Pointers for Practice: Protecting adults at risk from abuse and neglect

Developing person-centred plans requires a positive risking-taking approach. That is focusing on what the adult at risk can do rather than what they cannot do. For many adults at risk they have had a long history of practitioners focusing on the negative. This can lead to practitioners and carers doing to and doing for the adult at risk to reduce risk thereby reducing choice.

Planning should take a more strengths-based approach. This means recognising abilities, motivations, wishes and desired outcomes. In other words, finding out who they are and what they want. If the adult at risk is assessed as not having the mental capacity to provide this information at this stage, then others around them can provide insights.

Morgan and Williamson (2014) identified factors that should be taken into consideration when assessing risk for adults living with dementia. These points are relevant when developing person-centred care and support protection plans for any adult at risk.

The key points to consider are:

1. The focus of positive risk-taking is on making good decisions about risk; it is the taking of calculated and reasoned risks, not leaving things to chance.
2. There is no such thing as a risk-free decision; the risk-averse, apparently safe, option comes with its own risks.
3. It is all too easy to see the negatives and deficits and to remain oblivious to the adult at risk’s capabilities and potential and those of the resources they may have around them.
4. Making decisions is exercising power; other people (however well-meaning) often deny adults at risk this power.

They go on to argue decision-making and planning to reduce risk is not easy but should be based on:

• everyone who will be reasonably affected by the decision being involved, in varying capacities
• information and detailed thinking throughout regarding the likely risks and benefits of whatever intervention is chosen
• clear knowledge of the person’s abilities and level of understanding of the risks
• recognising the benefit a person gains in terms of a positive outcome from taking a specific risk
• a plan in place, with the support that can reasonably be made available, so the person taking a risk feels as safe as possible
• anticipation of how things could go wrong, with a reasonable crisis response or contingency plan in place.

For further information see:

The Morgan and West paper is no longer available online, but Health Innovation Network What is Important to People with Dementia provides advice on person-centred assessments and planning that is relevant to adults at risk (Accessed 21/7/2019)