Service-level and practitioner-level recommendations for better care of people with dementia who live alone and have no informal caregivers

Context A substantial proportion of people with dementia live alone without informal caregivers, yet services often assume family involvement, increasing risks of unmet need and adverse outcomes. Objective This study aimed to generate service-level and practitioner-level recommendations to best support people with dementia who live alone and lack informal caregivers. Methods A qualitative phenomenological co-design workshop was conducted with seven practitioners from statutory, voluntary, and private-sector roles across England. Prompts informed by earlier qualitative work were used as a template to stimulate reflection and develop recommendations for practice through inductive thematic analysis and input from a study advisory group including people with lived experience of dementia. Findings Practitioners recommended some service-level and practitioner-level recommendations. Service-level recommendations included flexible care pathways and sufficient time to build rapport in the absence of informal support. Practitioner-level recommendations, approaching the client with personability, humanity, warmth, respect, and humility, and adopting a sensitive yet honest communication, were essential for meaningful engagement and supporting autonomy. Curiosity and creativity helped practitioners understand behavioural motivations and tailor interventions. Experience underpinned all these competencies, with supervision and shadowing seen as vital for developing relational skills. Limitations The study sample was small, although it included a diverse range of practitioner backgrounds. No people living with dementia participated directly in the study, although people with lived experience of dementia were involved in the study advisory group. Implications High-quality support for people with dementia who live alone requires service structures that enable good practice from practitioners. Embedding flexibility, time investment, and relational practice within dementia services is essential to enable effective, person-centred care, particularly where formal systems must compensate for the absence of informal caregivers. These prerequisites are critical conditions to ensure equitable support for people with dementia who live alone.