Understanding Dignity of Risk in Aged Care and Disability Support

Have you ever made a poor decision? Or made a decision that the people in your life did not necessarily agree with or approve of what you were doing? Maybe you bought something that was a waste of money, or maybe you chose to pursue a career that did not have much stability or growth.

Now, let’s apply this to aged care and disability support. Imagine you support Steven, who is 60 years old and likes to play the pokies at their local pub. Despite knowing that gambling can be high-risk—losing money, feelings of regret—many Australians choose to gamble, and Steven is no different. However, as Steven’s care worker, you know that gambling could lead to risky or poor decisions. So, what would you do in this situation?

Here’s the truth: Steven has a right to make decisions about his life, both good and bad. This is known as dignity of risk.

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What is dignity of risk?

Simply put, dignity of risk refers to the right people have in making decisions, even if those choices may involve some risk. 

It highlights choice and control, where everyone has the right to choose how to live their lives, including making reckless, risky, or wrong decisions. The Aged Care Quality Commission and the NDIS Commission both outline the requirements for care and support workers regarding respecting a person’s dignity and risk.

Under the Strengthened Aged Care Standards, Standard 1: The Person and Standard 7: The Residential Community specifically outline how aged care providers must respect older people’s choice, uphold their right to dignity of risk, and support older people to take positive risks that increase their autonomy and quality of life.

Under the NDIS Practice Standards, specifically Core Module 1: Rights and Responsibilities, support workers must support people with disability to make informed choices and maximise their independence, including their right to dignity of risk.

Even though Steven’s decision to gamble carries the chance of something unwelcome happening,  you have to support their right to choice and dignity of risk.

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Duty of care vs dignity of risk

Dignity of risk can be challenging to come to terms with, particularly due to persistent attitudes towards people with disability and older people. They often tend to be infantilised, and those caring for them feel overprotective, making it difficult to respect and support their choices. However, it’s crucial to balance your duty of care with the person you support’s right to dignity of risk.

Duty of care refers to a care and support worker’s legal and moral responsibility to keep the people they support safe from harm and provide a high standard of care. It means care and support workers have a duty to protect the person they support from harm or injury and take reasonable measures to ensure they do not come into harm or injury.

When we say reasonable measures, we mean that your support should not limit a person’s independence or choices; rather, your support should promote choice and control. For example, when supporting Steven, you must meet your duty of care and ensure they are safe while respecting their choice to gamble.

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In practice

So, what does dignity of risk look like in practice? Here’s what you can do.

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1. Follow the person’s plan

Each person you support will have an individual care plan specific to their support needs.

As a support or care worker, you should always follow and implement the person’s plan. It’s also best practice to familiarise yourself with your organisation’s policies and procedures, as doing so ensures that you are clear on your role and how you should provide support.

If we go back to Steven, you will need to read their plan to see their support needs and what you need to do to best provide care.

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2. Assess the risks and help the person make informed choices

To fully support a person and ensure you’ve met your duty of care, you should aim to conduct a risk assessment about the choices they wish to make and determine the possible risks of those choices. 

Once you have done so, you should support the person to make informed choices by weighing up the pros and cons of their decisions. This may include determining other options so the person can make an alternative choice rather than none at all.

In Steven’s case, you could weigh up the pros and cons of playing the pokies. These could be winning vs losing, feeling excited vs feeling regretful, progressive jackpots vs misleading perceptions of winning odds, to name a few. You could also explore why Steven enjoys the pokies. If it’s a social connection, explore other options that would give Steven a chance to socialise. If it’s about enjoying the game, find new experiences that could pique Steven’s interest.

Once you weigh up these benefits and risks with Steven, the choice is entirely up to them. 

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3. Document everything

Most importantly, you must document everything. Any support professional knows the importance of documentation, as it provides a clear record of what happened, who was involved, and what steps were taken.

In Steven’s case, you should document every facet of the decision-making process, from what Steven wanted to do (play the pokies) to the information you provided to them (pros and cons of gambling) and the ultimate decision. You should also highlight any alternatives you may have presented to or explored with Steven to fully ensure that you supported them in making an informed decision—and that all the risks were considered.

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Wrap up

While it can be challenging, respecting a person's right to make their own choices, such as Steven's decision to gamble, is essential to fostering their autonomy and enhancing their quality of life. 

Care and support workers play a vital role in ensuring that individuals are informed about the risks involved in their decisions while upholding their right to make choices. Through thoughtful practice, we can help people like Steven navigate their choices while respecting their rights.