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Supporting Individuals with Dementia Policy

1. Purpose

At {{org_field_name}}, we are committed to providing high-quality, person-centred care and support for individuals living with dementia. Our approach ensures that individuals receive compassionate, dignified, and evidence-based care that enhances their well-being, maximises their independence, and safeguards their rights.

This policy is written with reference to the Health and Social Care Act 2008, the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, the Care Act 2014, the Mental Capacity Act 2005, the Human Rights Act 1998, the Equality Act 2010, UK GDPR, the Data Protection Act 2018, current Care Quality Commission (CQC) guidance and assessment framework, and NICE guidance including NG97: Dementia: assessment, management and support for people living with dementia and their carers.

2. Scope

This policy applies to all staff members, including permanent, temporary, agency, and volunteer workers who provide support to individuals living with dementia. It covers all aspects of dementia care, including assessment, care planning, daily support, and safeguarding against abuse and neglect.

This policy applies to all regulated activities delivered by the service in supported living settings, including care, support, risk management, medication support, communication, safeguarding, record keeping, partnership working, incident reporting and quality assurance. All staff must read this policy alongside the service’s policies on person-centred care, consent, safeguarding, complaints, incident reporting, duty of candour, medication, restrictive practice, equality and data protection.

3. Related Policies

• SL07 – Person-Centred Care Policy
• SL08 – Dignity and Respect Policy
• SL09 – Consent to Care Policy
• SL13 – Safeguarding Adults from Abuse and Improper Treatment Policy
• SL34 – Confidentiality and Data Protection (GDPR) Policy
• SL39 – Mental Capacity and Deprivation of Liberty Safeguards Policy
• SL21 – Medication Management and Administration Policy
• SL42 – Communication and Engagement with Service Users and Families Policy

• Complaints and Concerns Policy
• Incident Reporting, Notifications and Duty of Candour Policy
• Equality, Diversity, Inclusion and Human Rights Policy
• Restrictive Practice / Positive Behaviour Support Policy
• Risk Assessment and Positive Risk-Taking Policy
• End of Life Policy

4. Principles of Dementia Care

4.1 Person-Centred Approach

• Care is tailored to the individual’s history, preferences, and needs.
• Individuals are supported to maintain as much independence and autonomy as possible.
• Staff must use life history work, including memory books and personal objects, to promote familiarity and comfort.
• The individual’s voice, choices, and dignity must be upheld at all times.

Care and support plans must be based on a holistic assessment completed with the individual and, where appropriate and lawful, those who know them well. Assessments and plans must reflect the person’s physical, mental, emotional, social, cultural, spiritual, communication and sensory needs, identify desired outcomes, include agreed review dates, and be updated promptly when needs or preferences change. Staff must make reasonable adjustments to ensure the individual can understand information, express wishes, and participate in decisions to the maximum extent possible.

4.2 Dementia-Friendly Environments

• The living environment must be adapted to be dementia-friendly, ensuring good lighting, clear signage, and minimisation of noise and clutter.
• Assistive technology may be used only where it is appropriate, proportionate, and the least restrictive option available. Its use must be based on an assessed need, discussed with the individual wherever possible, and, where relevant, supported by lawful consent or a Mental Capacity Act best-interests decision. The purpose of the technology, risks, benefits, privacy implications, review arrangements and any restrictions on the person’s freedom must be clearly documented in the care and support plan and risk assessment.
• Spaces should promote orientation and familiarity, using personalised and visual cues to reduce confusion.

4.3 Effective Communication

• Staff must use clear, simple language, maintain eye contact, and allow extra time for responses.
• Non-verbal communication techniques such as gestures, facial expressions, and touch (where appropriate) should be used to reinforce understanding.
• Individuals who require alternative communication methods (such as pictures, Makaton, or communication boards) should have access to these aids.
• Staff must be trained in active listening skills to ensure they recognise and respond appropriately to individuals’ needs and emotions.

4.4 Supporting Daily Living and Well-Being

• Individuals are encouraged to participate in meaningful activities, such as gardening, music therapy, and reminiscence therapy, which promote cognitive engagement and emotional well-being.
• Mealtime assistance follows the Meeting Nutritional and Hydration Needs Policy (SL12), ensuring individuals receive appropriate support.
• Assistance with personal care must be conducted with respect, sensitivity, and in line with the individual’s preferences.

4.5 Understanding Distress and Changes in Behaviour

People living with dementia may communicate unmet need, fear, pain, discomfort or confusion through distress or changes in behaviour. Staff must respond in a calm, respectful and non-judgemental way and seek to understand the meaning of the person’s behaviour in the context of their history, communication style, environment, health and current circumstances.

Before considering medication, staff must consider and document possible causes of distress, including pain, delirium, constipation, dehydration, hunger, infection, medication side effects, sensory impairment, loneliness, boredom, trauma, bereavement, environmental stressors and inappropriate care approaches.

Support must be primarily non-pharmacological and person-centred, for example reassurance, de-escalation, meaningful activity, adaptation of the environment, changes to routine, comfort measures, communication support, and review of triggers and protective factors.

Psychotropic or antipsychotic medication must not be used for staff convenience or as a substitute for good dementia care. Any such medication must be prescribed and reviewed by an appropriate prescriber, with a clear clinical rationale, target symptoms, risk-benefit discussion, monitoring plan, review date and records of effectiveness and adverse effects.

Where a person shows a sudden deterioration or acute confusion, staff must promptly consider physical illness or delirium and escalate for clinical assessment in line with the service’s escalation procedures.

4.6 Risk Management and Safeguarding

Individuals with dementia may be at greater risk of financial abuse, neglect, or exploitation. All concerns must be reported following the Safeguarding Adults from Abuse and Improper Treatment Policy (SL13).

Risk assessments should be regularly reviewed to ensure safety measures, such as falls prevention strategies and emergency plans, are in place.

If an individual walks about, leaves the setting unexpectedly, or shows a pattern of movement that may place them at risk, staff must respond in a person-centred and least restrictive way. Language that labels the person as “wandering” should be avoided unless clinically necessary in external documentation. Staff must explore the reasons for the behaviour, including unmet need, distress, routine, culture, past habits, occupation, orientation needs, environmental triggers or attempts to exercise choice. Risk management must balance safety with the person’s rights, independence and quality of life, and any restriction must be necessary, proportionate, lawful, clearly documented, regularly reviewed, and escalated where it may amount to restraint or deprivation of liberty.

All safeguarding concerns, including self-neglect, financial abuse, neglect, psychological abuse, discriminatory abuse, organisational abuse, misuse of restraint, unexplained injuries, missing person incidents, medication errors or unlawful restrictions, must be reported immediately in line with local safeguarding procedures, internal reporting systems and statutory notification requirements where applicable.

4.7 Decision-Making and Mental Capacity

Staff must work in accordance with the Mental Capacity Act 2005 and its five statutory principles, including the presumption of capacity and the requirement to support individuals to make their own decisions wherever possible.

Capacity assessments must be decision-specific, time-specific, properly recorded, and completed by staff who are suitably trained and competent to do so. Where a person lacks capacity for a particular decision, any decision made on their behalf must be in their best interests, involve the person as far as possible, and take account of their past and present wishes, feelings, beliefs and values, as well as the views of family members, carers, attorneys, deputies, advocates and relevant professionals where appropriate.

Staff must consider whether any restriction is the least restrictive option available and whether it is necessary and proportionate to prevent harm.

Because this service operates in supported living, any care arrangements that may amount to a deprivation of liberty must be identified promptly and escalated without delay to the relevant manager and commissioning or local authority teams for legal review and, where required, application to the Court of Protection. Staff must not rely on Deprivation of Liberty Safeguards (DoLS) for supported living arrangements.

Where there is no appropriate family member or representative to support a person who lacks capacity and a serious decision is required, referral for advocacy, including an Independent Mental Capacity Advocate (IMCA) where applicable, must be considered.

4.8 Supporting Families and Carers

• Families must be involved in care planning, where consent is given, and provided with regular updates on their loved one’s well-being.
• A keyworker should be assigned to each individual to act as a liaison between the individual, their family, and other professionals.
• Families should have access to support groups, training, and respite services to help them manage their role as caregivers.

Staff must involve families, unpaid carers and other representatives in line with the individual’s wishes, confidentiality obligations, lawful authority and best-interests requirements. Where information cannot be shared because consent has not been given or there is no lawful basis to do so, staff must explain this respectfully while still listening to relevant concerns about safety, wellbeing or possible abuse.

4.9 Medication Management

Medication used in dementia care must be managed safely, lawfully and in a person-centred way. The service must ensure that medicines are administered, recorded, monitored and reviewed in line with prescriber instructions, the person’s care plan, current best practice and the organisation’s Medication Management and Administration Policy.

The use of PRN medicines, sedatives, antipsychotics or other psychotropic medicines for distress or behaviours of concern must be clearly justified, time-limited where appropriate, and subject to regular clinical review. Records must show the reason for use, alternatives tried, expected outcome, monitoring for side effects, and whether the medicine was effective.

Covert administration must only take place where it is lawful, necessary, recorded in accordance with the Mental Capacity Act 2005, based on a best-interests process, and supported by appropriate professional advice.

Staff must promptly report and respond to medication errors, omissions, adverse effects or concerns about over-sedation, and these must be reviewed through the service’s governance systems.

4.10 Equality, Diversity, Human Rights and Reasonable Adjustments

The service will support people living with dementia in a way that respects equality, diversity, identity and human rights. Care and support must take account of protected characteristics, culture, language, religion, sexuality, gender, relationships, disability, age and communication needs. Staff must make reasonable adjustments so that people can access support, understand information, express preferences and participate in decisions. Discrimination, stigmatising language and ageist assumptions are not acceptable and will be addressed through supervision, training and, where required, disciplinary procedures.

4.11 Complaints, Concerns and Speaking Up

Individuals living with dementia, their relatives, advocates, representatives and other stakeholders must be given clear and accessible information about how to raise a concern or make a complaint. Information must be provided in a format the person can understand. Complaints and concerns must be taken seriously, investigated promptly and fairly, and used as an opportunity for learning and improvement. Where the person needs support to complain, this must be offered, including support from relatives, advocates or other appropriate representatives. No person will be disadvantaged because they raise a concern in good faith.

4.12 Recognising Deterioration and Escalation

Staff must be alert to sudden or significant changes in presentation, behaviour, cognition, mobility, continence, nutrition, hydration, mood, sleep, pain, infection risk, falls, or ability to manage daily living. Sudden deterioration or acute confusion must prompt consideration of physical illness, pain, medication-related causes or delirium, and staff must escalate concerns without delay in line with the service’s escalation, emergency and clinical liaison procedures. All deterioration and escalation decisions must be clearly recorded.

5. Staff Training and Development

Staff must receive induction, mandatory training, supervision and ongoing competency assessment appropriate to their role and the needs of the people they support. Where the service supports people living with dementia, the training plan must include dementia-specific training appropriate to those needs.

Dementia training must include, as relevant to role: person-centred dementia care; communication; life history work; recognising distress and unmet need; de-escalation; safeguarding; the Mental Capacity Act 2005; consent; least restrictive practice; equality, diversity and human rights; medication awareness; nutrition and hydration; falls and frailty awareness; recognising pain, delirium and deterioration; recording; and working with families and advocates.

Staff must receive regular supervision and appraisal, and competency should be assessed through observation, discussion, audits, incidents, complaints and feedback from individuals and families. Where gaps in competence are identified, the service must take prompt action, including refresher training, supervision, restriction of duties, or disciplinary action where appropriate.

The service should identify staff with enhanced dementia knowledge or champion roles to support learning, reflective practice and service improvement.

6. Monitoring and Quality Assurance

The registered manager and provider will operate effective governance systems to assess, monitor and improve the quality and safety of dementia support delivered by the service.

Governance arrangements must include regular review of: care plans and reviews; risk assessments; capacity assessments and best-interests decisions; safeguarding concerns; incidents and accidents; complaints and compliments; medication records and psychotropic medicine use; restrictive practices; falls; nutrition and hydration; hospital admissions; missing person incidents; training compliance; supervision; staff competency; and feedback from individuals, families and professionals.

Audit findings, trends, actions and learning must be clearly recorded, allocated to named persons, and followed through to completion within agreed timescales.

The service must use feedback, complaints, incidents, safeguarding concerns and audit outcomes to drive improvement and reduce the risk of recurrence.

Where a notifiable safety incident occurs, the service must act in accordance with the duty of candour and related incident-reporting procedures.

7. Confidentiality and Data Protection

• Personal information relating to individuals living with dementia must be handled in accordance with UK GDPR, the Data Protection Act 2018, common law confidentiality duties, and the organisation’s Confidentiality and Data Protection Policy.
• Records must be accurate, complete, contemporaneous, securely stored and accessible to authorised staff who need them for care, support, safeguarding, governance or legal purposes. Information sharing must be lawful, proportionate and recorded, including where information is shared in the person’s best interests or to protect them or others from harm.
• Any discussions about care plans or medical decisions must be conducted in private settings and with consent where applicable.

8. Policy Review

This policy will be reviewed at least annually, and sooner where there are changes in legislation, CQC guidance, NICE guidance, case law, safeguarding requirements, learning from incidents or complaints, or service changes affecting people living with dementia.

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Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}
Reviewed on: {{last_update_date}}
Next Review Date: {{next_review_date}}
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