I was fortunate to have the opportunity to attend the Law for Aged Care Managers Conference recently. I would like to share some insights gained from the presentation by Kathryn Hinde, Head of Legal and Corporate Affairs for Allity Aged Care on Dignity of Risk.

Dignity of risk is an expression that was made popular in the 1970s, by those who promoted the deinstitutionalisation of the developmentally disabled. It was a term coined to reflect changes in attitude and how risk was managed in this cohort. Dignity of risk refers to the right of all people to undertake activities that have a level of risk. Risk is a natural part of life and for the older person living in residential aged care, it can provide reward and enrichment.

Older people have the right to autonomy, the right to exercise choice and have that choice respected. The Aged Care Quality Standards, Standard 1: Consumer dignity and choice, supports the rights of the consumer to exercise choice and independence.

Professor Joseph Ibrahim Head of Health Law and Ageing Research Unit at the Department of Forensic Medicine, promotes the right of the older person to ‘thrive before you die’. However understandably staff involved with caring for older persons are concerned about adverse outcomes from risk taking. So, we need to balance risk with the right to choose.

What happens when we fail to allow the consumer to take risks? It removes hope, diminishes the person and prevents them from reaching their potential.

We are presented with a dilemma when making a decision about an older person’s choice to take risks:

• Registered nurses must adhere to their Code of Practice around person-centred practice which requires them to promote shared decision making
• Carers and Leadership Teams have a ‘duty of care’ towards their consumers
• How to balance ‘duty of care’ vs ‘dignity of risk’.

When it comes to dignity of risk, you can discharge your ‘duty of care’ to the consumer by providing them the information they need to make an informed decision and evaluate the risk by using a validated risk assessment tool.

It is also important to determine the consumer’s capacity to make a decision and ensure that the consumer is aware of the consequences of the choices they are making.

Managing risk should focus on processes rather than outcomes. It should be less about ‘how we manage this’ and more about ‘how might we make this happen’. This may include actions to reduce the risk of the activity and provide alternatives that present less risk.

When facilitating dignity of risk, Sinclair et al (2018, p.5) recommend the Australian Law Reform Commission national decision-making principles be used as a guiding framework:

• Principle 1: All adults have an equal right to make decisions that affect their lives and to have those decisions respected
• Principle 2: Persons who require support in decision-making must be provided with access to the support necessary for them to make, communicate and participate in decisions that affect their lives
• Principle 3: The will, preferences and rights of persons who may require decision-making support must direct decisions that affect their lives
• Principle 4: Laws and legal frameworks must contain appropriate and effective safeguards in relation to interventions for persons who may require decision-making support, including to prevent abuse and undue influence.

Reference:

Sinclair, C, Field, S, & Blake, M, 2018. Supported decision-making in aged care: A policy development guideline for aged care providers in Australia, 2nd Edition, Sydney: Cognitive Decline Partnership Centre, accessed 25 August 2019 <https://cdpc.sydney.edu.au/wp-content/uploads/2019/06/SDM-Policy-Guidelines.pdf>

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