Dignity of Risk

A practical guide for the aged care team in Australia and New Zealand on supporting resident-led decisions — including infection and safety risks — without losing sight of dignity.

Aged care has always lived with a quiet tension. We are responsible for keeping residents safe and honouring their right to live as they choose. Most days, those two priorities sit comfortably together. Some days, they don’t — and that’s when our practice is truly tested.

From 1 November 2025, the Strengthened Aged Care Quality Standards took effect in Australia, and Standard 1 places the dignity of risk where it belongs - at the heart of how we treat older people. New Zealand’s Ngā Paerewa Health and Disability Services Standard (NZS 8134:2021) has been conveying the same message since 2022 - residents have the right to make their own choices, including choices that carry risk.

For aged care teams, this is not a minor adjustment. It is a cultural shift. We are moving away from a reactive, risk-averse mindset that quietly erodes choice in the name of safety, and towards a proactive, person-led approach where the resident’s voice leads — and our role is to make that choice as safe as is reasonably possible.

Risk in aged care is multi-layered. It includes physical harm, nutritional compromise, emotional distress, and — increasingly — infection risk. Dignity of risk does not mean ignoring or minimising these risks. It means recognising that the resident’s informed choice sits alongside our obligation to identify, explain, and manage them as effectively as possible.

Dignity of risk is the principle that older people have the right to live as they choose, even when those choices involve the possibility of harm. It reflects a simple truth: a life with no risk isn’t really a life.

In a residential aged care facility (RACF), this might involve a resident who:

These aren’t failures of care. They are acts of personal choice, and the current standards explicitly protect them.

The Strengthened Aged Care Quality Standards, Standard 1: The Individual, recognise dignity of risk as a core right. Older people are recognised as having autonomy and are free to live as they choose, make informed decisions, and exercise dignity of risk. Providers are expected to support residents to understand the risks associated with their choices and how those risks might be managed — not to override choice simply because it feels uncomfortable.

In New Zealand, Ngā Paerewa is equally clear. Residents have the right to refuse treatment, withdraw consent, and be fully informed of alternative options. Choice is framed as a Te Tiriti-aligned, person- and whānau-centred right, not a privilege granted at the discretion of the service.

Infection prevention and control is often where dignity of risk feels most challenging. When infection risk increases — during outbreaks, seasonal illness, or periods of heightened vulnerability — teams can feel pressure to default to restriction, isolation, or enforced compliance.

The strengthened standards do not remove our responsibility to prevent infection. They do, however, require IPC measures to be applied proportionately, transparently, and in partnership with the resident wherever possible. This means explaining risk, exploring alternatives, and documenting informed consent or refusal — not automatically substituting resident choice with blanket rules.

IPC-related restrictions should be clinically justified, time-limited, regularly reviewed, and implemented using the least restrictive approach available.

Both frameworks ask the same thing of us: respect the person, support the choice, manage the risk, and document the process thoroughly.

Sources: Strengthened Aged Care Quality Standards (Aged Care Quality and Safety Commission, effective 1 November 2025); Ngā Paerewa Health and Disability Services Standard NZS 8134:2021 (Ministry of Health NZ, 2021).

This is the hardest part — and it deserves to be said out loud. Sometimes a resident will make a choice that the care team finds genuinely difficult to support. The choice may increase fall risk, worsen a chronic condition, or shorten life expectancy. Our clinical instincts surface, and the urge to protect, persuade, or intervene is strong.

Dignity of risk asks us to pause. It reminds us that the resident — not the facility, not the family, and not the clinical team — is the author of their own life. Our role is not to remove risk, but to ensure the resident understands it, has access to relevant information, and is supported to live with the consequences of their decision.

Disagreeing is not disrespectful. Clinical concerns can be documented, alternatives offered, and escalation to the GP undertaken — while still honouring a resident’s right to choose. What we cannot do, and what the standards explicitly caution against, is quietly restricting, withholding, or overriding choice simply because it makes us anxious.

Mr Jones is 82 and lives in a residential aged care facility. There is an increase in respiratory illness in the community, and the service has implemented heightened IPC precautions, including visitor screening and recommendations to limit non--essential visits.

Mr Jones understands the increased infection risk but chooses to continue seeing his family each week. He tells staff that these visits are essential to his wellbeing and mental health, and that isolation during previous outbreaks was deeply distressing for him.

The team is concerned about the potential risk to Mr Jones and to others in the home. A purely risk-averse response might be to strongly discourage the visits, apply blanket restrictions beyond the current guidance, or frame the visits as “not allowed right now.”

A dignity-of-risk approach looks different:

Mr Jones continues to see his grandchildren. The infection risk has not been ignored — it has been managed thoughtfully, transparently, and in partnership with the resident.

In another wing; Mrs Henderson is 89, has osteoporosis, and fell three weeks ago. She’s now insisting on her morning walk to the garden, unaccompanied, as she did before the fall. The team is concerned.

A reactive response would be to discourage her, walk her there ourselves every time, or quietly stop offering the option. A dignity-of-risk response looks different:

• Sit with Mrs Henderson and ask what the walk means to her
• Share the clinical information honestly - what changed after the fall and what could happen
• Offer practical risk-management options: a walking aid, a check-in time, hip protectors, and a safer route
• Document the conversation, her decision, and the agreed plan in her care plan
• Communicate the plan to the whole team so everyone consistently supports it

Mrs. Henderson is still walking to the garden. The team is still concerned, but the worry is held alongside her choice, not used to override it.

Dignity of risk is everyone’s responsibility, not just the clinical team. Lifestyle staff, care workers, kitchen teams, cleaners, and volunteers all either strengthen a resident’s autonomy or chip away at it.

Practical things every team member can do:

Treat family input as input - the resident’s voice still leads.

The new standards are not asking aged care teams to be reckless. They are asking us to be brave enough to let residents remain the experts in their own lives. Risk does not disappear when choice is removed — it simply shifts to quality of life, trust in the service, and a person’s sense of dignity and identity.

Honour the choice. Manage the risk. Document the conversation. Trust your team to hold concern and respect at the same time.

That is what dignity of risk looks like in 2026.

For more blogs, see the HUB That tricky question? Ask EVE for a quick answer or talk to our team at support@infectioncontrol.care