Strengths-Based Dementia Planning: Supporting Ability, Not Just Managing Decline
Strengths-based planning in dementia services is frequently misunderstood. Some teams interpret it as ignoring risk or pretending decline is not happening. In reality, strengths-based dementia planning is about recognising retained abilities, adapting support as cognition changes, and using those abilities to promote stability, dignity and independence for as long as possible.
This article forms part of Dementia – Person-Centred Planning & Strengths-Based Support and directly links to Dementia – Service Models & Care Pathways, because strengths-based approaches look different across homecare, supported living, residential and integrated dementia pathways.
What “strengths-based” really means in dementia care
In dementia services, a strengths-based approach does not deny loss. Instead, it focuses on:
- Abilities that remain consistent (habits, procedural memory, long-held skills).
- Abilities that fluctuate and need flexible support.
- Abilities that can be preserved longer through the right environment and prompting.
Effective planning shifts the emphasis from “what the person can no longer do” to “what the person can still do, with the right support, at the right time, in the right way.”
Commissioner expectation: maintaining independence and preventing avoidable escalation
Commissioner expectation: commissioners increasingly expect dementia services to demonstrate how support maintains independence and delays deterioration, rather than accelerating dependency. Strengths-based planning is often scrutinised in relation to:
- Reducing avoidable increases in commissioned hours.
- Preventing unnecessary moves into higher-cost settings.
- Supporting reablement principles even within progressive conditions.
Plans that default to “staff will do” without justification are difficult to defend during reviews or funding reassessments.
Regulator / Inspector expectation: least restrictive, enabling practice
Regulator / Inspector expectation (CQC): inspectors routinely test whether services are enabling people to do as much as possible for themselves. In dementia settings, this includes:
- Evidence that staff prompt, cue and support rather than take over.
- Proportionate risk management that balances safety with autonomy.
- Clear documentation of why restrictions exist and how they are reviewed.
Where staff routinely remove choice “because of dementia,” inspectors often identify a breach of person-centred and least restrictive principles.
Identifying strengths in dementia planning
Good strengths-based dementia plans identify abilities across several domains:
1) Procedural and habitual skills
Many people with dementia retain long-established routines: making tea, folding laundry, personal grooming sequences, or setting a table. These skills often persist even when short-term memory deteriorates.
2) Communication strengths
Some people lose verbal fluency but retain non-verbal communication, humour, music, rhythm, or visual recognition. Plans must capture how staff should communicate, not just that communication is “limited.”
3) Environmental strengths
Familiar environments, visual cues, colour contrast, and consistent layouts can dramatically improve independence. Strengths-based plans describe how the environment compensates for cognitive loss.
Operational Example 1: Homecare strengths-based planning that prevents dependency
Context: A homecare service noticed that a person with moderate dementia was becoming increasingly passive during visits, despite previously being independent with meals.
Support approach: The plan was rewritten to identify retained procedural skills and remove unnecessary task takeover.
Day-to-day delivery detail:
- Staff stopped preparing meals in advance and instead supported meal preparation step by step.
- Visual prompts were introduced: labelled cupboards and a picture-based recipe card.
- Staff used verbal cueing (“What do we do next?”) rather than instructions.
- Time was built into visits to allow the person to complete tasks at their pace.
How effectiveness is evidenced: Daily notes showed increased participation, reduced passivity, and fewer expressions of frustration. Commissioners could see that support hours were being used to maintain skills rather than replace them.
Operational Example 2: Supported living strengths-based planning and positive risk-taking
Context: In supported living, staff restricted a person’s access to cooking facilities due to concerns about forgetfulness and safety.
Support approach: A strengths-based review identified that the person retained strong procedural memory for cooking but needed environmental safeguards.
Day-to-day delivery detail:
- A hob safety cut-off and timer were installed.
- Cooking was scheduled at predictable times when the person was most alert.
- Staff used discreet check-ins rather than constant supervision.
- The plan documented clear thresholds for intervention if risks increased.
How effectiveness is evidenced: The person resumed independent meal preparation without incidents. Risk reviews showed controls were effective, and the service evidenced least restrictive practice during inspection.
Operational Example 3: Residential dementia planning that preserves identity
Context: A resident with dementia had previously worked as a cleaner and took pride in keeping spaces tidy, but staff had discouraged this due to perceived risk.
Support approach: The care plan was revised to embed this strength into daily life.
Day-to-day delivery detail:
- The resident was supported to help wipe tables and arrange communal spaces.
- Tasks were adapted using lightweight equipment and clear boundaries.
- Staff reinforced the role positively, acknowledging contribution and purpose.
How effectiveness is evidenced: Distress reduced, engagement increased, and staff reported fewer episodes of agitation. The service documented how identity-based strengths improved wellbeing.
Strengths-based planning and safeguarding
Strengths-based approaches must always sit alongside safeguarding. This means:
- Clear documentation of risks linked to retained abilities.
- Proportionate controls rather than blanket restrictions.
- Regular review as dementia progresses.
Safeguarding concerns often arise not from enabling activity, but from failing to review plans as abilities change.
Governance: keeping strengths visible as needs change
Strong services use governance systems to ensure strengths-based planning remains relevant:
- Planned reviews that reassess abilities, not just risks.
- Incident reviews that ask, “Did we remove ability unnecessarily?”
- Staff supervision focused on enabling practice, not just compliance.
- Outcome tracking linked to independence, engagement and wellbeing.
Common mistakes in strengths-based dementia planning
- Confusing strengths-based with “hands-off” support.
- Failing to update plans as cognition fluctuates.
- Using risk as a reason to remove choice without review.
- Not evidencing the positive impact of enabling approaches.
When strengths-based planning is operationalised properly, dementia services become calmer, more consistent, and easier to defend to commissioners and inspectors alike.