Positive Risk-Taking in Dementia Care: Enabling Choice While Managing Safety
Positive risk-taking is a core principle of high-quality dementia care, yet it remains one of the most misunderstood and inconsistently applied areas of practice. Providers are expected to protect people from avoidable harm while also enabling autonomy, identity and meaningful activity. In dementia services, this balance becomes particularly complex as cognitive impairment, fluctuating capacity and progressive need increase risk sensitivity. Within effective service models, positive risk-taking is not about ignoring risk, but about understanding it in context and managing it proportionately. This article draws on practice approaches commonly embedded within dementia positive risk-taking frameworks and operational delivery seen across established dementia service models.
Understanding positive risk-taking in dementia care
Positive risk-taking refers to a structured, person-centred approach that weighs potential harm against the benefits of choice, independence and wellbeing. In dementia care, risks are rarely static. They change as cognition fluctuates, physical health alters and environments shift. Effective services recognise that over-restriction can be as harmful as unmanaged risk, leading to loss of confidence, reduced mobility, emotional distress and institutionalisation.
Rather than relying solely on generic risk assessments, positive risk-taking requires dynamic assessment, ongoing review and shared decision-making. This includes the person, where possible, alongside family members, advocates and the multidisciplinary team. Decisions are documented, proportionate and subject to governance oversight.
Operational example 1: Supporting independent walking
In a community-based dementia service, an individual with early to mid-stage dementia wished to continue walking to a local café daily. The identified risks included road safety, disorientation and falls. Rather than prohibiting the activity, the service undertook a detailed risk enablement assessment.
The support approach included route mapping, visual prompts, agreed check-in times and staff observation at peak risk points. Staff practised the route alongside the individual, reinforcing landmarks and safe crossing points. Effectiveness was evidenced through incident monitoring, wellbeing observations and a reduction in agitation previously linked to restricted movement.
Operational example 2: Kitchen access in supported living
A supported living service faced concerns regarding a person with dementia using kitchen appliances independently. Instead of blanket restrictions, the provider introduced environmental adaptations, including temperature-controlled kettles, clear labelling and supervised practice sessions.
Day-to-day delivery focused on staff confidence as much as the person’s ability. Training sessions reinforced positive risk-taking principles, ensuring staff understood when to intervene and when to observe. Governance oversight included monthly incident reviews and documented learning outcomes, demonstrating reduced risk events and increased independence.
Operational example 3: Social relationships and community engagement
A care home supported a resident who wished to maintain a personal relationship outside the service. Risks related to exploitation and emotional vulnerability were identified. The service worked with safeguarding leads, family members and the local authority to agree boundaries and support mechanisms.
Staff monitored wellbeing indicators, maintained open communication with involved parties and reviewed the arrangement regularly. Effectiveness was evidenced through safeguarding assurance logs, emotional wellbeing assessments and positive feedback from the resident.
Commissioner expectation
Commissioners expect providers to demonstrate that risk is assessed and managed proportionately, not avoided by default. Positive risk-taking must be embedded within care planning, supported by evidence of review, learning and outcomes. Services should be able to show how risk enablement supports independence, reduces escalation and aligns with contractual quality standards.
Regulator expectation (CQC)
The CQC expects services to protect people from avoidable harm while respecting their rights and choices. Inspectors look for clear evidence that restrictions are the least restrictive option, risks are reviewed regularly and staff are confident in applying positive risk-taking in practice.
Embedding positive risk-taking into governance
Strong governance is essential to sustain positive risk-taking. This includes risk enablement policies, staff training, incident trend analysis and regular audit. Services that evidence learning from near-misses and adapt practice accordingly demonstrate maturity and regulatory confidence.
Ultimately, positive risk-taking in dementia care supports dignity, autonomy and quality of life. When underpinned by structured assessment and governance, it strengthens both outcomes and assurance.