This informal CPD article, ‘Holding the Family Too: Relational Practice in Dementia Care‘, was provided by Regina Riley of Adoniso, a training and development organisation committed to enhancing the quality of care for children and young people through emotionally intelligent, trauma-informed practice.
Dementia care is never just about the person living with the diagnosis. In residential care, each individual resident arrives with a wider emotional system: partners, adult children, siblings, friends, histories, unresolved tensions, guilt, grief and expectations. The person may be the named resident, but the family often carries its own form of distress into the home.
This is why dementia-informed care must include family-informed practice. NICE guidance on dementia explicitly covers support for people living with dementia and their carers, including the need for staff training and carer support. Alzheimer’s research also emphasises that a person’s experience of dementia is shaped not only by the condition itself, but by relationships, environment and support.
Importance of family-informed practice
When I managed care homes for older people, I saw this tension repeatedly. A resident’s presentation was never the only story in the room. Sometimes the harder work was holding the family’s fear, anger, guilt or mistrust while still protecting the dignity and care needs of the person living with dementia. Staff were not only supporting memory loss, confusion, personal care and changing needs. They were also navigating sons who felt excluded, daughters who felt responsible for everything, spouses who were grieving before death, and relatives who arrived already braced for conflict.
Not every difficult family member is simply “difficult”. Some are frightened. Some feel guilty for agreeing to residential care. Some are exhausted from years of caring before the move happened. Some are carrying old family wounds that dementia has brought painfully close to the surface. Some fear that if they stop watching closely, their loved one will disappear completely from view.
This does not excuse disrespect towards staff. It does, however, help explain why family interactions can become so emotionally charged.
Dementia often creates what Pauline Boss, educator and researcher describes as ambiguous loss: a loss that is unclear, ongoing and without clean closure. In dementia, the person may be physically present while aspects of memory, personality, recognition or shared history are changing. That kind of grief can be deeply destabilising for families.
In care homes, this grief may appear as control. A relative may question every item of clothing, every meal choice, every bruise, every missed phone call. Another may avoid visiting because seeing the decline feels unbearable. Another may arrive rarely, then criticise loudly because guilt has nowhere else to go. These patterns are often the emotional language of helplessness.
For frontline staff, this can be draining. They may feel blamed for decline they cannot stop. They may feel watched, criticised or distrusted. They may also feel protective of the resident, especially when family relationships appear strained or painful. Without space to reflect, staff can begin to harden. Care becomes task led. Conversations become defensive. Families become “the problem”.
A person-centred approach
A dementia care culture cannot be truly person-centred if staff are left unsupported in the emotional realities of the work. Tom Kitwood’s person-centred approach challenged depersonalised models of dementia care and placed the person first, not merely the disease. But in practice, person-centred care also requires relationally supported staff. Workers cannot keep offering warmth, patience and emotional attunement if their own emotional labour is ignored.
The emotional labour of care is real. Staff are often required to stay calm while being challenged, kind while feeling accused, professional while absorbing distress, and boundaried while still appearing compassionate. Research into care work continues to highlight the emotional demands placed on workers, and dementia resources recognise the need to support the adult social care workforce, including care home staff, family carers and community teams.
Reflective supervision part of dementia care
Practical language for families
This is why “working with families” should not be treated as an optional extra in dementia training. It is central to safe, relational care.
Staff need practical language for difficult moments. For example:
When a relative becomes ‘controlling’, staff can respond with clarity rather than defensiveness:
“We can see how important this is to you. Let me explain what we are doing and how we can keep you involved.”
When grief is showing up as anger, staff can acknowledge the feeling without absorbing the blame:
“This sounds very painful. We want to understand what is worrying you most today.”
When criticism becomes personal or repeated, boundaries are still needed:
“We want to work with you, but we also need this conversation to remain respectful so we can focus on your mum’s care.”
When a family member avoids visiting, staff should resist judgement. Avoidance may be sorrow, shame, fear or emotional overwhelm. Gentle invitation often works better than pressure.
The key is not to excuse every behaviour. The key is to understand what may sit beneath it, while still protecting staff from hostility and residents from emotional harm.
Importance of Managers
Managers have a crucial role in naming these dynamics. In my experience, staff often coped better when they were helped to understand the emotional context behind a family’s behaviour. The question shifted from “Why are they being like this?” to “What might they be carrying, and what boundary do we need here?” That shift does not make the work easy, but it makes it more thoughtful.
Reflective supervision should be part of dementia care, not a luxury. Staff need space to process difficult family encounters, explore their own emotional responses and think carefully about what the resident may be experiencing. Without that space, resentment grows quietly. Staff may become avoidant, blunt or emotionally detached. Not because they do not care, but because they are overloaded.
Supporting care home transition
Care home transitions can also be emotionally complex for families. When someone moves into a care home, relatives may experience guilt, sadness, uncertainty and difficulty adjusting to changes in role and relationship. This matters because families do not stop needing support once residential care begins. In many cases, their identity as “carer” becomes unclear. They are no longer doing the daily physical care, but they are still emotionally bound to the person.
Good dementia care therefore includes helping families find a new role. They may need reassurance that they still matter. They may need guidance on how to visit when conversation is difficult. They may need support to understand that connection is still possible, even when recognition changes.
This is where staff can become bridges. They can help families see the person who remains, not only the abilities that have changed. They can share small moments: “She smiled when we played that song,” or “He seemed settled after your visit.” These moments matter. They restore humanity when dementia has made everything feel uncertain.
The need for training and support
But staff can only offer this kind of relational care consistently when organisations recognise the complexity of the role. Dementia care is not simply personal care, medication, meals and risk assessments. It is emotional holding. It is grief work. It is communication under pressure. It is boundary-setting. It is safeguarding dignity while families are trying to survive loss in real time.
Dementia-informed care must include relational awareness: understanding the person, the family, the staff team and the emotional field around them all. When staff are trained to see beyond behaviour, they become less reactive and more confident. When families feel heard, many soften. When managers create reflective spaces, staff are less likely to carry the emotional weight alone.
In dementia care, we are not only caring for memory loss. We are often holding the echoes of a family’s history, grief and love. Staff deserve training, support and recognition for the depth of that work.
We hope this article was helpful. For more information from Adoniso, please visit their CPD Member Directory page. Alternatively, you can go to the CPD Industry Hubs for more articles, courses and events relevant to your Continuing Professional Development requirements.
References
Alzheimer’s Society. (2022). Understanding and supporting a person with dementia. Available from Alzheimer’s Society.
Alzheimer’s Society. (2025). Guilt and dementia: How to manage guilty feelings as a carer. Available from Alzheimer’s Society.
Boss, P. (2014). Ambiguous loss: A complicated type of grief when loved ones disappear. Bereavement Care, 33(2), 63–69.
Carers UK. (2023). The experiences of former carers. London: Carers UK.
Kitwood, T. (1997). Dementia Reconsidered: The Person Comes First. Buckingham: Open University Press.
NICE. (2018). Dementia: assessment, management and support for people living with dementia and their carers (NG97). Last reviewed October 2025. London: National Institute for Health and Care Excellence.
Skills for Care. (n.d.). Dementia resources. Leeds: Skills for Care.
Skills for Health, Health Education England and Skills for Care. (2018). Dementia Training Standards Framework.
