Managing Safeguarding Risk Through Positive Risk-Taking in Dementia Care
Safeguarding in dementia care is often perceived as a reason to restrict choice, yet high-quality services recognise that safeguarding and positive risk-taking must operate together. Overly defensive practice can increase harm by reducing independence, confidence and wellbeing. Effective services manage safeguarding risk through structured enablement, oversight and review. This approach is fundamental to robust positive risk-taking practice within well-governed dementia service models.
Safeguarding beyond restriction
Safeguarding in dementia care extends beyond preventing abuse or neglect. It includes protecting people from unnecessary loss of independence, emotional harm and institutionalisation. Positive risk-taking reframes safeguarding as enabling safer choice rather than eliminating risk entirely.
Clear thresholds, documentation and shared understanding across teams are essential to avoid inconsistent or risk-averse practice.
Operational example 1: Managing self-neglect risk
A community dementia service supported a person whose personal hygiene routines had declined. Rather than escalating immediately to restrictive interventions, staff explored underlying causes including anxiety and sensory sensitivity.
The support approach involved adapting routines, offering choice and introducing gradual prompts. Effectiveness was evidenced through improved self-care, reduced safeguarding alerts and positive feedback from the individual.
Operational example 2: Exploitation and social vulnerability
A care provider identified risks of financial and emotional exploitation linked to new social contacts. Instead of restricting contact, the service worked with safeguarding teams to introduce education, monitoring and agreed boundaries.
Day-to-day delivery focused on staff awareness and timely review. Governance logs demonstrated that risks were managed proactively without removing social connection.
Operational example 3: Medication refusal and health risk
A person with dementia regularly refused medication, raising safeguarding concerns. Rather than covert administration, the service reviewed timing, communication style and consent.
Staff adjusted approaches, offered explanation and choice, and involved healthcare professionals. Effectiveness was evidenced through improved adherence and reduced escalation.
Commissioner expectation
Commissioners expect safeguarding approaches to be proportionate and person-centred. Providers must evidence how safeguarding decisions balance protection with rights, independence and outcomes, supported by clear review mechanisms.
Regulator expectation (CQC)
The CQC looks for evidence that safeguarding processes are embedded without unnecessary restriction. Inspectors assess whether services understand risk, involve individuals and review safeguarding decisions regularly.
Governance frameworks for safeguarding-led risk enablement
Strong governance includes safeguarding audits, incident trend analysis and reflective supervision. Services should demonstrate how safeguarding learning informs practice and reduces future risk.
When safeguarding and positive risk-taking work together, dementia services deliver safer, more humane and more effective care.