Performance Improvement 2007. What Role Do Negotiated Risk Agreements Play in Assisted Living?



Negotiated risk agreements were developed as a mechanism to enable older persons residing in regulated assisted living settings to make choices, even when they entail some risk. Negotiated risk agreements are written documents that list: the behavior or resident preference of concern to the provider; the potential or actual risk; the resident preferences and potential provider accommodations or suggested alternatives to the behavior that reduce risk while meeting resident preferences; a negotiated resolution; and the resident's acknowledgement and acceptance of the potential negative consequences of his or her actions. The study examined states' statutory and regulatory provisions related to negotiated risk agreements and analyzed the policy objectives that the agreements were designed to meet. The study also analyzed the debate surrounding these agreements; and gained an understanding of how assisted living providers, staff and residents viewed and used such agreements. This study was designed to inform state policymakers, assisted living providers, and key stakeholders about agreements and issues related to their use.

Balancing the need to assure both autonomy and safety is a major challenge when providing long-term care services to older persons who live in licensed group settings. Provider policies and state regulations intended to ensure safety can conflict with individuals' ability to make the choices they prefer. Negotiated risk was conceived to help assisted living programs provide residential alternatives to institutional care. Residential assisted living programs provide frail and cognitively impaired older persons an option that maximizes their privacy, independence, choice, and enables them to maintain a normal lifestyle. These qualities are generally lacking in institutional long-term care settings.

Over the past decade, many assisted living providers have adopted negotiated risk agreements, and several states have regulatory provisions regarding their use. However, their use is not without controversy. Assisted living providers, policy makers, aging advocates, and long-term care experts have defined negotiated risk agreements as a mechanism to enhance resident choice by providing a rigorous process designed to balance autonomy and risk for residents and providers in assisted living. While the sample is small and not representative, the findings suggest that negotiated risk agreements can be a useful means to help residents and providers achieve a balance between desires for autonomy and concerns about safety. At the same time, they suggest that the negotiated risk agreement concept is proving difficult to broadly and consistently apply.

Report Title: Study of Negotiated Risk Agreements in Assisted Living Facilities
Agency Sponsor: ASPE, Office of the Assistant Secretary for Planning and Evaluation
Federal Contact: Kennedy, Gavin, 202-690-6443
Performer: Research Triangle Institute; Research Triangle Park, NC
PIC ID: 8345

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"PerformanceImprovement2007.pdf" (pdf, 717.63Kb)

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