Balancing risk and choice Helping residents to be as independent as possibleIt’s really important for residents to remain as independent as possible – it’s key for their health and wellbeing. The care home is responsible for keeping residents safe so the team will have to consider how risky an activity is for residents. But every resident is an individual, so some activities will be risky for some people, and not for others. Everyone is different. If someone has always gone for a daily walk then it is important to try to support them to carry on doing it, if they want to. It’s important to not only look at the physical risks of an activity but also the psychological and social aspects. For example, if a resident wants to go out for a walk, there may be a risk of falling (physical risk), but going for a walk can help them to feel part of the outside world (emotional benefit). The challenge for a care home can be balancing the wishes of one individual with the rights of the other residents, the capacity of staff and the concerns of family and friends. So it’s important to assess the situation fully. An occupational therapist can assess and advise on areas of risk, particularly for people with complex needs. Case study Since living in the home, Mrs Smith’s Alzheimer’s disease has progressed. She has always gone for an early morning walk taking the same route. Her family recognise how important this is for her health and wellbeing. Staff can’t go with Mrs Smith every day, and there are now concerns about her memory and getting lost. Mrs Smith and her family meet with the care home staff. A risk enablement plan is drawn up and they all agree that stopping Mrs Smith from taking her daily walk would cause her great distress. They all agree that she still has the mental capacity to decide whether to take a walk or not. Staff continue to support her to go out by making sure she is dressed appropriately and noting the time she leaves. The family buy Mrs Smith a GPS location tracker with an integrated fall sensor which she wears when she goes on a walk. If Mrs Smith is not back within half an hour, there is an agreed plan that a member of staff will go to find her. When making decisions around risk, remember that: Knowing the person, their strengths, routine, interests and wishes is vital. People’s perception of risk will be influenced by their personality and life experiences. Risk enablement plansPeople may need risk enablement plans for certain activities. These plans should list: The risks and benefits The likelihood that risk might occur The seriousness/severity of those risks Actions to be taken to minimise the risks Actions to be taken if the risks occur. Here’s an example for Mrs Smith’s case study The value of the activity The risks associated with this activity Likelihood of risk High Medium Low Myself Others Severity of risk High Medium Low Myself Others How the risk will be managed Highly valued daily activity and a routine Mrs Smith has had for many years. Falls Medium risk to Mrs Smith Medium GPS location tracker with falls sensor. Getting lost High risk to Mrs Smith Medium / high Staff to check if Mrs Smith has not returned within 30 minutes. Whenever possible, there should be a shared agreement between the resident, and with their consent, their relatives. As care home staff, you need to understand your responsibilities under the Mental Capacity Act 2005 for England and Wales[1], Adults with Incapacity (Scotland) Act 2000[2] and Mental Capacity Act (Northern Ireland) 2016[3]. A person’s ability to make decisions may change from day-to-day, so it’s it’s important that you, as a member of staff, have a good working knowledge of the legislation. References Great Britain. Parliament (2005) Mental Capacity Act 2005. London: Stationery Office. Scotland. Parliament (2000) Adults with Incapacity (Scotland) Act 2000. Edinburgh: Stationery Office. Great Britain. Parliament (2016) Mental Capacity Act (Northern Ireland) 2016. London: Stationery Office.
