Balancing Safeguarding and Autonomy Through Positive Risk-Taking in Dementia Care
Safeguarding is a core duty in dementia care, yet it is also one of the most common drivers of over-restriction. When concerns about exploitation, self-neglect or harm escalate, services can default to removing choice rather than enabling safer autonomy. Positive risk-taking provides the operational framework for managing safeguarding risk without undermining dignity or independence. Embedded within positive risk-taking practice and aligned to modern dementia service models, it allows providers to meet safeguarding duties while still supporting meaningful everyday life.
Why safeguarding and restriction become blurred
In dementia services, safeguarding risks often present gradually rather than as single incidents. Financial vulnerability, unsafe relationships, self-neglect or environmental hazards can prompt risk-averse responses that feel justified in the moment. However, when restrictions are applied without structured review, they can escalate harm by increasing isolation, distress and loss of skills.
Effective safeguarding practice requires services to distinguish between unmanaged risk and supported risk, ensuring people are protected without being controlled.
What safeguarding-led positive risk-taking looks like
Safeguarding-focused risk enablement requires:
- Clear identification of the specific harm being prevented
- Evidence of the person’s wishes and past preferences
- Exploration of alternative ways to reduce risk without removing choice
- Time-limited and reviewed controls
- Documented proportionality and rationale
This ensures safeguarding interventions remain defensible, person-centred and reviewable.
Operational example 1: Financial safeguarding without removing control
Context: A person with dementia was repeatedly giving money to acquaintances, raising concerns about financial exploitation. The immediate proposal was to remove access to cash entirely.
Support approach: The service worked with the person and family to introduce graded financial safeguards. A small weekly cash allowance was agreed, alongside supported budgeting sessions and staff oversight for larger transactions.
Day-to-day delivery detail: Staff supported weekly planning conversations, recorded spending patterns, and used clear prompts around safe money handling. The person retained autonomy for everyday purchases while higher-risk decisions were supported.
Evidence of effectiveness: Exploitation risk reduced, financial stress decreased, and the individual reported feeling respected rather than controlled. Reviews documented why full restriction was disproportionate.
Operational example 2: Managing unsafe relationships without isolation
Context: A resident formed a relationship with another individual who exhibited controlling behaviour. Staff considered restricting contact entirely.
Support approach: The service completed a safeguarding assessment and implemented supervised contact in communal areas, alongside staff monitoring and clear boundaries. Education and reassurance were provided to the resident.
Day-to-day delivery detail: Staff observed interactions, intervened when behaviour became concerning, and documented triggers. Regular reviews assessed whether restrictions could be reduced further.
Evidence of effectiveness: Harm was prevented while social contact was preserved. Governance records showed proportionate safeguarding rather than blanket restriction.
Operational example 3: Self-neglect addressed through enablement
Context: A person with dementia refused support with hygiene and nutrition, raising safeguarding concerns. Restrictive measures were considered.
Support approach: Staff introduced flexible routines, preferred products, and choice-led support times rather than enforced care. The focus shifted to engagement rather than compliance.
Day-to-day delivery detail: Staff documented what approaches worked, escalated health concerns appropriately, and avoided coercive practice.
Evidence of effectiveness: Engagement improved, health risks reduced, and safeguarding concerns stabilised without restrictive intervention.
Commissioner expectation
Commissioner expectation: Commissioners expect safeguarding to be proactive and proportionate. Providers must evidence that restrictions are necessary, reviewed, and balanced against individual outcomes, not applied as default risk avoidance.
Regulator expectation (CQC)
Regulator / Inspector expectation (CQC): CQC expects safeguarding systems that protect people while promoting autonomy. Inspectors will look for evidence that restrictions are the least restrictive option and that safeguarding decisions are person-centred and reviewed.
Governance systems that support defensible safeguarding
- Safeguarding risk registers linked to review dates
- Multi-disciplinary input for complex cases
- Recorded alternatives trialled
- Outcome-focused safeguarding reviews
Practical takeaway
Safeguarding and autonomy are not opposites. Through structured positive risk-taking, dementia services can protect people while preserving dignity, choice and meaningful connection.