Working in Partnership With Families in Dementia Care: Roles, Boundaries and Shared Responsibility
Partnership working with families is a defining feature of good dementia care. Families often hold deep personal knowledge of the person, their history, routines and triggers, while providers bring professional expertise, governance and accountability. Within family, carers and partnership working in dementia services, clarity around roles and shared responsibility is essential. Without this, relationships can drift into conflict, blurred accountability or unsafe practice. This article sits within wider dementia service models that emphasise collaboration without undermining professional judgement or regulatory duties.
Why partnership with families matters in dementia care
Dementia is progressive and unpredictable. Families often notice subtle changes long before they are clinically obvious, such as shifts in sleep, appetite, mood or communication. When services actively work with families, care becomes more responsive and less reactive.
However, partnership does not mean transferring responsibility. Providers remain accountable for safe care, lawful decision-making and adherence to care plans. Effective partnership recognises family insight as an asset, while maintaining professional leadership.
Defining roles and responsibilities clearly
One of the most common causes of tension is unclear responsibility. Families may assume they can direct day-to-day practice, while staff may feel undermined or uncertain about whose direction to follow.
Good services explicitly define:
- The role of family members in providing background knowledge and preferences
- The role of staff in assessment, planning and risk management
- Decision-making authority where capacity is fluctuating or lost
Operational example 1: Clarifying boundaries early
In a supported living dementia service, a daughter regularly instructed staff to alter medication times. The provider introduced a structured partnership meeting, clearly explaining clinical oversight arrangements and documenting agreed communication routes. Day-to-day care improved, and medication errors reduced. Effectiveness was evidenced through MAR audits and reduced incident reporting.
Shared responsibility without diluted accountability
Shared responsibility means working together, not sharing liability. Providers must ensure families understand that safeguarding, medicines management and restrictive practice decisions remain professionally governed.
Operational example 2: Co-produced care planning
A residential dementia service revised care plans jointly with families, using structured review meetings. Families contributed life history and early warning signs, while staff retained responsibility for risk assessment. Outcomes improved, shown through reduced distress behaviours and fewer unplanned GP calls.
Managing disagreement constructively
Disagreement is inevitable, particularly as dementia progresses. Services must treat disagreement as a governance issue, not a relationship failure.
Operational example 3: Escalation pathways
Following repeated disagreements about night-time supervision, a provider implemented a formal escalation process involving senior review. Decisions were documented with rationale and shared transparently. This reduced complaints and demonstrated defensible decision-making during inspection.
Commissioner expectation
Commissioners expect providers to demonstrate structured family engagement that improves outcomes, reduces escalation and supports continuity of care. Evidence should include documented reviews, communication records and measurable impact on service stability.
Regulator expectation
CQC expects providers to work in partnership with families while retaining clear accountability. Inspectors look for evidence that families are listened to, disagreements are managed safely, and decisions remain person-centred and lawful.
Governance mechanisms that support partnership
Strong partnership working is underpinned by governance, including:
- Documented family involvement frameworks
- Clear consent and information-sharing protocols
- Recorded decision-making and escalation routes
Conclusion
Partnership with families in dementia care is not optional—it is fundamental. When roles, boundaries and shared responsibility are clearly defined, services become safer, more responsive and more resilient under scrutiny.