“Life itself is a risk. We cannot eliminate risk without eliminating the person.”
Professor Rhonda May
What is it that makes us so uncomfortable when a service user wants to take a risk? When Nancy wants to make her own tea or Clive wants to have a go at DIY the warning bells start ringing. We immediately think of all the dangers involved. We are programmed to do this. Health and safety has gone mad. If Mary wants to have a go at some knitting, even though this is something that she has done all her life, the first thing that pops into our mind is that she may use the knitting needle as a weapon.
Care workers have the best of intentions but are frightened of repercussions and end up playing it safe. Unfortunately, service users end up being de-skilled because everything is done for them. Providing a reasonable level of safety and supporting good quality of life involves striking a delicate balance between a resident’s right to independence and their abilities. Positive risk- taking focusses on what the person can do rather than their limitations. Are the risks of the activity greater than the risks of inactivity and loss of skills and independence?
Of course, we need robust risk management, particularly for those who lack insight into their personal safety. But we can think outside the box and support them to take risks. If Fred wants to go and climb a tree, that may well not be possible, but don’t dismiss it straight away. He may be happy to have a walk in the woods, tell you tales of his adventures and enjoy the sights and sounds that were once so familiar. Don’t stop Mary from knitting but make sure she is supervised when doing so or engage her with winding wool into balls. You might not be able to let Clive lose with a chain saw but with supervision he might be able to use a battery powered screwdriver or spend some time with some sandpaper doing something meaningful that gives a great sense of satisfaction. The benefits of taking considered risks such as improved self-confidence, greater independence and a sense of wellbeing will often far outweigh the dangers.
Both the HSE and CQC have legislative powers to act in the interests of safe practice in care homes but they both encourage “positive risk taking” for all service users whether in a care home or living in their own home. HSE say that risks assessments should enable people to live fulfilled lives safely, rather than being a mechanism for restricting their reasonable freedoms.
Legislators and regulators need to continue to support and promote service users’ rights to take risks and provide assurance to care providers that they will not be “punished” for taking risks. We should be shouting about our successes with positive risk-taking and sharing and promoting these areas of good practice.