Jennifer Poynton, Admiral Nurse at Dementia UK, explores why positive risk-taking is essential in dementia care — and how providers, families and professionals can balance safety with independence, dignity and quality of life.
With 15 years’ experience across mental health, learning disability and dementia services, and working as an Admiral Nurse with Dementia UK since 2021, I regularly support families and professionals with complex decisions about independence, safety and risk.
As dementia care continues to evolve, so does our understanding of what good, person-centred support looks like. There is now a strong focus on safety, safeguarding and managing risk — and rightly so. But in practice, this can sometimes lead to people being protected to the point where their independence, confidence and sense of self are reduced.
This is where positive risk-taking becomes important. It recognises that risk is part of everyday life for all of us. None of us live completely risk-free, and trying to remove all risk for someone with dementia can mean taking away the very things that give their life meaning.
At its heart, positive risk-taking is about helping people continue to make choices, stay independent and do the things that matter to them, while putting sensible support in place. It is a shift away from asking, “What could go wrong?” towards asking, “What matters to this person, and how can we help them do it safely?”
In day-to-day care, positive risk-taking is often about ordinary moments. Someone may want to continue cooking their own meals, even if there are concerns about forgetting steps or leaving appliances on. Another person may want to keep going for walks alone or continue visiting a local shop they have always known. Rather than stopping these activities, the focus is on how to support them through small changes at home, simple technology aids or agreed ways of checking in.
Often, it is about professionals, families and the person themselves working together to find a balance that feels right.
From my experience as an Admiral Nurse, these conversations are rarely straightforward. Families and staff are often weighing up genuine concerns about safety while also wanting to respect the person’s wishes. There is not always a perfect answer, but there is often a better option than simply stopping the activity altogether.
It is understandable that care can become risk-averse. Staff are under pressure, families are worried, and there are clear safeguarding responsibilities. But when avoiding risk becomes the default, it can leave people feeling restricted, isolated and disconnected from the things they enjoy.
For positive risk-taking to work, there needs to be open communication and shared decision-making, with organisations supporting staff to make thoughtful decisions rather than always choosing the most cautious option.
Some situations are particularly challenging, including wanting to remain at home as needs increase, declining care or support services, continuing to drive or travel independently, managing money without help, or forming relationships others feel unsure about.
These situations can be difficult for everyone involved. It is important to look beyond immediate risks and consider the person’s wishes, values and rights. As dementia progresses, the level of support someone needs may change, so decisions may need to be reviewed over time.
Where capacity is in question, assessments can help guide decision-making, but they should sit alongside open, compassionate conversations.
The environment, both physical and emotional, plays a big role in enabling positive risk-taking. Helpful changes can include clear signage, good lighting, familiar layouts, reminders, tracking devices and sensors that alert someone if something is not right.
Just as important is how care is delivered. Many providers now use a person-centred, strengths-based approach. In simple terms, this means focusing on what someone can still do, rather than what they cannot.
For example, if someone has always made their own breakfast, the aim would not be to take that away because it carries some risk. Instead, carers might simplify the kitchen setup, label cupboards or introduce safer equipment. The person keeps their independence, but with the right support around them.
Families are often at the heart of these decisions, and their concerns are completely valid. Wanting to keep someone safe comes from a place of love, but it can sometimes lead to more cautious choices. Part of supporting families is helping them understand that some level of risk may be unavoidable and can also bring benefits.
This is where Admiral Nurses can make a real difference. They work closely with families to talk through options, manage risk and help them feel more confident in the decisions being made.
For staff, supporting positive risk-taking can sometimes feel uncomfortable, especially where the focus has traditionally been on avoiding risk. Many worry about getting it wrong.
To build confidence, staff need practical day-to-day tools, risk-benefit approaches such as Nothing Ventured, Nothing Gained and NICE guidance on decision-making and mental capacity, scenario-based training, access to specialist advice and reassurance that their organisation will support thoughtful, balanced decision-making.
When positive risk-taking is done well, the benefits can be significant. People with dementia are more likely to feel in control of their lives, maintain their identity and stay connected to the things they enjoy. Supporting meaningful activities can improve mood, reduce anxiety and bring a sense of purpose.
Balancing safety with independence is not always easy, and there will always be grey areas. But by focusing on what matters most to the individual and managing risk thoughtfully, it is possible to find that balance.
Positive risk-taking is not about ignoring danger. It is about understanding it — and supporting people with dementia to live as fully as possible.
