Co-Producing Dementia Support Plans With People and Families
Co-production is often referenced in dementia care but poorly defined in day-to-day practice. Too often, support plans are written about people rather than with them, particularly as cognitive impairment increases. Effective dementia services recognise that co-production remains possible throughout the dementia journey, but it must adapt as capacity, communication and decision-making change.
This article sits within Dementia – Person-Centred Planning & Strengths-Based Support and links closely to Dementia – Service Models & Care Pathways, because co-production looks different in homecare, supported living, residential care and integrated dementia pathways.
What co-production means in dementia care
In dementia services, co-production means:
- Involving the person as fully as possible, for as long as possible.
- Recognising families and advocates as partners, not proxies.
- Adapting methods of involvement as cognition changes.
- Recording how views were sought, understood and used.
It does not mean waiting until capacity is lost before involving others, nor does it mean families automatically replace the person’s voice.
Commissioner expectation: evidence of meaningful involvement
Commissioner expectation: commissioners increasingly expect services to evidence how people and families are involved in shaping support. In dementia services this includes:
- Clear records of discussions at assessment and review.
- Evidence that preferences influence commissioned support.
- Demonstration that family input complements, not overrides, the person’s wishes.
Generic statements such as “family involved” without detail are frequently challenged during reviews.
Regulator / Inspector expectation: respecting voice, choice and consent
Regulator / Inspector expectation (CQC): inspectors look for evidence that services respect voice, choice and autonomy, even where capacity is fluctuating or reduced. This includes:
- How staff seek consent in accessible ways.
- How disagreements between family and the person are managed.
- How best-interest decisions are evidenced when required.
Operational Example 1: Homecare co-production in early dementia
Context: A person newly diagnosed with dementia was anxious about losing control over daily routines.
Support approach: The provider used structured co-production during assessment rather than relying on family assumptions.
Day-to-day delivery detail:
- Visits were scheduled around preferred routines identified directly with the person.
- Support tasks were ranked by importance by the individual.
- Written plans used the person’s own words wherever possible.
How effectiveness is evidenced: Reduced resistance to care, stable routines, and positive review feedback documented in reassessment notes.
Operational Example 2: Supported living and shared decision-making
Context: In supported living, a person with moderate dementia began to rely more on family support.
Support approach: A three-way planning model was introduced involving the person, family and staff.
Day-to-day delivery detail:
- Planning meetings used visual prompts and simplified choices.
- Staff checked understanding rather than assuming agreement.
- Family input was recorded separately from the person’s expressed wishes.
How effectiveness is evidenced: Clear audit trails showed how decisions were reached and whose views informed each element.
Operational Example 3: Residential care and best-interest decisions
Context: A resident lost capacity to consent to certain aspects of care.
Support approach: Best-interest processes were embedded without removing everyday choice.
Day-to-day delivery detail:
- Formal best-interest meetings addressed major decisions only.
- Daily preferences (clothing, activities, meals) remained led by the resident.
- Life history informed decisions where verbal input reduced.
How effectiveness is evidenced: Inspectors could see clear separation between capacity-based decisions and routine choice.
Governance: embedding co-production consistently
Strong governance systems ensure co-production does not depend on individual staff:
- Assessment templates that prompt recording of involvement.
- Supervision discussions focused on balancing voices.
- Audits reviewing quality of co-production evidence.
Common pitfalls in dementia co-production
- Over-reliance on family views too early.
- Failure to adapt communication methods.
- Poor recording of how decisions were made.