A Dementia Action Week panel heard that care providers are increasingly willing to challenge regulatory caution in pursuit of better quality of life for residents, from forest walks to garden ponds. The message from Care England and NADCAS was blunt, a tick-box approach to risk is quietly causing the decline it claims to prevent.

Why Some Care Homes Are Choosing Risk Over Regulatory Comfort 

Care providers are being encouraged to rethink how they weigh up risk in dementia care, after a Dementia Action Week webinar heard that overly cautious, document-led approaches are leaving residents disengaged and deconditioning, even as the Care Quality Commission itself is willing to be persuaded otherwise when providers make their case properly.

The session was hosted by NADCAS, the dementia-focused arm of the National Activity Providers Association, as part of a wider Dementia Action Week programme. The panel brought together Sam Dondi-Smith, occupational therapist at NADCAS, Richard, social care advisor at Care England, Sarah, director at the Care Consultant Accreditation Framework (CCAF), and Vivien Steed, head of recreational wellbeing at Nellsar Care Group.

The Cost Of Playing It Safe

Richard, social care advisor at Care England, told the panel that person-centred care has become a phrase used so loosely it risks meaning nothing at all. He said providers are operating against a backdrop of workforce pressure, funding constraints and rising acuity, conditions that make it tempting to fall back on generic frameworks rather than genuinely individualised support. It is, he said, about being focused on individuals and their particular needs, not applying a label and assuming the job is done.

That distinction matters because, as the panel repeatedly stressed, dementia is not a single, homogeneous condition. Richard described it as a spectrum that manifests differently in every person, which is precisely where generic training tends to fall down, a gap IC News examined recently in Dementia Training Is Broken. Could Better Technology Help Fix It? An eight-hour course, Richard argued, cannot possibly prepare staff for the full range of ways dementia presents in practice.

Forest Walks And Garden Ponds

The clearest illustration of what happens when providers move beyond that framework-first mindset came from a service in Cambridge that took residents, many living with both cognitive and physical impairment, on a ten thousand step walk through uneven forest terrain, complete with tree roots, bridges and rivers. On paper, Richard said, nobody would have signed off on taking these residents into that environment. One man, who still has insight into his own diagnosis, spoke to the group afterwards about the racing bike rides he still goes on, despite a recent fall into a ditch. Rather than curtailing the activity, the home had built one-to-one support around it. The residents who completed the forest walk went straight into a dance class on their return, rather than settling into a chair for the rest of the afternoon.

A second example concerned a home in the West Country that wanted to install a garden pond and was initially refused by the CQC. Instead of abandoning the idea, the provider built it to a standard they judged safe and made their case directly to the inspecting team. Richard, social care advisor at Care England, said: “They just had to build up to a level where it was safe to do so.” Even where the regulator’s starting position was no, he said, the outcome changed once the home demonstrated how the risk was being actively managed. A similar pattern emerged with a dementia cycling club, where residents ride adapted tricycles with one-to-one support alongside them.

Richard was careful to frame all of this as considered risk management rather than recklessness, insisting that safety still has to be built in. But he was equally clear that residents need environments that feel real to them. Corridors designed to resemble outdoor streets, or lounges papered with images of bookshelves, were offered as examples of design choices that misjudge what people living with dementia actually perceive. Someone showering an eighty-year-old who is cognitively living at the age of fifteen, he said, still knows “that’s wrong and they lose dignity” the moment they are stripped naked, regardless of the person’s cognitive stage.

Confidence Starts With Leadership

Sam Dondi-Smith, occupational therapist at NADCAS, linked the sector’s caution less to policy itself and more to staff confidence. She said care teams are frequently unsure whether a more permissive, enabling approach is actually sanctioned, and that uncertainty is only resolved when managers are visibly present in living and dining spaces, modelling the behaviour they want to see rather than issuing it as guidance from an office. “It comes back to the leadership team within a home being out on the floor and providing permission that this kind of approach is okay,” she said, adding that new team members absorb culture directly from what they see modelled, rather than through a rushed induction of a couple of shadow shifts.

Sarah, director at CCAF, raised the practical strain this places on services that lean on agency staff working from care plans reduced to a couple of lines. She said consultants need to spend time with frontline teams, not only managers, and warned against uniform solutions applied without regard to the individual, citing homes that change every toilet seat in a unit to yellow regardless of whether that intervention suits the residents living there. “That one size doesn’t fit all,” she said. It is the same underlying question of judgement over blanket rules that IC News found running through the CQC’s recent approach to AI in care calling, explored in What CQC’s AI Rules Actually Mean As Care Calling Tech Scales Up, where inspectors again showed more interest in how risk is demonstrably managed than in whether a rule was followed to the letter.

What Providers Can Act On Now

The panel offered several steps providers could apply without waiting for a full culture change programme. These included checking lighting levels in living spaces and bedrooms using a smartphone light sensor, with Sam Dondi-Smith citing University of Stirling research pointing to roughly 150 lux as a threshold that supports alertness and engagement. She also pointed to qualitative observation tools, including Dementia Care Mapping and the person-centred observation and reflective tool, known as PORT, as low-cost ways for teams to reflect on the quality of their own interactions. A further recommendation was simply ensuring communal areas contain resources residents can pick up and engage with, rather than sitting empty, a gap Richard partly attributed to changes in practice since the pandemic.

Vivien Steed, head of recreational wellbeing at Nellsar Care Group, whose contribution was cut short after a connection failure partway through the session, had earlier described asking staff to describe a resident and finding they could list every medical condition in detail but struggle to answer a simpler question. “What makes their heart sing? What makes them tick?” she asked. “What makes them tap their feet? What makes them happy? And what makes them sad? We couldn’t tell you.” She said she had set homes across her organisation a challenge for Dementia Action Week: properly learn the life stories of five residents each.

The panel’s message sits at odds with a common assumption in the sector, that regulatory scrutiny and meaningful quality of life are in permanent tension. What emerged instead was a picture of a regulator willing to move when providers demonstrate active risk management rather than avoidance, and a sector where the barrier is often internal confidence rather than external rule. With Care England indicating a continued focus on dementia within its policy work, and NADCAS pushing to connect homes sharing this kind of practice, the open question is whether individual examples of positive risk-taking can be embedded as standard practice rather than remaining notable exceptions.

None of what the panel described required new funding or new technology. It required providers willing to build a case for risk rather than default to its avoidance, and leadership willing to be in the room when it counts.

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