Positive Risk-Taking and Mental Capacity in Dementia Care Decisions
Positive risk-taking in dementia care cannot be separated from mental capacity considerations. As dementia progresses, capacity may fluctuate across decisions and over time, creating complexity for frontline staff and managers alike. High-quality services recognise that risk enablement must sit alongside lawful, well-evidenced decision-making that respects autonomy while protecting individuals from avoidable harm. This balance is central to effective positive risk-taking in dementia and must be embedded within day-to-day delivery across modern dementia service models.
Mental capacity and risk: a practical relationship
In dementia care, capacity is decision-specific and time-specific. A person may have capacity to decide what to eat or wear, but lack capacity to understand risks associated with financial decisions or complex activities. Positive risk-taking requires services to assess capacity for each relevant decision, rather than applying blanket assumptions based on diagnosis.
Where capacity is present, individuals have the right to make unwise decisions. Where capacity is lacking, services must follow best-interest processes that consider the person’s wishes, values and past preferences, alongside professional judgement.
Operational example 1: Capacity to go out alone
A supported living service supported a person with moderate dementia who wished to continue visiting local shops independently. A capacity assessment confirmed the individual understood the purpose of the activity and basic safety considerations but struggled with complex route planning.
The support approach involved partial enablement: staff accompanied the person initially, introduced visual prompts and agreed time-bound check-ins. Effectiveness was evidenced through maintained independence, reduced anxiety and no safeguarding incidents, all documented through review notes.
Operational example 2: Managing financial risk
A care home identified concerns about a resident giving money to others. Capacity assessments indicated limited understanding of financial consequences. A best-interest decision was made to introduce managed access to funds while preserving personal choice for small purchases.
Day-to-day delivery included staff support during spending, regular reviews and family involvement. Governance oversight ensured decisions were proportionate, recorded and reviewed, demonstrating a reduction in financial risk without unnecessary restriction.
Operational example 3: Consent to personal care routines
A person with dementia resisted certain personal care tasks at specific times of day. Capacity fluctuated, and staff initially escalated concerns as non-compliance. A revised approach involved reassessing capacity at different times, adapting routines and offering choice.
Effectiveness was evidenced through reduced distress, improved cooperation and fewer incidents recorded. Staff confidence increased through reflective supervision.
Commissioner expectation
Commissioners expect providers to demonstrate lawful decision-making aligned with the Mental Capacity Act. Risk enablement decisions should clearly reference capacity assessments, best-interest processes and evidence of review, ensuring defensibility and transparency.
Regulator expectation (CQC)
The CQC expects services to understand and apply mental capacity principles correctly. Inspectors look for evidence that people are supported to make decisions wherever possible and that restrictions are lawful, proportionate and reviewed.
Governance and assurance in capacity-led risk enablement
Strong governance includes regular audits of capacity assessments, best-interest decisions and restrictive practice logs. Services that embed learning and supervision around capacity demonstrate maturity and regulatory confidence.
When positive risk-taking is grounded in mental capacity law, services protect rights while enabling meaningful lives.