Neglect and acts of omission

Senior man close up

There are different types of adult abuse, some of which are also criminal offences. See below for more information about adult abuse, however please also note that evidence of one indicator should not be taken on its own as proof that abuse is happening. The list of indicators is not exhaustive, there are other indicators that do not appear here, and individuals may be subject to more than one type of abuse at the same time.

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

Real life example of neglect and acts of omission

Nursing home abuse implies that the caregiver intends to harm the elderly person, whilst nursing home neglect is a form of substandard care, or a breach of duty that causes harm to the person.
In early 2018 Dunmurry, a care home for older people in Northern Ireland was exposed for a catalogue of abuse and neglect against residents.

Neglectful behaviour included:

  • Residents found in a wet bed
  • Residents kept in the dark for long periods of time
  • Residents found besides plates of uneaten food (unable to feed themselves or food not edible)
  • Clothing being worn by residents including underwear, socks and shoes found soaked in urine
  • Residents being found overly warm or very cold

Resident, Annie, aged 89 complained to her family that she was not being fed and they could see she was losing weight. It transpired that there would be occasions where staff would just go past her and not give her any food. Annie wasn't being looked after with regards to her personal care and the family reported having to go over to do it themselves. Annie’s personal hygiene started to slip and there were times where family would go over on an October evening and she would be sitting without a blanket in her nightclothes next to an open window.

Annie’s family complained to the manager and received excuses (Annie didn’t like being washed) and assurances of change. Eventually Annie’s family visited to find her with vomit across her face, and on taking her to hospital the doctor diagnosed pneumonia and failing kidneys. The care home eventually admitted Annie had been in a high backed chair in this state of health for at least 12 hours. 

Signs of neglect in nursing homes can be:

  • Sudden weight loss – this can indicate dehydration or malnutrition
  • Bedsores
  • Discontent expressed by the resident
  • Isolation
  • An unclean environment
  • Bruises that don’t have a reasonable cause, or repeated bruises in odd areas such as around wrists or on shoulders
  • Depression and/or anxiety
  • Lack of attention from staff, or delayed care
  • Any sign that a basic need (such as timely and appropriate toilet visits) are not being met