U.S. Department of Health and Human Services – A Study of Negotiated Risk Agreements in Assisted Living

The U.S. Department of Health and Human Services (HHS) has issued a report discussing the use of negotiated risk agreements (NRAs) in long-term care facilities in order to provide an appropriate balance between residents’ autonomy and safety.

The content of a typical NRA includes:
• 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
• the resident’s acknowledgement and acceptance of the potential negative consequences of his or her actions
Over the past decade, many assisted living providers have adopted NRAs, and several states have regulatory provisions regarding their use.

For example, Illinois has the strongest statement of a resident’s right to assume risk, stating a resident has the right “to direct his or her own care and negotiate the terms of his or her own care,” and “to refuse services unless such services are court ordered or the health, safety, or welfare of other individuals is endangered by the refusal, and to be advised of the consequences of that refusal.”

The Illinois statute regarding NRAs provides that a “responsible party” may sign a risk agreement as a proxy for the resident.

The Illinois statute regulating the use of NRAs can be found here.

To view the report:

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