Risk Enablement in Dementia Services: Moving Beyond Restrictive Practice
Risk enablement is increasingly recognised as a marker of quality in dementia care, yet many services struggle to move beyond risk aversion. Restrictive practices often emerge unintentionally, driven by fear of blame, workforce confidence gaps or unclear governance. Effective dementia services adopt risk enablement as a structured, defensible approach that aligns with individual choice and regulatory requirements. This approach is central to established positive risk-taking frameworks in dementia and is increasingly expected within modern dementia service models.
From restriction to enablement
Restrictive practice in dementia care can include locked doors, reduced access to community activities, or limitations on daily routines. While often introduced to manage perceived risk, these measures can undermine wellbeing and autonomy. Risk enablement reframes the question from “How do we stop this?” to “How can this be done safely?”
This requires a cultural shift supported by leadership, policy and training. Risk decisions must be transparent, recorded and subject to review rather than left to informal staff judgement.
Operational example 1: Managing falls risk without confinement
A residential dementia service identified repeated falls in a resident who enjoyed independent movement. Rather than increasing confinement, the service reviewed environmental factors, mobility aids and staff response times.
Day-to-day practice focused on enabling movement with support, including physiotherapy input and personalised prompts. Effectiveness was measured through reduced injury severity, maintained mobility and improved mood indicators.
Operational example 2: Medication management and choice
A person with dementia expressed a wish to self-administer medication. Risks included missed doses and incorrect administration. The service implemented a staged enablement plan with blister packs, visual reminders and daily oversight.
Staff documented compliance, reviewed capacity regularly and adjusted support as cognition fluctuated. Governance oversight ensured accountability and learning, demonstrating a reduction in errors without removing autonomy.
Operational example 3: Access to outdoor spaces
In a care home setting, outdoor access had previously been restricted due to absconding concerns. A risk enablement review introduced secure garden areas, staff observation protocols and personalised engagement strategies.
Effectiveness was evidenced through increased outdoor use, reduced agitation and no safeguarding incidents, supported by clear audit trails.
Commissioner expectation
Commissioners expect services to evidence that restrictive practices are avoided unless absolutely necessary and time-limited. Risk enablement should be clearly documented, outcome-focused and reviewed in partnership with individuals and stakeholders.
Regulator expectation (CQC)
The CQC assesses whether services are caring, responsive and well-led by examining how risk is managed. Inspectors expect providers to show how positive risk-taking is embedded, staff are trained and decisions are reviewed through governance systems.
Governance and assurance mechanisms
Effective governance includes restrictive practice registers, risk enablement audits and regular policy review. Services should demonstrate how learning from incidents informs practice and reduces future risk.
Risk enablement, when properly implemented, strengthens both quality and defensibility. It allows people with dementia to live fuller lives while ensuring services remain safe, compliant and confident.