
35 Service users can be helped to prevent abuse by: Access to user groups, advocacy schemes and independent feedbackBeing listened toBeing given clear and accessible information about rights and servicesShared decision making and person centred planningWell publicised and accessible Complaints Procedure
36 Staff can help to prevent abuse by: Following guidance re: personal care, behaviour issues and sexualityAcknowledging ‘it could happen here’Being alert to signs of distress or intimidationReporting concerns at earliest opportunity and keep reporting until action – line management, other professions, CSCIRequesting and attending training and development eventsAsking for help
37 Managers can help to prevent abuse by: Ensuring adequate staffing levelsRecruitment procedures and checksSupervision and trainingKeeping communication channels openClear polices which promote good practiceSound recording systems
38 Further Reading Working with Adult Abuse (e-book) by Jacki Pritchard Brown, K (2006) Vulnerable Adults and Community Care Exeter: Learning Matters‘Lessons from the murder of Stephen Hoskins’ (audio-visual)under ‘Safeguarding Adults’