Creating and Sustaining the Balance Between the Up-side and the Down-side Risk of LIVING

Ray Miller, MSOSH, Director of Risk & Safety Solutions, Direct Supply

When we think of “risk,” particularly in the healthcare setting, we often think of the “fire” or the “fall” — the “downside risk.” And while I am not advocating that we ignore such untoward and undesired events, I am advocating for a broader and perhaps even “choice-empowering” view.

The view to which I refer is the view of creating the balance between Person-centered care/person-directed care and the resulting upside and down-side risks.

First, an example: I have a friend, well-respected, wise and caring, that has ENABLED Residents on oxygen to go camping. In another instance, she EMPOWERED Residents to go for a flight in a hot air balloon. To both of those, some might say “TOO RISKY.” I feel now, and I felt at the time she taught me, “That is a Community that I could see myself living in (someday, though not just yet).”

In both cases we might ask but why? Why the risk? Why the bother? Why? Because they never had, yet always wanted to. HOW did her care team accomplish it you ask? By seeking and adhering to that balance.

For another way to think of “risk,” I’ll use the name “Peter.” Peter taught us this: “Don’t get me wrong, carers (care givers) are the most important people in the world; but you can have “carers,” and you can have ‘keepers.’ The keepers try to AND assume total responsibility for your life, prematurely”.[i]
Might I say, “OUCH”.

So what if we consider “risk” from a slightly different perspective? Another friend of mine, again a well-respected, wise and caring person taught me this as said by the visionary Maria Montessori, “That which you do FOR me, you take FROM me.” Not immediately, and perhaps not even intentionally, but nonetheless IF you repeatedly, consistently, and I would add, UNWISELY and PREMATURELY, “keep me,” “prevent me” or “protect me” from doing things — normal things, daily life things -i THEN I will lose the ability to do those things at all.

Which areas of ability will I lose? Physical, mental, emotional, muscle memory, desire, all of these and others are the abilities that will begin to decline, to diminish, to decay.

Really? You want to put me in a wheelchair? I get it, I walk slowly. I’ve gotten to the point that I struggle to make it the whole way to the dining room. But please DON’T put me in your stinking (yes, a swear word) wheelchair. Why? Because, at least I can still walk!

“But we’ve always done it that way!” Here are a couple of responses to that habitual retort:
NOT everyone does it that way or thinks that way.

The 2012 Life Safety Code provides an alternative (and by-the-way, THREE Cheers for Pioneer Network!!) You can now, following the clearly-outlined requirements, have “furniture clusters” (my expression) in your hallways where residents can rest, visit and hold onto the dignity of WALKING.
There is a balance that CAN and MUST be achieved between the downside risk and the upside risk of LIVING.

As Henry Ford taught us:”Coming together is a beginning; staying together is progress; and working together is success.” So I invite you to give this more thought, and continue the conversation with your family, your co-workers, your residents.


[i] ‘Nothing Ventured, Nothing Gained’: Risk Guidance For People With Dementia. CONTACT INFORMATION: Claire Goodchild, Older People and Dementia Branch DOH, Room 304, Wellington House 135-155 Waterloo Road London, SE1 8UG 0789653199.

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