We received a call from a spouse caring for her husband, who is living with a brain injury. She struggles with balancing being the “sheriff” and supporting her husband’s desire for autonomy and independence. She explains how the other day her husband was up on a ladder hanging Christmas lights by himself. There were no safety measures in place, and he had a near fall. She was calling asking how to determine the extent of risk as it relates to her husband and how can she try to work with him to make decisions that aren’t putting himself or her at harm.
In general, the term “living at-risk” means individuals are free to engage in activities or act in certain ways that might be considered risky, so long as they are mentally competent and don’t place others at risk or expose them to harm. This includes a range of activities, including getting up on a ladder with no safety measures and poor balance. Other activities might include eating when at risk of aspiration, riding a bike without a helmet, smoking around oxygen supplies or refusing to use a walker to minimize the likelihood of falls.
With age or someone living with a chronic disease or injury comes a higher likelihood of exposure to risk than other adults. Changes in health, presence of chronic disease or varying mental capacity can make the people we care for more vulnerable to accidents or injuries.
There are no easy answers and each situation bring its own set of complex circumstances. A good starting place is to start by evaluating and assessing the risk including the following:
- Is the assessment of the risk influenced by personal fears or desires?
- Is the risk real, or would less guilt and worry be experienced knowing the person being cared for is safe?
- What is the major risk the person being cared for is choosing and why are they choosing it?
- Is person being cared for capable to make decisions for themselves or is an assessment required?
- Is the person being cared for aware of the impacts of their decisions and choices on others?
- What are possible ways to eliminate or minimize the risk?
- What possible interventions or planning can be done that satisfies both the needs of the care recipient and the caregiver?
Family caregivers are often challenged to respect the person they are caring for and their choices and accept risk while continuing to offer support. The goal is to find a way to balance and respect the needs of both the person being cared for and the caregiver. It shouldn’t, however, be limited to non-interference. Caregivers also have the right to negotiate ways of honouring their own limitations and to not cause greater harm to themselves and the person for whom they are caring.
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Wendy Johnstone is a Gerontologist and a consultant with Family Caregivers of British Columbia in Victoria, BC.