Adult Day Services, Person-Centered Planning: Participant Choice vs. Risk
Posted On June 23, 2018
I wanted to share the answer to a question that I recently received, and one that I am often asked related to Person-Centered Planning, participant choice, and risk.
“Hi Amanda, how do we ensure participant safety and participant choice when a participant, whom we’ve assessed to be a fall-risk, requiring “stand-by assist”, doesn’t want the assistance. Can you let me know how to deal with this with a participant who has dementia and one that doesn’t? My staff and director have concerns about liability.”
Here was my answer:
For the person with dementia- and I don’t know the whole picture- You will be looking at the impact of his or her discomfort/anxiety/agitation related to the stand-by assist. Is there something specific that is bothering the participant when providing stand-by assist? Is it an independence issue, a privacy issue, or something else? Do they like some staff more than others, can these staff provide the support? Instead of calling it “stand by assist” and looking at it from that angle, perhaps have staff view it as walking with the participant rather than “stand by assist” (which is clinical-based language, and moderately dehumanizing).
Remember, as always, when supporting people with cognitive challenges to which they are opposed, go to the “why”. What about the support do they not want, or agree with? In this case, take a look at the staff’s “why”. Staff can often be overly involved in a person’s support, forgetting that our participants are grown adults, who have lived full and complete lives, and, in this case, do not want people hovering around them when they walk to the dining room or restroom.
I personally would find it annoying, and mildly offensive. Why wouldn’t our participants as well?
For the person without cognitive impairment, document his or her preferences. Is there really a high risk of his or her falling? Does the person live at home alone without support? If the person is at a high level for risk of falling, then what has the social worker done to ensure that the participant is safe at home? If it’s not that severe of a risk, then it may feel more like a liability issue, rather than a safety issue. Ultimately, if staff conclude that the participant is absolutely not safe walking without stand-by assist, clinically requires it to ensure he or she does not fall, and the participant refuses, then the participant may need to be discharged. In this case, documentation would be extensive, including all of the attempts staff made to work with the participant to ensure his or her safety.
As for the liability… good, clear, documentation is essential, and we’re never free from liability claims even if we do everything “by the book” and our documentation is perfect.
Take a look at in our Person-Centered Policy and Procedure Manual’s “Mitigation of Risk” policy for further guidance. Use the “Mitigating Risk Form” from Total’s Person-Centered Forms Manual to ensure and document the participant/family (if appropriate) choice, and the staff’s input. Its a great form that will guide you, your staff and the participant through the process of ensuring that participant choice is honored, and participant safety/center liability is addressed. Be sure to continue to update it regularly.
Hope that helps!