Types of abuse and neglect

This describes direct or indirect involvement in sexual activity without the person’s consent. Often it can involve the inability to consent, or situations where there has been pressure or inducement to consent or take part. While it mainly affects women, men can also be victims. 

At one end of the scale adult sexual exploitation can describe a one-off situation between two adults, while at the other end it may include instances of organised crimes where a number of adults are trafficked and sexually exploited. 

What might it look like? 

• rape, sexual assault or sexual acts to which the adult has not consented to, was unable to consent to, or was pressured into consenting to 
• indecent exposure; sexual harassment 
• inappropriate looking or touching 
• sexual teasing or innuendo 
• sexual photography, subjection to pornography or witnessing sexual acts 

How might you recognise it? 

• Bruising, particularly to the thighs, buttocks and upper arms and marks on the neck 
• Torn, stained or bloody underclothing 
• Bleeding, pain or itching in the genital area 
• Unusual difficulty in walking or sitting 
• Foreign bodies in genital or rectal openings 
• Infections, unexplained genital discharge, or sexually transmitted diseases 
• Pregnancy in a woman who is unable to consent to sexual intercourse 
• The uncharacteristic use of explicit sexual language or significant changes in sexual behaviour or attitude 
• Incontinence not related to any medical diagnosis 
• Self-harming 
• Poor concentration, withdrawal, sleep disturbance 
• Excessive fear/apprehension of, or withdrawal from, relationships 
• Fear of receiving help with personal care 
• Reluctance to be alone with a particular person

Financial or material abuse is about unauthorised or fraudulent access to money, property or any resources of the adult at risk. It is often present with other types of abuse. 

Some forms of this, such as scams, fraud, direct theft are quite easy to recognise, but financial abuse can start small and develop – a neighbour starts by helping with shopping and doesn’t return all the change, begins to charge large amounts for the service, perhaps then puts emotional pressure on an adult at risk to help buy a car, or to change their will. 

What might it look like? 

• Fraud, scamming (including internet scams), theft 
• Preventing a person from accessing their own money, benefits or assets 
• Lending money that is never paid back 
• Undue pressure, duress, threat or undue influence (coercion) put on the person in connection with loans, wills, property, inheritance or financial transactions 
• Arranging less care than is needed to save money to maximise inheritance 
• Someone stopping others helping to manage/monitor financial affairs 
• Refusing access to benefits 
• Misuse of personal allowance in a care home 
• Misuse of benefits or direct payments in a family home 
• Someone moving into a person’s home and living rent free without agreement or under duress 
• False representation, using another person's bank account, cards or documents 
• Exploitation of a person’s money or assets, e.g. unauthorised use of a car 
• Misuse of a power of attorney, deputy, appointeeship or other legal authority 
• Rogue trading – e.g. unnecessary or overpriced property repairs and failure to carry out agreed repairs or poor workmanship 

How might you recognise it? 

• unexplained or sudden inability to pay bills, especially when there is someone appointed to support with this; debt building up 
• unexplained withdrawal of money from accounts 
• personal possessions going missing 
• contrast being known income and actual living conditions 
• unusual interest by friend/relative/neighbour in financial matters 
• pressure from next of kin for formal arrangements being set up. 
• Receipts not being provided for shopping or other services

The term Modern Slavery is used to describe a range of situations including human trafficking, forced labour and inhumane treatment. Victims of modern slavery can be any age, gender, nationality and ethnicity. 

Traffickers often use violence and threats, forcing people into debt, and is always about controlling people to exploit them for financial or personal gain. They may use concerns about an individual’s immigration status or worries that their families may be at risk if they resist. 

Human trafficking is the process by which people become trapped and exploited. It does not have to involve travel, although people may be moved across borders or into countries. 

What might it look like? 

• Sexual exploitation including prostitution and ‘adult entertainment’ 
• Forced labour – commonly in agricultural, construction, food processing, the hospitality industry, factories, car washes, nail bars,  farming, textile production and also workers in the care home sector 
• Domestic servitude 
• Organ harvesting 
• Forced criminality – includes cannabis cultivation, street crime, forced begging, burglary, metal theft and benefit fraud 

How might you recognise it?  People may be: 

• Distrustful of authorities 
• Expression of fear or anxiety 
• Signs of psychological trauma 
• Acts as if instructed by another 
• Injuries apparently a result of assault or controlling measures 
• Evidence of control over movement, either as an individual or as a group 
• Found in or connected to a type of location likely to be used for exploitation 
• Restriction of movement and confinement to the workplace or to a limited area 
• Limited social contact / contact with family 
• Unable or reluctant to give details of accommodation or work address 
• Perception of being bonded by debt 
• Money deducted from salary for food or accommodation 
• Threat of being handed over to authorities 
• Threats against the individual or their family members 
• No or limited access to bathroom or hygiene facilities, or medical care 
• Passport or documents held by someone else 
• Being placed in a dependency situation

Cuckooing, also known as forced home invasion, is a form of criminal exploitation where individuals or gangs linked to drug networks, take over the home of a vulnerable adult to use it for illegal activities. This can include drug dealing, storing weapons, human trafficking, and financial abuse. 

Cuckooing is closely linked to county lines drug networks and often overlaps with other forms of criminal exploitation.   

What might it look like? 

• Increased foot traffic or unfamiliar visitors at all hours. 
• Anti-social behaviour, noise complaints, or property damage. 
• Reports of young people frequenting the property. 
• Unusual deliveries or takeaway orders at odd hours 
• Bikes and cars always arriving or parked nearby 

How might you recognise it? 

• The resident appearing anxious, withdrawn, or fearful. 
• disengaging services or missing appointments. 
• A change in behaviour, for example, less contact with family, friends or neighbour 
• A change in routine 
• A change in appearance, for example, an injury, weight loss or not taking care of how they dress

This describes situations where an adult has care needs and relies on someone else for support, which is not provided. This can be intentional or unintentional. This category will often mean situations where the neglect or omission could reasonably have been prevented, or is intentional, or is persistent. This is because human error or unusual circumstances can mean that things are missed when caring for someone else but is a one-off or temporary issue. 

What might it look like? 

• Failure to provide or allow access to food, shelter, clothing, heating, stimulation and activity, personal or medical care 
• Failure to provide care in the way the person wants 
• Failure to administer medication as prescribed 
• Not taking account of individuals’ cultural, religious or ethnic needs 
• Not taking account of educational, social and recreational needs 
• Ignoring or isolating the person 
• Failure to allow choice and preventing people from making their own decisions 
• Failure to ensure appropriate privacy and dignity. 

How might you recognise it? 

• Poor hygiene/cleanliness of the person in need of care and support 
• Repeated infections e.g. urine or chest infections 
• Dehydration, unexplained weight loss, malnutrition 
• Repeated or unexplained falls or trips 
• Not having the proper items they needs to help them e.g. walking frame, hearing aid, glasses, pressure mat 
• Pressure sores or ulcers 
• Untreated injuries and medical problems 
• Inconsistent or reluctant contact with medical and social care organisations 
• Large amount of medication not taken 
• Social isolation that is unusual for that person 
• Wrong clothing e.g. someone else’s, too big / too small, not right for the weather or situation

This describes situations where someone treats you differently or unfairly because they think you are different to them. This might be because of: 

•    Age (actual or perceived) •    Disability •    Gender / gender identity •    Ethnic, racial, cultural or national origin •    Religious belief / non-belief •    Sexual orientation 

These are known as “protected characteristics” under the Equality Act 2010. The Act makes it a crime to treat anyone differently because of these things. 

What might it look like? 

• Verbal abuse, derogatory remarks or inappropriate use of language related to a protected characteristic 
• Denying access to communication aids, not allowing access to an interpreter, signer or lip-reader 
• Harassment or deliberate exclusion on the grounds of a protected characteristic 
• Poor quality service relating to a protected characteristic, or being refused access to a service 
• Lack of disabled access 

How might you recognise it? 

• acts or comments motivated to harm and damage including inciting others to commit abusive acts 
• lack of effective communication provision e.g. interpreters 
• the adult being subjected to racist, sexist, ageist, gender-based abuse 
• abuse specifically about their disability 
• the person appears withdrawn and isolated 
• the person expresses anger, frustration, fear or anxiety

This describes where someone has experienced harm due to poor working practices or care within an organisation or institution such as a hospital or care home for example or relating to care provided in a person’s own home. 

It can be restrictive practices which are in place to meet the needs of staff, the service, or the organisation, rather than reflecting the individual needs of the people receiving the services. Organisational abuse can often affect more than one person in that environment. 

What might it look like? 

• Discouraging visits or the involvement of relatives or friends 
• Run-down or overcrowded establishment 
• Authoritarian management or rigid regimes 
• Lack of leadership and supervision 
• Insufficient staff or high turnover resulting in poor quality care 
• Abusive and disrespectful attitudes towards people using the service 
• Inappropriate use of restraints 
• Lack of respect for dignity and privacy 
• Failure to manage residents with abusive behaviour 
• Not providing adequate food and drink, or assistance with eating 
• Not offering choice or promoting independence 
• Misuse of medication 
• Failure to provide care with dentures, spectacles or hearing aids 
• Not taking account of individuals’ cultural, religious or ethnic needs 
• Failure to respond to abuse appropriately 
• Interference with personal correspondence or communication 
• Failure to respond to complaints 

How might you recognise it? 

• Little flexibility and choice for people using the service 
• Too few staff to meet people’s needs 
• People being hungry or thirsty 
• Lack of personal clothing and possessions; communal use of personal items 
• Lack of adequate procedures 
• Poor record-keeping and missing documents 
• Lack of training for staff, poor moving and handling practices 
• Absence of visitors 
• Few social, recreational and educational activities 
• Public discussion of personal matters 
• Unnecessary exposure during bathing or using the toilet 
• Absence of individual care plans 
• Lack of management overview and support 
• High level of minor injuries 
• Strong smell of urine

The term self-neglect covers a wide range of behaviours which can present individually or together. such as: 

• Lack of self-care  resulting in neglect of one’s personal hygiene, nutrition, hydration, or medication which impacts on the persons safety and wellbeing 
• Lack of care of one’s environment resulting conditions that are dirty or where items or animal are collected in large quantities 
• Refusal or failure to seek services 
• Inability or unwillingness to manage one’s personal affairs 

Self-neglect and Hoarding can often happen in isolation from each other. And both are different to the other forms of abuse listed here as they do not involve someone else who is initiating the harm. However self-neglect and hoarding may harm other people living in the same property.

How might you recognise it? 

• Living in very unclean home environment e.g. build-up of rubbish or waste. 
• Physical or health needs not adequately cared for, causing them to deteriorate. 
• Inadequate diet and nutrition, which impacts on the individual’s health and wellbeing. 
• Social contacts not being maintained, resulting in isolation . 
• Finances not being managed and no assistance being sought. 
• Not attending medical appointments and/or prescribed medication not being taken or being declined 
• Refusing to allow access to health and/or social care staff in relation to care needs, health needs or property maintenance, or unwilling to attend appointments with staff.