I’d like to start this blog by asking you a simple question:
What are you doing right now?
Now, I know you’re reading an internet page but how? And what else? What brought you here? Maybe you’re sitting on a bus, reading this on your phone while balancing a takeaway coffee on your lap. Or maybe you are waiting for the casserole you put in the oven to cook and are enjoying a moment of quiet before the family come charging in, hungry for their tea.
Now – stop to consider if tomorrow someone told you that you could no longer do even just one element of what you’re doing now.
You can’t go on a bus by yourself.
You can’t use your cooker.
What would that mean to you? How would you feel – not just now but in a few weeks? What would be the potential impact on your mood? Your confidence? Your sense of self-identity?
What you are describing and feeling is at the heart of risk enablement. For although it seems like a complicated and, let’s face it, “risky” process, it is really just about seeing the bigger picture around what gives meaning and purpose to our lives:
“People with dementia often feel that dementia becomes the only thing others know about them. But they remain individuals in their own right and dementia is not the most important thing about them. Many are still able to do what they did before despite their life changing and some things becoming increasingly difficult to do.” (Alzheimer’s Society, 2010).
So, you have started the process of risk enablement by identifying the value of tasks and activities, using yourself as a case example. But what next? How can you support people living with dementia to take positive risks within their daily lives, whether you are a health or care practitioner, a friend or carer or you your self are living with dementia, risk enablement can seem like a daunting task, so with that in mind, here are seven top tips to help start the process.
- Start the conversation
Whilst risk management checklists and “safety first” approaches are often the norm, they are also one of the biggest barriers to empowering people with dementia (Department of Health, 2010). By talking about risk taking as a positive process, you can begin to create a culture of risk enablement.
- See the individual
Knowing what matters to the person living with dementia is the key to risk enablement. Be clear about who needs to be involved in the conversations and discussions. Try to avoid making generalisations and take an individualised approach (Joseph Rowntree Foundation, 2014).
- Acknowledge fear
Research has shown that your approach to risk is more likely to be based on your own culture and norms than on the actual probability of harm occurring (Department of Health, 2010). Positive risk taking requires trust & commitment so it is essential that we acknowledge our own fears and the fears’ of others.
- Take a balanced view
It is easy to become focused on the physical domains of risks & worst case scenarios but risk enablement requires negotiation. Potential downsides of facilitating an activity or being involved in your favourite hobby must be weighed against the health benefits of engaging in an activity/occupation and the potential harm from withdrawing the task.
For staff, tools such as HEAT maps or personal risk portfolios can be a good starting point and can be found in the Department of Health document “Nothing ventured, nothing gained: risk guidance for dementia” on page 52
Attached is a leaflet we designed to assist NHS staff clinical reasoning when faced with complex situations within acute/general hospital based practice http://www.knowledge.scot.nhs.uk/media/CLT/ResourceUploads/4064579/274993%20Enablement%20Framework%20PROOF8.pdf
- Use a strengths based approach to finding solutions
Risk enablement is about supporting people living with dementia to take risks by creating plans to minimise or manage potential negative outcomes. Using a strengths based approach means all plans start from the point of “can do”, helping to lead you to a person-centred solution.
- Accept there is not always a perfect fit
Risk enablement is complex and not all risks can be managed or mitigated – and some risks are just “too risky”.
- Remember to review
Risk enablement is an evolving process & what works today may not be the best solution tomorrow. But the cyclical process is essential to ensure that at every stage, the least restrictive solution is implemented:
“When the day comes that I have to start asking for help…[and]…if that independence is taken away…then I hope its only taken away from me in the right way…I would like to think that I could still be consulted and still have some say in my independence”(Alzheimer’s Society, 2010).
I would welcome comments on my blog post, or you may want to consider;
- What can we all do to support people living with dementia to take positive risks within their daily lives?
- How do you ensure you know what matters to a person living with dementia?
Alzheimer’s Society (2010) – “My name is not dementia”.
Department of Health (2010) – “Nothing ventured, nothing gained: risk guidance for dementia”. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/215960/dh_121493.pdf
Joseph Rowntree Foundation (2014) – “How can ‘positive risk-taking” help build dementia friendly communities?”
AHP Consultant, NHS Greater Glasgow and Clyde
Christine studied Occupational Therapy in Glasgow. After graduating with a BSc (Hons) degree, she began working as a Basic Grade OT within a busy acute hospital. Since then, Christine has worked in a range of clinical areas including adult community mental health, acquired brain injury & addictions and most recently was employed as a Practice Development Head OT within Glasgow’s North East mental health services (adult & over 65’s). Christine has been on secondment as an AHP Dementia Consultant since August 2010, with a particular focus on the care of people with dementia within acute hospital settings.