Positive Risk-Taking for Older People at Home: A Governance Model Commissioners Can Trust
Independence at home depends on daily decisions about risk: walking to the kitchen unaided, using the shower, going outside, taking medication, cooking, or answering the door. Providers can unintentionally restrict these choices through risk aversion, especially when staff confidence varies or documentation is weak. Commissioners increasingly look for services that can demonstrate safe, lawful positive risk-taking that supports independence and avoids unnecessary escalation of care. This sits within Outcomes, Independence & Community Inclusion and should be underpinned by consistent governance across teams. Further related resources are available in the ageing well outcomes and independence collection.
What positive risk-taking means in domiciliary care
Positive risk-taking is not “taking chances.” It is a structured approach to enabling a person to do what matters to them while identifying risks, putting proportionate controls in place, and reviewing whether those controls work. For older people, positive risk-taking often relates to:
- Mobility and falls risk
- Nutrition, hydration and choking risk
- Medication routines
- Cooking and home safety
- Going out and community participation
The test is whether the approach supports independence without exposing the person to avoidable harm, and whether the decisions are recorded and reviewed in a way that can be audited.
Why risk aversion creates hidden restrictive practice
In home care, restrictive practice is not always obvious. It can appear as “we don’t let people do that” rules, staff discouraging activity, or escalating to hands-on support without exploring enablement. Examples include preventing someone from using the kettle, insisting on bed baths due to falls risk, or discouraging a person from leaving home because it is “safer.” These approaches may reduce short-term risk but can increase long-term dependency, reduce dignity and accelerate decline.
Operational example 1: Supporting safe showering after a fall
Context: Mr D (84) had a fall in the bathroom. Following the incident, some staff want to stop showers completely and switch to strip washes. Mr D strongly prefers showering and views loss of this routine as loss of dignity.
Support approach: Positive risk assessment with proportionate controls, reviewed after implementation.
Day-to-day delivery detail: The service completes a bathroom risk assessment: flooring, grab rails, shower chair suitability, lighting, and footwear. Staff are trained on safe support positioning and ensuring Mr D is not left unattended during transfer. A “shower checklist” is introduced for the first two weeks (chair placement, towel ready, call bell accessible). Staff record Mr D’s stability, confidence and any near-misses each time.
How effectiveness is evidenced: After four weeks, records show no further falls, improved confidence, and consistent completion of the shower checklist. The plan is reviewed and simplified (reducing unnecessary steps once stability is demonstrated). Evidence shows risk managed without removing choice.
Operational example 2: Enabling cooking with dementia and safety controls
Context: Ms E (80) has early dementia. Family are concerned about her cooking safely, and ask the provider to “stop her using the cooker.” Ms E values making her own breakfast and becomes distressed when prevented.
Support approach: Least restrictive enablement with capacity-sensitive decision-making and clear boundaries.
Day-to-day delivery detail: Staff complete a functional risk assessment covering sequencing, hazard awareness and forgetfulness risks. The plan supports Ms E to prepare breakfast with staff present, using simplified steps (pre-portioned items, labelled controls). Controls include a timer prompt and confirmation that the cooker is off at the end. If Ms E attempts cooking alone outside supported times, staff record triggers and discuss with family and GP memory service as appropriate.
How effectiveness is evidenced: Evidence includes incident data (no burns/fire), consistent completion of the end-of-task “safe off” check, and reduced distress recorded during visits. The approach demonstrates that risk can be reduced without blanket restriction.
Operational example 3: Walking outside with high falls risk
Context: Mrs F (87) is at high falls risk but wants to walk to the local shop weekly because it is part of her identity and social routine. A purely risk-averse approach would stop this, increasing isolation and deterioration.
Support approach: A graded mobility plan with positive risk controls and contingency planning.
Day-to-day delivery detail: Staff practise the route initially at quiet times, using a mobility aid assessment and pacing plan (rest points identified). Staff carry a phone, agree a “return point” if fatigue occurs, and document footwear, weather and Mrs F’s baseline on the day. The plan includes clear criteria for postponing (e.g., dizziness, unsafe weather), so decisions are consistent across staff.
How effectiveness is evidenced: The service evidences participation (walk completed), stability (no falls during supported walks), and wellbeing impact (recorded mood, appetite and engagement). If a near-miss occurs, the plan is updated and learning shared through supervision.
Commissioner expectation: risk decisions must be consistent, documented and reviewable
Expectation: Commissioners expect providers to manage risk in a way that supports independence and avoids unnecessary escalation of packages. They also expect the rationale for risk decisions to be clear and consistent across staff.
In practice: Providers should show standard risk assessment methods, clear documentation of controls, and review evidence demonstrating whether the approach works. This supports defensible decision-making in contract reviews and reduces disputes when incidents occur.
Regulator / inspector expectation: lawful, least restrictive practice with oversight
Expectation: Inspectors expect providers to respect rights, demonstrate person-centred care, and avoid informal restriction. They also expect safe systems and management oversight of risk practice.
In practice: Evidence should show how risks are assessed, how staff follow plans, and how learning is used to improve practice. Where capacity is relevant, the documentation should reflect appropriate consideration and involvement of the person and family.
Governance model: how to make positive risk-taking safe at scale
1) Standardised templates and language
Use consistent templates for risk assessments and “risk enablement plans,” including: the person’s goal, identified risks, agreed controls, what staff must do each visit, and review dates.
2) Management sampling and escalation thresholds
Managers should sample risk-related records monthly and use clear thresholds for escalation (e.g., repeated near-misses, inconsistent staff recording, increased incidents). Complex cases should trigger multidisciplinary discussion where appropriate.
3) Workforce assurance
Positive risk-taking depends on staff confidence. Supervision should test understanding using real cases: “What would you do if Mrs F is unsteady today?” Training should cover practical risk controls, not only theory.
4) Audit trails that link risk, incidents and learning
When incidents occur, the audit trail should show: what the plan was, whether staff followed it, what changed, and how learning was shared. This is what commissioners and inspectors often look for when assessing governance credibility.
Key takeaway
Positive risk-taking is a practical governance discipline, not a slogan. The strongest providers enable older people to live their lives with proportionate controls, consistent documentation and management oversight. This is how independence is protected in daily practice and how services demonstrate defensible, inspection-ready delivery.