The person you support is at the heart of everything you do as a carer. Being person centred is at the core of enabling positive risk taking in practice.
You need to know the person, their individual life story, their wants and desires. What is important to them? Spending time with the person and listening to their choices is a key part of the risk enablement process.
Thinking about the people with dementia that you support, you will already know and understand that there is not a ‘one size fits all’ approach to being person centred. Everyone’s needs are different.
The more you know a person the better you will understand their preferences and enable them to take risks.
The 4 Essentials of Risk Enablement are:
These are shown in Figure 4.
One Essential is not more important than the other, they are in no right order and you need to think about all of them together. Enabling positive risk taking is a dynamic process. It is constantly changing, depending upon the situation and the person’s needs.
Positive outcomes can come from taking risks. Remember those feelings you experienced when you took a risk in your own life, and it had a good outcome and how your feelings changed when you were not supported to take part in a risky activity?
Putting Positives First is about supporting positive risk taking. This Essential is not about eliminating risk.
When supporting an individual with dementia, you need to remember the benefits they can achieve from engaging in supported risk taking. Attempting to avoid risk will create negative outcomes. Table 1 below shows some of the benefits you can get from putting positives first compared with what is achieved through trying to eliminate risk.
Table 1. Outcomes that can come from risk enablement versus risk elimination
|Risk Enablement: Putting Positives First
|Loss of confidence
|Meet new people
|Learn something new
|Missed opportunity to learn new things
|Experience something different
|No new experiences
|Engaged and enthusiastic
When someone you support wants to participate in a risky activity, you need to spend some time working out how to make this happen. Saying ‘no’ can often be an immediate reaction, especially when at first you might not be sure how to make the activity happen. You might also need to provide support in a different way which could be unfamiliar to you and will take time to think about and plan.
In risk enablement, Being Proactive is about identifying the risk and then finding a way forward for the activity to go ahead. When the person you support wants to undertake a risky activity, you should change your reactive response from ‘no’, to a more proactive response like:
“Let’s see how we can make that work for you”
This Essential encourages you to think about being positive. You need to think about your response and think ahead about making this activity occur so that the person can follow through on their preference. The choice to participate in activities involving risk belongs to the person you support and your task is to make their choices happen.
Staying true to preferences means that you need to understand the preferences of the person you support and then act on those. This Essential asks you to consider:
What does this person who is in this position want?
As a carer, you will need to work closely with the person and others who know them well to further understand and explore the risk they want to undertake. Talk with the person to determine the severity of the risk and then make a judgement about proceeding with either of the following:
When you stay true to a person’s preferences, you maximise their choice and control.
Minimising harm while enabling a person with cognitive disability to take risks is an important balance you need to manage. Harm minimisation is not the same as harm elimination.
This Essential involves you thinking about reducing likely harm that may occur to one of the following areas of a person’s life:
Often, carers explain that they find themselves giving more priority to reducing harm, but this approach is aversive and can prevent an individual from engaging in risk.