Lewisham Safeguarding Adults Board

Carers

Safeguarding Information for Carers

Spotting signs of abuse: Information for carers

It is not always easy to spot the symptoms of abuse. Someone being abused may make excuses for why they are bruised, they don't want to go out or talk to people, or they are short of money.

It is important to know the signs of abuse and where they are identified, gently share your concerns with the person being abused. If you wait, hoping the person will tell you what's been happening to them, you could delay matters and allow the abuse to continue. 

The lists of possible indicators and examples of behaviour are not exhaustive and people may be subject to a number of abuse types at the same time.

Physical abuse +

Types of physical abuse

  • 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
  • Unauthorised restraint, restricting movement (e.g. tying someone to a chair)

Possible indicators of physical abuse

  • 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 GP

Domestic violence or abuse +

Any incident or pattern of incidents of controlling, coercive, threatening behaviour, violence, or abuse between two people aged 16 or over who are ‘personally connected’. This includes those who are, or have been, intimate partners, or relatives, regardless of gender or sexual orientation. This may include psychological, physical, sexual, financial, emotional abuse, and so-called honour-based violence. See the full definition here: Domestic Abuse Act 2021 - Statutory Guidance July 2022

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
  • Regulating everyday behaviour

Possible indicators of domestic violence or abuse

  • 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

Sexual abuse +

Types of sexual abuse

  • 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 the capacity to consent to
  • Inappropriate looking, sexual teasing or innuendo or sexual harassment
  • Sexual photography or forced use of pornography or witnessing of sexual acts
  • Indecent exposure

Possible indicators of sexual abuse

  • 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

Psychological or emotional abuse +

Types of psychological or emotional abuse

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

Financial or material abuse +

Types 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 pressure, 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 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 – eg. 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 to 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
  • Unnecessary property repairs

Modern slavery +

Types of modern slavery

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

Possible indicators of modern slavery

  • 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
  • Fear of law enforcers

Further Home Office information on identifying and reporting modern slavery

Discriminatory abuse +

Types of discriminatory abuse

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 protected characteristic
  • Substandard service provision relating to a protected characteristic

Possible indicators of discriminatory abuse

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

Organisation or institutional abuse +

Types of organisational or institutional abuse

  • 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

Possible indicators of organisational or institutional abuse

  • 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
  • Lack of management overview and support

Neglect and acts of omission +

Types of neglect and acts of omission

  • 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.
  • Failure to ensure privacy and dignity

Possible indicators of neglect and acts of omission

  • 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

Self-neglect +

Types of self-neglect

  • 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
  • Inability or unwillingness to manage one’s personal affairs

Indicators of self-neglect

  • 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

Please do not ignore your concerns, that could allow any abuse to carry on or escalate.

Carers who are at risk of harm/or who harm

The Care Act defines a carer as someone who ‘provides or intends to provide care for another adult’ (but not as a volunteer or contracted worker).

There are three main considerations in relation to safeguarding, domestic abuse and carers.

  1. Carers may cause harm, through abuse or neglect of the person they care for.
  2. They may be caused harm by the person they care for, or they may be important observers and reporters of harm by others.
  3. Some people with care and support needs are intentionally abusive to their carers.

However, others may not have capacity to choose not to be abusive; their disability may cause abusive behaviour, and in some cases involving people with dementia, support to address domestic abuse should be offered if abuse is causing a carer’s physical or mental health to deteriorate, or preventing them from caring for another adult.

The carer may feel unable to leave or seek help for themselves due to fear of leaving the person they care for with an abuser, or fear of being unable to care for them on their own.

See here for more information: Carers and safeguarding: a briefing for people who work with carers | Local Government Association

The Local Authority has a duty to assess a carers needs for support to maintain their well-being – including protection from abuse. Many carers may not meet the criteria under the Care Act Safeguarding Duty (s.42) to be involved in a Safeguarding Enquiry, but carers are identified as a specific at risk group so enquiries can still be conducted if proportionate and necessary.  

If you are a Carer and live in Lewisham and think that you need an assessment of your needs please contact the Adult Social Care.

Tel: 020 8314 7777

Email: Gateway@lewisham.gov.uk

Opening hours:

Monday - Friday 9am - 5pm

Carers - Information and Support

If you help another person who needs support to live in their home then you may be a Carer. The person you care for could be mentally or physically disabled, ill or elderly and frail. They could be your parent, child, partner, relative or friend.

The Open University Free - Caring for Adults Course

Caring for adults is an introductory course for anyone in a caring role, either paid or unpaid. It builds on what you already know to give you a better understanding of your role as a carer. It also supports your own well-being by giving you some ideas and information about looking after yourself and dealing with stress.

After studying this course, you will be able to:

  • describe the role and responsibilities of carers
  • recognise some of the basic concepts that will enable a person-centred approach to care
  • identify the different needs of a cared-for person, at different stages of their care
  • understand the impact that caring may have upon carers, and how this might be managed
  • explain some of the legal responsibilities within the caring role.

Support for Carers

Lewisham Council logo

Lewisham Council has a whole section dedicated to Support for Carers on their webesite where you will be able to find information including:

Find out if you're eligible for additional support as a carer

Support available to all carers

Image of South London and Maudsley NHS Foundation Trust

If you are caring for someone who struggles with their mental health the South London and Maudsley (SLaM) has a whole section on their website on information for carers, families and friends. 

Information for carers

Carers, families and friends
Image of Carers Hub Lewisham Logo
Carers Hub Lewisham Support Carers in the London Borough of Lewisham. They provide practical and emotional support to unpaid carers, empowering people who care for a family menmber, neighbour or close friend to actively manage the challenges they face and thrive.

Their services include:

  • Information and Advice providing practical support, such as applying for a Carers Assessment, welfare benefits or emergency grants.
  • Specialist services tailored to people who care for someone with dementia or mental health needs.
  • Health and Wellbeing activities that help carers exercise, relax and share experiences with others.
Imago.community Logo

Imago – Maximising Wellbeing of Unpaid Carers - Supporting Unpaid Carers to access the support they need.

Imago deliver the Maximising Wellbeing of Unpaid Carers, which supports Adult Carers across the borough of Lewisham. If you are an unpaid carer or know someone who provides care but is not getting paid, help and support are available. 

If you or someone you know is an unpaid carer, please get in touch. Their Proud to Care family will ensure that you are valued, visible to others, and fully supported.

Financial Support for Carers - Benefits and financial support if you're caring for someone.

gov.uk logo new Feb 2024

We recommend that you first contact the Carer's Allowance Unit for information and advice on benefits that you can claim.

Visit the Gov.uk website for information on Help you can get if you regularly spend time caring for someone.

Image of Independent Age Logo

Independent Age recognise that caring for someone can be demanding, both emotionally and financially. They have lots of information in their Support for Carers Section and want to make sure you know your rights as a carer and can check what support and benefits are available to help you and the person you care for.

Image of Community Connections Lewisham Logo

Community Connections Lewisham have a weekly drop in clinic with a Department for Work and Pensions Advisor visit their Thursday Drop in webpage for further information.

Carer's Wellbeing

Lewisham Council logo

Lewisham Council recognise that as a carer, it is important that you are also aware of your own physical and mental health.

Read more on what you can access locally to support your mental and physical wellbeing. 

Image of Community Connections Lewisham Logo

Community Connections Lewisham can connect you with groups, activities and services in our local community that can support your health and wellbeing ~ bringing Lewisham to you!

Iamge of Alzheimers Society Logo

Supporting a person with dementia can be positive and rewarding, but it can also be challenging. Looking after yourself is important for both you and the person you are supporting. The Alzheimer's Society has a lot of supportive information including 

Carers Emergencies

Lewisham Council logo

Lewisham Council has advice for carers who suddenly can't care for someone on their website. Including information about what to do if you suddenly can't care for someone who depends on you.

Information and Support for Young Carers

Lewisham Council logo

Lewisham Council has Information and Support for Young Carers on their website.

Including information on:

  • Who counts as a young carer
  • What support we offer young carers
  • Links between children and adult services

Image of Carers Hub Lewisham Logo

Carers Hub Lewisham provide a wide range of tailored support to young carers aged 5-25, all of which are divided by age, enabling young people to meet friends with similar ages and ensuring we provide the support that is right for each person.

If you're a young carer and would like advice and support contact the Carers Hub for a chat. 

Imago.community Logo

Imago – Maximising Wellbeing of Unpaid Carers - Supporting Unpaid Carers to access the support they need.

Imago deliver the Maximising Wellbeing of Unpaid Carers, which supports Young Adult Carers and Young Carers across the borough of Lewisham. If you are an unpaid carer or know someone who provides care but is not getting paid, help and support are available. 

If you or someone you know is an unpaid carer, please get in touch. Their Proud to Care family will ensure that you are valued, visible to others, and fully supported.

Other Useful Links for Carers
Professionals using too much jargon?

If you're finding it difficult to navigate the mind field of jargon that can often be used by professionals in the care and support occupations Think Local Act Personal have a useful Jargon Buster that can help carers understand the language that is commonly used in care and support work.

Information for Professionals Supporting Carers

If you're a profesional supporting a Carer there's lots of helpful information on the ADASS Supporting Carers Hub.

Local Support for Young Carers and Young Adult Carers is offered by Carers Lewisham.

Read more in our Information for Professionals section.