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There are many different types of abuse that are usually classifed in 5 main headings. These include:
Physical abuse is the act of a person making contact with someone to intentionally caus pain, harm or injury
Sexual abuse is forcing sexual contact or behaviour, towards a person who doesn’t give consent. In some cases people are deemed unable to consent due to age or mental health.
Psychological abuse is where a person is subjected to mentally stressing situations whic causes motional distress.
Abusive realationships are a prime example of psychological abuse where there is an imbalance of power and the abuser has control.
Finanical abuse is where an indvidual tries to take control or gain access to anothers finanances illegally and without the persons consent.
Institutional abuse is the mistreatment of a person within a care environment. Usually due to lack of staff training and unacceptable standards of service.
Self-neglect is where a person does not care for their basic needs, such as their basic hygine. People who self-neglect regularlly put themselves at risk of harm or place themselves in dangerous situations.
Neglect by others
Neglect is where a person responsible for the care needs of another fails to meet their needs. This is usually because they do not relaise the importance of giving the care that is needed or they choose not to.
The potential signs for physical abuse can include:
Fractures and dislocation, multiple bruising in well-protected areas of the body, scratches or cuts, pressure ulcers, sores or rashes, black eyes or bruising to ears, welt marks, scalds or cigarette burns, a history of falls, injuries or a history of accidental overdose unable to provide an explanation consistant to their injuries, clinical intervention without any clear benefit to the person, deterioration of health without an obvious cause, loss of weight, inappropriate, inadequate or soiled clothing, withdrawal or mood changes, carer’s resistance to allow people to visit, reluctance to be left alone with the alleged abuser.
The physical signs of sexual abuse are bruises, scratches, burns or bite marks to the body, scratches, abrasions or persistent infections in the genital regions, pregnancy, recurrant genital or urinary infections, blood or marks on underwear, abdominal pains with no diagnosable cause. As well as the physical signs their can also be behavioural signs which act as an indicator of sexual abuse, these can include: provocative sexual behaviour or promiscuity, prostitution, sexual abuse of others, self-injury or self-distructive behaviour such as alcohol and drug abuse or repeated suicide attempts, behaviour that invites further exploitation, disappearing from a home environment, aggression, anxiety or fearfulness, reluctance to be left alone with the alleged abuser, frequent masterbation, refusal to undress for activities such as swimming or bathing.
The potential indicators for psychological abuse can include: refusal to be left alone with the alleged abuser, carer seems to ignore the person’s needs and presence, reports from neighbours of shouting, screaming and swearing. Fearful of raised voices, distressed if they feel their in trouble, a culture of teasing or taunting which causes distress and humiliation the carer refers to the cared for person in a derogatory way no valuing of basic human rights cared for person being treated like a child.
The signs and symptoms that are associated with financial abuse can include: very few or no personal possessions, unusual change in spending pattern, unexplained shortage of money, unexplained disappearance of possessions, family regularly asking for money from the persons’ allowance, family unwilling to pay from person’s funds for services they get, person not made aware of financial matters, enduring power of attorney set up without consulting a doctor where the person is already confused, other people taking over person’s property, person not being allowed to manage their own financial affairs, sudden changes of a will.
There are many signs and symptoms of institutional abuse but the key factor to identifying it, is that the abuse is accepted or ignored by the care organisation.
Examples of this are: complaints procedures are deliberately made unavailable, access to advice and advocacy is restricted or not allowed, excessive or inappropriate doses of sedation or medication are given, the setting is run for the convenience of the staff, privacy and dignity are not respected, freedom to go out is limited by the institution, refused choices over day-to-day decisions such as mealtimes, bedtimes, what to wear or use the toilet.
The signs and symptoms of self-neglect can sometimes be hard to recognise as it could be that the person has decided on this lifestyle choice and is happy to live this way. These situations are difficult to make decisions and a balance must be achieved to ensure we don’t remove a person’s ability to choose how they live yet safeguarding and protecting vunerable people.
The signs to watch for can include: becoming ill, regularly loss of weight, being dirty and unwashed, wearing soiled clothing, an unclean living environment, withdrawal from society.
Neglect by others
The signs and symptoms of neglect by others are similar to self-neglect but the person relies on others for their care. For example not given adequate food or not given assistance to eat, doesn’t get support with personal care and fails to maintain a clean living environment being left alone, not supporting communication needs or aiding with mobility, failing to maintain medical or health care needs, not supporting social contacts.
Every individual is open to abuse and there are many risk factors that can make a person more vulenerable to abuse. However a person may still be abused when no obvious factors are present. Some factors that are known to contribute to the risk of abuse are: poor communication between the person and their carer, challenging behaviour by the cared, young or immature carers, carers feeling unable to carry on or strong feelings of frustration, person and their carer have a history of a troubled relationship, carer having an alcohol or drug dependancy, carer believing that the person is being deliberately difficult or ungrateful, carer not taking on the role of carer willingly and had to make big lifestyle changes, carer having more than one care responsibilities, person being violent towards carer, carer having disturbed sleep, both person and carer being socially isolated, financial or housing pressures, delays to provide support, no family support or contact.
If you suspect an individual of being abused it is important that you speak to the individual and allow them to be open with you. Listen to the individual and do not judge their word. Try to establish what it is that has occurred without asking any leading questions. Reassure the individual that they are being taken seriously and that you will help them to make it stop. Ensure that the facts are recorded and the appopriate paperwork and is signed and dated; making sure to report the incident to a senior member of staff.
When an individual speaks out about abuse it is important to take the allegations seriously. Reassure them that they can tell you everything and you’ll do everything in your power to help it stop. Make a written account of what has been said making sure to include only the facts and not your own opinions. Sign and date the paperwork and report it to senior members of staff for them to take the matter further.
to record the facts immediately making sure to sign and date the paperwork record any physical signs of abuse using a body map, try to describe the injuries size, shape and colour try not to tamper with any evidence unless you have to for the wellbeing of the individual if you have to touch anything, record what you have done report the evidence to senior members of staff immediately.
Both nationally and locally the protection of vulnerable adults forms part of the safeguarding adults agenda. Local boards are responsible for delivering a multi-based agency to respond to the safeguarding of adults. They are also responsible for conducting Serious Case Reviews when someone has died as a result of abuse. Nationally there are legislations that provide the basis for dealing with vulnerable adults that are being abused. Such as the Care Standards Act 2000, Safeguarding vulnerable groups act 2006 and the Mental healt act 1983.
Many different agencies are responsible for safeguarding and protecting individuals from abuse this is to ensure that abuse if easyer to be found, recorded and report to the right authorities. These agencies include: Medical professionals such as GP, hospital staff, nurses, docors etc. They can examine, diagnose & treat abuse, they will record all evidence including photographic evidence. An Expert Witness such as paediatris, geriatrics, psychiatrics etc can report evidence of abuse The local authority would carry out an assessment of needs, through social workers. This would assess the risks of abuse for the individual The Safeguarding Team, within Social Services investigates & ensures safety and will work with other agencies such as police.
A Safeguarding & Protection Officer would lead the Adult Protection Alert. The Police will investigate and prosecute abusive cases, they will work with other agencies, to provide support to victims and raise awareness of abuse. Care Quality Commission regulate & inspect care providers, ensuring that safeguarding policies are being adhered to. Independent care homes, following safeguarding policies, to safeguard & protect vulnerable people before employment commences, including CRB checks
The biggest example of failures to protect individuals from abuse would be the report by the Care Quality Commission on the services provided at Winterbourne View. Despite a senior nurse alerting the care home’s management and the CQC on several occasions about cases of abuse, his concerns were failed to be followed up. CQC inspectors found that the home had failed to ensure people under the care of Winterbourne View were adequately protected from risk CQC also added that the home failed to meet standards required by law such as: managers did not report majors incidents to the CQC, planning and delivery of care did not meet individual needs, they did not have robust systems to assess and monitor the quality of services they have not responded to, or considered complains about the service investigation into the conduct of staff was not robust and didn’t safeguard individuals, they didn’t take steps to identify the risks of abuse or to avoid abuse happening, they ignored allegations of abuse and did not respond appropriately, they did not have steps in place to protect individuals from abuse, used exessive use of restrait, staff were inexperienced and untrained to deal with the individuals in their care.
There are many ways to access information on safeguarding and protecting individuals from abuse such as national polices and proceedures, individual care plans, local authorities polices and proceedures, training in areas such as safeguarding and information from management.
Understanding ways to reduce the likelihood of abuse.
Explain how the likelihood of abuse may be reduced by:
Ensuring that the individual maintains the right to make choices for themselves. That they are confident and have a vision of self worth to help individuals feel less vulnerable towards abuse. Understanding that they have a choice to be heard and knowing that they can share anything and that information will be taken seriously will reduce the likelihood of abuse taking place. Active participation builts self esteem, refusing to tolerate abuse and be more likely to report it.
When the complaints proceedure is clear and easily accessable an indivdual is more likely to report an incident of abuse and abusers will be more likely be investigated on their behaviour. Knowing this would make them less likely to abuse. Individuals that are vulnerable to abuse will feel protected and empowered to report any incidences of abuse.
In a care setting unsafe practies that affect the well-being of individuals could include:
Staying in line with policies and proceedures we have to ensure that the safety of the individual is protected and away from any risks. Report everything to senior management and write down what is suspected and why on appropriate paperwork and try to preserve the evidence of the practices without endangering others.
If nothing has been done in response to reporting to a senior member of staff, the deputy manager or home manager should be informed. If again noting happens the local safeguarding authorities such as council, police or other agencies should be contacted to invested the matter further. The CQC should also be contact about the matter. Keeping all information that has been reported written down with times and dates of the unsafe practices, when they orginally reported and who you reported it to.
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