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Physical abuse

Physical abuse includes assault, slapping, punching, kicking, hair-pulling, biting, and so on. However, it also includes some potentially less obvious acts, such as physical punishments, deliberately making someone physically uncomfortable (for example removing blankets) and involuntary isolation or confinement. Finally, physical abuse could take the form of unauthorised restraint/restrictions, forcible feeding or withholding food and misuse of medication (for example, over-sedation).

Possible signs or indicators of physical abuse include:

unexplained or inconsistent explanations for injuries
bruising, cuts, welts, burns and/or marks on the body
frequent injuries
unexplained falls
subdued or changed behaviour by the person being abuse
signs of malnutrition or unexplained weight loss
failure to seek medical treatment or frequent changes of GP
fractures
bed sores
fear
depression
assault (can be intentional or reckless)

Case study

Harry lives with his wife Geraldine. A year ago, Harry was in a road accident which left him with permanent physical disabilities. He has carers twice a day, and Geraldine takes on the caring role the rest of the time. About 6 months after he started receiving the care, the carers noticed that Harry had some bruising on his arms – Harry initially told them he had bumped them on the sides of his bed, but the bruising kept re-occurring. The carers also noticed a change in Harry’s mood and behaviour – he was more withdrawn and appeared depressed. Some days when they arrived for the morning care call, Harry was very sleepy and difficult to rouse – Geraldine would explain that Harry had been in significant pain overnight so she had to give him extra pain relief.

The manager of the care agency contacted the Local Authority safeguarding team for some guidance – she was worried about raising a safeguarding concern straightaway as she did not want the relationship the carers had developed with Harry and Geraldine to be jeopardised. The safeguarding team provided the manager with some advice, suggesting that she and a carer Harry liked/trusted attempted to hold a private conversation with him where they raise their concerns directly with him.

The manager and carer managed to speak with Harry alone at length, who disclosed that Geraldine had become increasingly impatient with him, and was grabbing his arms quite roughly when he needed moving and handling support. He said that she was also giving him significant sedation overnight because she was so tired of being disturbed by him in the night due to his pain or needing personal care.

Harry agreed to support from the safeguarding team, but was keen to stress that he did not want Geraldine to know and did not want her to get into trouble. A safeguarding social worker came to speak to Harry in private in order to find out what he wanted to happen. Harry said he wanted Geraldine to get more support and some time for herself, as he felt that what was happening was a result of the strain and pressure on her. The social worker offered Geraldine the opportunity to meet with a carer support worker and to have a Carer’s Assessment. Geraldine now meets with the support worker regularly to chat and offload, and also receives a carer’s grant which she uses for health and wellbeing therapies. Harry and Geraldine also agreed to an additional care call overnight several times a week, so that Geraldine’s sleep would be less disturbed.

After a few weeks, Harry reported that the situation at home was much improved for both him and Geraldine, and said he would be happy for the safeguarding support to come to an end. The social worker gave Harry advice on how to get back in touch if he experiences similar difficulties again in the future.