There are 10 categories of abuse and neglect as defined by the care and support statutory guidance.

1. Physical abuse including but not limited to:

• Assault
• Hitting
• Slapping
• Pushing
• Misuse of medication
• Restraint
• Inappropriate physical sanction

Signs of physical abuse may include but are not limited to:

• 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
• Failure to seek medical treatment or frequent changes of general practitioner (GP)

2. Domestic abuse including but not limited to:

• Psychological
• Physical
• Sexual
• Financial
• Emotional abuse
• So called ‘honour’-based violence

Signs of domestic abuse may include but are not limited to:

• Appears to be afraid of a partner and / or of making choices for themselves
• Behaves as though they deserve to be hurt or mistreated
• May have low self-esteem or appear to be withdrawn
• Appears unable or unwilling to leave the perpetrator
• Leaves the perpetrator and then returns to them
• Makes excuses for or condones the behaviour of the perpetrator
• Blames abuse on themselves
• Minimises or denies abuse or seriousness of the harm
• The perpetrator is always with the victim and will not let the victim speak for themselves, for example, at GP visits
• Low self-esteem
• Feeling that the abuse is their fault when it is not
• Physical evidence of violence such as bruising, cuts, 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
• Limited access to money

3. Sexual abuse including but not limited to:

• Rape
• Indecent exposure
• Sexual harassment
• Inappropriate looking or touching
• Sexual teasing or innuendo
• Sexual photography
• Subjection to pornography or witnessing sexual acts
• Sexual acts to which the adult has not consented or was pressured into consenting

Signs of sexual abuse may include but are not limited to:

• 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

4. Psychological or emotional abuse including but not limited to:

• Emotional abuse
• Threats of harm or abandonment
• Deprivation of contact
• Humiliation
• Blaming
• Controlling
• Intimidation
• Coercion
• Harassment
• Verbal abuse
• Cyber bullying
• Isolation
• Unreasonable and unjustified withdrawal of services or supportive networks

Signs of psychological or emotional abuse may include but are not limited to:

• 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
• Apparent false claims, by someone involved with the person, to attract unnecessary treatment
• Gaslighting

5. Financial or material abuse including but not limited to:

• Theft
• Fraud
• Internet scamming
• Coercion in relation to an adult’s financial affairs or arrangements, including in connection with wills, property, inheritance, or financial transactions
• The misuse or misappropriation of property, possessions, or benefits

Signs of financial or material abuse may include but are not limited to:

• Lack of access to money or needing to ask others permission to access accounts
• 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 the mental capacity to manage their finances so that it appears that they are continuing to do so
• The person allocated to manage financial affairs is evasive or uncooperative
• The family or others show an 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 lawyer
• Recent changes in deeds or title to a 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
• The disparity between the person’s living conditions and their financial resources, for example, insufficient food in the house
• Unnecessary property repairs

6. Modern slavery encompasses but is not limited to:

• Slavery
• Human trafficking
• Forced labour and domestic servitude
• Traffickers and slave masters using whatever means they have at their disposal to coerce, deceive, and force individuals into a life of abuse, servitude, and inhumane treatment

Signs of modern slavery may include but are not limited to:

• 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.
• Never alone, always in the presence of another person
• 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
• Fear of police and other law enforcers

7. Discriminatory abuse including but not limited to:

• Harassment
• Slurs or similar treatment because of race, gender and gender identity, age, disability, sexual orientation, or religion

Signs of discriminatory abuse may include but are not limited to:

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

8. Organisational or institutional abuse including but not limited to neglect and poor care practice within an institution or specific care setting such as hospital or care home, for example, or in relation to care provided in one’s own home. This may range from one-off incidents to ongoing ill-treatment. It can be through neglect or poor professional practice as a result of the structure, policies, processes, and practices within an organisation.

Signs of organisational or institutional abuse may include but are not limited to:

• Incidents of abuse or neglect are not reported, or there is evidence of incidents being deliberately not reported
• Lack of flexibility and choice for people using the service
• Inadequate staffing levels
• People being hungry or dehydrated
• Poor standards of care or frequent, unexplained deterioration in service users' health and well-being
• Repeated cases of the service user not having access to nursing, medical or dental care
• Lack of procedures and safeguards in place relating to the safe handling of service users’ money
• A sudden increase in safeguarding concerns in which abuse or neglect has been identified
• Repeated instances of service users, families and carers feeling victimised if they raise safeguarding concerns
• The service fails to improve or respond to actions or recommendations in local compliance visits or audit frameworks from the local authority, clinical commissioning groups or the Care Quality Commission
• Lack of personal clothing and possessions and communal use of personal items
• Lack of adequate procedures
• Poor record-keeping, missing documents, or evidence of redacted, falsified, or incomplete records
• 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

9. Neglect and acts of omission including but not limited to:

• Ignoring medical, emotional, or physical needs
• Failure to provide access to appropriate health, care, and support or educational services
• The withholding of the necessities of life, such as medication, adequate nutrition, and heating

Signs of neglect and acts of omission may include but are not limited to:

• Poor environment – dirty or unhygienic
• Poor physical condition and / or personal 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
• Inappropriate or inadequate clothing

10. Self-neglect

This covers a wide range of behaviour, including but not limited to neglecting to care for one’s personal hygiene, health, or surroundings, and includes behaviour such as hoarding.

Signs of self-neglect may include but are not limited to:

• 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 inappropriate conditions
• Non-compliance with health or care services
• Inability or unwillingness to take medication or treat illness or injury