“Don’t get me wrong, carers are the most important people in the world but you can have carers and keepers. The latter try and assume total responsibility for your life prematurely, and there are many of them around”.
This was a quote from a person with dementia and it clearly reflects some people’s experiences in relation to care services.
Managing risk is a balancing act. It is about balancing the positive effects of taking the risk versus the negative effects of avoiding the risk for the person. As carers (both family and paid) we want to protect the person but this is, more often than not, about the person's physical health. We are inclined to neglect the impact on the person's emotional and psychological wellbeing.
Putting safety first can deny the person the right to choice and self-determination. This can lead to a loss of self-esteem, increased dependence and does not support the principles of person-centred care.
Recognise and build upon the person's strengths. Don’t forget that they may have built some good strategies for managing risk throughout their life. Concentrate on the meaning of the situation for the individual – not the risky situation. Any interventions or alternatives must be the least restrictive. Everyone involved in the person's care should try to come to a shared understanding of risk with the person – not necessarily a shared agreement.
Best practice principles when promoting a risk enablement approach include:
- Consultation and Communication
- Preparing a risk plan
- Ensuring everyone signs up to it
- Sharing Information
- Monitoring and Reviewing
- Supporting Staff
- Focusing on enablement to manage uncertainty rather than creating certainty
- Collectively promoting risk-enablement as a team
- Ensuring people with dementia have an advocate (when necessary)
- Reviewing your tools – what weighting is physical / emotional /benefits / losses?
- How do you manage differing family views?
Remember there is no such thing as a risk-free decision; the risk-averse, apparently safe option comes with its own risks.
The focus of positive risk-taking is on making good decisions about risk; it is the taking of calculated and reasoned risks, not leaving things to chance.
Making decisions is exercising power; other people (however well-meaning) often deny people living with dementia this power.
It is all too easy to see the negatives and deficits around someone living with dementia and to remain oblivious to their capabilities and potential and those of the resources they may have around them.
A programme to assist you to develop your leadership qualities to promote and enhance quality dementia care.