Good practice tips in safeguarding people with dementia

Practical advice when working with adults with dementia to prevent abuse and neglect, and promote safeguarding

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This article presents a few key pieces of advice from Community Care Inform Adults’ guide on safeguarding adults living with dementia, last updated in June 2023. The full guide outlines the challenges and dilemmas that arise in the practical implementation of safeguarding and risk assessment in dementia care, and gives advice on the steps to take when a safeguarding enquiry has been triggered. Inform Adults subscribers can access the full content here.

The guide is written by social worker Kate Metcalf, and has been updated by Jill Manthorpe, professor emerita of social work at King’s College London.

Common symptoms of dementia include memory loss, disorientation, confusion, difficulty communicating, behavioural changes, low mood (feeling depressed) and overall cognitive impairment, all of which can put a person at risk of abuse or neglect.

Concerns about neglect and self-neglect are common because dementia can hinder a person’s ability to speak out or remember events, or make them confused about what is happening around them. Vulnerability to financial and other forms of abuse, such as theft, scams and exploitation, may arise if they stop understanding bills or finances and entrust them to someone who does not act in their best interests.

Where a safeguarding enquiry has been triggered, practitioners should:

Take a person-centred approach

  • The person’s views and the outcomes they want to achieve should be central at every stage and should be recorded in case notes.
  • Just because someone with dementia has experienced abuse or the risk of it, it doesn’t mean you should lose sight of the things they can do, for example, requesting an apology or making a statement to the police or trading standards officers.

Keep an open mind

  • Assume mental capacity to take relevant decisions unless the contrary is shown, in line with section 1 of the MCA, and keep an open mind, even if someone has been found to lack capacity to make certain decisions before.
  • Sometimes dementia may lead the person to make accusations or claims which are found not to be true. Always take new allegations seriously, even if earlier ones have proved to be unfounded.

Tailor communication

  • Always use plain language and do not go too quickly. Use terms like “safety planning” and “distressing” or “upsetting”, rather than “safeguarding”, “abuse” or “risk”.
  • Ask simple questions, not leading ones.
  • Give the person time to respond to your questions.
  • Check that you have understood answers by briefly summarising what has been said.
  • Make sure they can hear you or use other communication techniques.
  • Resist focusing your attention on others who may try and speak for or over them.

Minimise distress

  • Safeguarding concerns should be discussed with the individual where possible, but be sensitive to circumstances.
  • If the person cannot remember whatever gave rise to the safeguarding concern, ask yourself whether it is ethical to remind them of it, weighing it up against the severity of any harm, risk of repetition and the availability of other solutions.
  • Sometimes the person will be better safeguarded by working with a relative or care worker, or an advocate, for example, if memory loss means that the person might be continually reminded of the abuse.

Enable risk

  • Try not to associate risk with danger. We all take risks and people with dementia should be able to do so too if they choose (like choosing to buy cigarettes instead of a meal, or spending time with individuals who might take advantage of them to avoid being lonely).
  • If there are various courses of action available to someone who is unable or unwilling to choose for themselves, always aim for the least restrictive option.
  • Put the person at the centre of your thinking and review their desired outcomes with them as much as possible, especially if they have memory problems.

While dementia often puts people at increased risk of abuse or neglect, safeguarding practice should be enabling and you should return to the person’s views, wishes and feelings throughout any enquiry, while ensuring that you follow the law.

If you have a Community Care Inform Adults licence, log in to access the full guide and read more detailed information on carrying out safeguarding enquiries and dealing with particular forms of abuse and neglect.

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