In Safe Hands - Action on Elder Abuse

.7.16 Abuse which occurs within an institutional setting often includes more than one formof harm as a result of rigid and insensitive routines, unskilled, intrusive or invasiveinterventions or an environment which allows inadequate privacy or physical comfort. Thistype of abuse falls within the remit of regulators as well as purchasers of care. Legislation isbeing introduced to widen the type of settings which are regulated. However, contractspecification monitoring also has a role to play in protecting vulnerable adults. <strong>In</strong>stitutionalabuse is therefore not a separate category of abuse but a particular manifestation of, andcontext for, it.7.17 Where a vulnerable adult appears to be able to make informed choices and is notbeing unduly intimidated the available options should be explored with them and theirwishes respected, unless these conflict with a statutory duty to intervene, or unless anotherperson(s) is considered to be at risk. <strong>In</strong> all circumstances they should be consulted andinvolved in decision making as far as possible. Service users have a right to make choicesand maintain their independence even when this involves a degree of risk. Where theindividual chooses to accept this risk, their wishes should be respected within their capacityto anticipate and understand the risk. Making sound professional judgements in thesesituations may require formal assessment of capacity in relation to consent. Sexual acts orfinancial transactions are abusive in the absence of valid, informed consent, - lack ofunderstanding, misuse of authority, intimidation or coercion cut across autonomous decisionmaking on the part of vulnerable adults so that an initial refusal of help should not always betaken at face value.18