What is adult abuse?

The Care Act 2014 guidance (p233) describes different types of abuse which can affect people, especially when they are unable to protect themselves or tell their own story. These are:

Physical Types of physical abuse include:
  • Assault, hitting, slapping, punching, kicking hair-pulling, biting, pushing;
  • Rough handling;
  • Scalding and burning;
  • Physical punishments;
  • Inappropriate or unlawful use of restraint;
  • Making someone purposefully uncomfortable e.g. opening a window and removing blankets;
  • Involuntary isolation or confinement;
  • Misuse of medication e.g. over-sedation;
  • Forcible feeding or withholding food; and
  • Unauthorised restraint, restricting movements e.g. tying someone to a chair.

Possible indicators of physical abuse include:

  • No explanation for injuries or inconsistency with the account of what happened;
  • Injuries are inconsistent with the person's lifestyle;
  • Bruising, cuts, welts, burns and/or marks on the body or loss of hair in clumps;
  • Frequent injuries;
  • Unexplained falls;
  • Subdued or changed behaviour in the presence of a particular person;
  • Signs of malnutrition; and
  • Failure to seek medical treatment or frequent changes of GP. 


Types of sexual abuse include:

  • Rape, attempted rape or sexual assault;
  • Inappropriate touch anywhere;
  • Non-consensual masturbation of either or both persons;
  • Non-consensual sexual penetration or attempted penetration of the vagina, anus or mouth;
  • Any sexual activity that the person lacks capacity to consent to;
  • Inappropriate looking, sexual teasing or innuendo sexual harassment;
  • Sexual photography or forced use of pornography or witnessing of sexual acts; and
  • Indecent exposure.

Possible indicators of sexual abuse include:

  • 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; and
  • Reluctance to be alone with a particular person. 

Psychological or Emotional

Types of psychological or emotional abuse are:

  • Enforced social isolation - preventing someone accessing services, educational and social opportunities and seeing friends;
  • Removing mobility or communication aids or intentionally leaving someone unattended when they need assistance;
  • Preventing someone from meeting their religious and cultural needs;
  • Preventing the expression of choice and opinion;
  • Failure to respect privacy;
  • Preventing stimulation, meaningful occupation or activities;
  • Intimidation, coercion, harassment, use of threats, humiliation, bullying, swearing or verbal abuse;
  • Addressing a person in a patronising or infantilising way;
  • Threats of harm or abandonment; and
  • Cyber-bullying.

Possible indicators of psychological or emotional abuse:

  • An air of silence when a particular person is present;
  • Withdrawal or change in the psychological state of the person;
  • Insomnia;
  • Low self-esteem;
  • Uncooperative and aggressive behaviour;
  • A change of appetite, weight loss/gain;
  • Signs of distress: tearfulness, anger; and
  •  Apparent false claims, by someone involved with the person, to attract unnecessary treatment.

Financial or Material

Type of financial or material abuse:

  • Theft of money or possessions;
  • Fraud, scamming;
  • Preventing a person from accessing their own money, benefits or assets;
  • Employees taking a loan from a person using the service;
  • Undue pressures, duress, threat or undue influence 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;
  • Denying assistance to manage/monitor financial affairs;
  • Denying assistance to access 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 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; and
  • Rogue trading - e.g. unnecessary or overpriced property repairs and failure to carry out agreed repairs or poor workmanship.

Possible indicators of financial or material abuse:

  • Missing personal possessions;
  • Unexplained lack of money or inability to maintain lifestyle;
  • Unexplained withdrawal of funds from accounts;
  • Power of attorney or lasting power of attorney (LPA) being obtained after the person has ceased to have mental capacity;
  • Failure to register an LPA after the person has ceased to have mental capacity to manage their finances, so that it appears that they are continuing to do so;
  • The person allocated the manage financial affairs is evasive or uncooperative;
  • The family or others show unusual interest in the assets of the person;
  • Signs of financial hardship in cases where the person's financial affairs are being managed by a court appointed deputy, attorney or LPA;
  • Recent changes in deeds or title to property;
  • Rent arrears and eviction notices;
  • A lack of clear financial accounts held by a care home or service;
  • Failure to provide receipts for shopping or other financial transactions carried out on behalf of the person;
  • Disparity between the person's living conditions and their financial resources e.g. insufficient food in the house; and
  • Unnecessary property repairs.


Types of discriminatory abuse include:

  • Unequal treatment based on age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion and belief, sex or sexual orientation (known as 'protected characteristics' under the Equality Act 2010);
  • 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;
  • Denying basic rights to healthcare, education, employment and criminal justice relating to a protective characteristic; and
  • Substandard service provision relating to a protected characteristic.

Possible indicators of discriminatory abuse include:

  • The person appears withdrawn and isolated;
  • Expressions of anger, frustration, fear or anxiety; and
  • The support on offer does not take account of the person's individual needs in terms of a protected characteristic. 

 Neglect and acts of omission

Types of neglect and acts of omission include:

  • Failure to provide or allow access to food, shelter, clothing, heating, stimulation and activity, personal or medical care;
  • Providing care in a way that the person dislikes;
  • Failure to administer medication as prescribed;
  • Refusal of access to visitors;
  • Not taking account of individuals' cultural, religious or ethnic needs;
  • Not taking account of educational, social and recreational needs;
  • Ignoring or isolating the person;
  • Preventing the person from making their own decisions;
  • Preventing access to glasses, hearing aids, dentures etc; and
  • Failure to ensure privacy and dignity.

Possible indicators of neglect and acts of omission:

  • Poor environment - dirty or unhygienic;
  • Poor physical condition and/or person hygiene;
  • Pressure sores or ulcers;
  • Malnutrition or unexplained weight loss;
  • Untreated injuries and medical problems;
  • Inconsistent or reluctant contact with medical and social care organisations;
  • Accumulation of untaken medication;
  • Uncharacteristic failure to engage in social interaction; and
  • Inappropriate or inadequate clothing.

Organisational or institutional abuse

Types of organisational or institutional abuse include:

  • 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; and
  • Failure to respond to complaints.

Possible indicators of organisational or institutional abuse include:

  • Lack of flexibility and choice for people using the service;
  • Inadequate staffing levels;
  • People being hungry or dehydrated;
  • Poor standards of care;
  • Lack of personal clothing and possessions and communal use of personal items;
  • Lack of adequate procedures;
  • Poor record-keeping and missing documents;
  • 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; and
  • Lack of management overview and support.

Domestic violence

Domestic violence can include any indicators of abuse relating to physical, psychological, sexual, financial and emotional.

Domestic violence and abuse includes any incident or pattern or incidents of controlling, coercive or threatening behaviour, violence or abuse between those aged 16 or over who are, or who have been, intimate partners or family members, regardless of gender or sexuality. It also includes honour based violence, female genital mutilation and forced marriage. 

Coercive or controlling behaviour is a core part of domestic violence. Coercive behaviour can include:

  • Acts of assault, threats, humiliation and intimidation;
  • Harming, punishing or frightening the person;
  • Isolating the person from sources of support;
  • Exploitation of resources or money;
  • Preventing the person from escaping abuse; and
  • Regulating everyday behaviour.

Possible indicators of domestic violence or abuse include:

  • Low self-esteem;
  • Feeling that the abuse is their fault, when it is not;
  • Physical evidence of violence, such as bruising, cuts and broken bones;
  • Verbal abuse and humiliation in front of others;
  • Fear of outside intervention;
  • Damage to home or property;
  • Isolation - not seeing friends and family; and
  • Limited access to money. 

Modern slavery

Types of modern slavery include:

  • Human trafficking;
  • Forced labour;
  • Domestic servitude;
  • Sexual exploitation, such as escort work, prostitution and pornography; and
  • Debt bondage - being forced to work to pay off debts that realistically they will never be able to.

Possible indicators of modern slavery include:

  • Signs of physical or emotional abuse;
  • Appearing to be malnourished, unkempt or withdrawn;
  • Isolation from the community, seeming under the control or influence of others;
  • Living in dirty, cramped or overcrowded accommodation and/or living and working at the same address;
  • Lack of personal effects or identification documents;
  • Always wearing the same clothes;
  • Avoidance of eye contact, appearing frightened or hesitant to talk to strangers; and
  • Fear of law enforcers. 


Types of self-neglect include:

  • Lack of self-care to an extent that it threatens personal health and safety;
  • Neglecting to care for one's personal hygiene, health or surroundings;
  • Inability to avoid self-harm;
  • Failure to seek help or access services to meet health and social care needs; and
  • Inability or unwillingness to manage one's personal affairs.

Indicators of self-neglect include:

  • Very poor personal hygiene;
  • Unkempt appearance;
  • Lack of essential food, clothing or shelter;
  • Malnutrition and/or dehydration;
  • Living in squalid or unsanitary conditions;
  • Neglecting household maintenance;
  • Hoarding;
  • Collecting a large number of animals in appropriate conditions;
  • Non-compliance with health or care services; and
  • Inability or unwillingness to take medication or treat illness or injury. 

 People with care and support needs, such as older people or people with disabilities, are more likely to be abused or neglected. They may be seen as an easy target and may be less likely to identify abuse themselves or to report it. People with communication difficulties can be particularly at risk because they may not be able to alert others. Sometimes people may not even be aware that they are being abused, and this is especially likely if they have a cognitive impairment. Abusers may try to prevent access to the person they abuse.

Signs of abuse can often be difficult to detect. Many types of abuse are also criminal offences, and should be treated as such. 

Abuse can happen anywhere, in people’s own homes, in care and nursing homes, in hospitals or out in the community. The people who carry out abuse and are responsible for the harm or risk can be from all walks of life, family members, neighbours, health professionals, care workers or even total strangers.

Organisations offering advice and support

Age UK Shropshire and Telford & Wrekin

Age UK work with and for older people to improve the quality of later life by:

Providing older people with information and advice to enable them to make choices;

Providing services to help older people remain independent; and

Campaigning with and for older people, both locally and nationally.

POhWER Telford and Wrekin

POhWER offer the following services in Telford and Wrekin:

Independent Mental Capacity Act Advocacy (IMCA), including Deprivation of Liberty Safeguards (DoLS), is a statutory advocacy service to support people who lack capacity and need to make important decisions but have no representatives as defined under the Mental Capacity Act 2005;

Direct Payment Support and Advice Service where Direct Payments Advisors support individuals to consider receiving their personal budget as a Direct Payment so that they can fund their own care. Advisors will support will all aspects of setting up a Direct Payment account and employing Personal (care) Assistants (PA) where needed; and

POhWER has a website dedicated to supporting employers to find a PA, and PA's to find work. 

The Glade Sexual Assault Referral Centre (SARC)

The Glade SARC Telford provides an initial response for victims of sexual assault living in West Mercia. Their services are available to men, women and children. 

A SARC is a 'one stop' centre where a victim can feel safe and supported and where their immediate medial needs are met. 

Telford Carers Centre

The role of Carers Centre is to support and enable carers to improve their quality of life and to be more confident and able in their caring role. 

Carers Centre has support workers who understand the problems and who are there to listen and offer specialist, individual and group support to carers that care for Adults with Physical Disability or Illness, Older People, Adults with a Learning Disability and Adults with a Mental Health problem.

West Mercia Women's Aid West Mercia Women's Aid runs a 24-hour helpline, 3 refuges and a well-developed and expanding outreach service which includes the provision of community support to families, group programmes and links to education and employment opportunities, as well as Independent Domestic Violence Advisor Services.