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Person-centred care in clinical governance requires partnership with consumers – this ‘recognises the value of the consumer's voice, and the need for consumer experience and expertise to help shape decisions about health care at the level of the system, service, and individual.’

While this statement by the Australian Commission on Safety and Quality in Health Care (ACSQHS) lies in the context of healthcare, it is ubiquitous to aged care – where dignity of risk is a core requirement of the Aged Care Quality Standards (the Standards).

The concept of dignity of risk is integral to ‘consumer dignity and choice’ in Standard 1, which is central to all other Standards. Regulation plays a role in clinical governance and Standard 1(3)(d) supports person-centred care by specifically requiring consumers to be ‘supported to take risks to enable them to live the best life they can.’ This is dignity of risk. Since dignity of risk relates to consumer dignity and choice, it concerns person-centred care, and is, therefore, an essential part of clinical governance in aged care (which must also include management of risk).

Dignity of risk is defined in the guidance to the Standards as ‘ the right of consumers to make their own decisions about their care and services, as well as their right to take risks.’ However, more broadly, dignity of risk in aged care is ‘the principle of allowing an individual the dignity afforded by risk-taking, with subsequent enhancement of personal growth and quality of life.’ Such risks might include taking a walk for ice cream, or having champagne and strawberries to celebrate a birthday. They might include everyday choices such as what to have for dinner, or whether to take medication. The concept of dignity of risk recognises that a competent adult has a right to be exposed to some risk without being ‘over-protected’- that they are entitled to accept a risk they choose, as they have always done. Therefore, dignity of risk represents a continuum of life choices, but may also reflect a changed life situation, and hence priorities and values.

Clinical governance in relation to dignity of risk is complex since it involves risk mitigation – whereas dignity of risk means facilitating a person’s choice, even if that choice has the potential to cause them harm. Hence, clinical governance frameworks for aged care must address competing tensions – between supporting dignity of risk, and mitigating the risk of harm. Such tensions should be considered in accordance with an appropriate risk management framework, be balanced against autonomy versus a legal duty of care to prevent harm, and as always, factor in accountability.

Further, assessment and choice of risk are subjective, and choices can change – sometimes even fluctuate, as can decision-making capacity. We cannot predict what a person wants simply on the basis of previous decisions, and therefore effective communication and contemporaneously informed consent are also essential to supporting dignity of risk - just as they are in patient-centred care.

Dignity of risk in aged care means acknowledging that an older person remains autonomous, even if they require care. It emphasises a consumer’s right to accept risks they choose, as they have always done, to support their values and promote quality of life. Most of all, dignity of risk means the person is always at the centre of any decision - and is therefore all about consumer-centred care.

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^{Links reviewed on 15/02/2024}

^{https://www.safetyandquality.gov.au/our-work/partnering-consumers/person-centred-care (accessed on 8/8/21)}

^{Quality of Care Principles 2014 (Cth)}

^{‘Guidance and resources for providers to support the Aged Care Quality Standards’. Aged Care Quality and Safety Commission, accessed on 8/8/21 at: https://www.agedcarequality.gov.au/providers/standards}

^{M Woolford et al. ‘Recommendations for the prevention of deaths among nursing home residents with unexplained absences’. Int J Older People Nurs. 2019;14:e12237., DOI: 10.1111/opn.12237.}

^{‘Dignity of Risk: Elderly should be allowed to do ‘risky’ activities to improve lifestyle, Professor says’. ABC news, accessed on 8/8/21 at: https://www.abc.net.au/news/2015-11-22/risky-activities-could-improve-quality-of-life-for-elderly/6939166}

^{J Ibrahim et al. ‘Managing risk for aging patients in long-term care: a narrative review of practices to support communication, documentation, and safe patient care practices’. Risk Management and Healthcare Policy 2019: 12 31-39, accessed at: Managing risk for aging patients in long-term care: a narrative review | RMHP (dovepress.com)}

^{M Woolford et al. ‘Applying dignity of risk principles to improve quality of life for vulnerable persons’. In J Geriatr Psychiatry. 2020; 35: 122-130. DOI: 10.1002/gps.5228}

^{A Fleming and K Slank. ‘Making a Choice: Self-Other Differences in Decision Making in Risky Situations.’ North American Journal of Psychology; Winter Garden Vol. 17, Iss. 3, (Dec 2015): 633-648.} 

^{J Ibrahim and M Davis. ‘Impediments to applying the ‘dignity or risk’ principles in residential aged care services. Australian Journal of Ageing, Vol 32 No 3 September 2013, 188-193, DOI: 10.11.11/ajag.12014}