Sarah couldn’t get the picture of her mom lying on the floor in the kitchen out of her mind. The fall hadn’t been serious; there’d been minimal damage. But Sarah’s mind and even her dreams kept crowding with what ifs. What if she hadn’t come to visit that day? What if Mom had laid there for hours? What if she’d broken something, or had a concussion?
Sarah had done all she could think of to make her mom’s apartment safer. She called several times a day until Mom told her to knock it off, and that one call a day was sufficient. The bottom line remained, she couldn’t guarantee her mom’s safety. Even if she insisted that mom come to live with her (which wouldn’t work for Mom or Sarah’s family) there were no guarantees.
Did other care partners deal with these feelings? Sarah did some research and discovered something called a negotiated risk agreement which was used in long-term care facilities. Although the situation differed for her and her mother, she saw some principles which could be applied.
A negotiated risk agreement in a care community should include:
- A clear statement of the risk or potential risk in question for the resident
- Probable consequences of the risk for the resident (e.g., serious injury)
- Acknowledgment and explicit acceptance by the resident of the specific risk and possible injury from the risk
- Recognizes that the resident and his family are aware of the opportunity for the resident to move to a higher level of care or alternative residency community but are choosing not to do so
- A negotiated plan of care for the risk
- A clear explanation of what care the community will and will not provide to the resident regarding that risk (e.g., the community does not provide 24/7 or 1:1 care to the resident)
- A negotiated waiver or limitation of the community’s liability regarding the risks at issue.
- Statements regarding the voluntary nature of the agreement. 1.
Sarah realized three things.
- Her mother’s quality of life involved some risk.
- Safety was important to both her and her mother. Mom understood the implications of another fall.
- Mom’s autonomy, the right to make her own decisions, mattered to them both.
Sarah and her mother had many conversations about this. They identified ways they could make the apartment safer, and some of these made life easier as well. She loved her new grab bars in the bathroom. Mom agreed to certain ideas, such as staying inside on snowy days or arranging for an Uber rather than taking a bus. Other ideas, Mom clearly wasn’t open to, and Sarah had to accept that.
In the end, they wrote their own agreement, and it was Mom who suggested they revisit it every six months, or if Mom’s health changed. Mom realized Sarah’s concerns came from a heart of love, and Sarah realized her mother needed to make her own decisions. They printed it, with a copy for each.
“Should we frame it?” asked Sarah.
“No, I have a better idea.” Mom went to her desk and pulled out some bubble wrap, securing it around each paper. They grinned at each other.
- https://www.bakerdonelson.com/bakers-dozen-negotiated-risk-agreements-in-the-assisted-living-community-setting