Negotiated Risk Agreement Assisted Living

Alaska states that one of the objectives of its regulations is to establish standards that protect residents of assisted living facilities, while fostering an environment conducive to the growth and independence of residents, without discouraging the installation and operation of homes. Alaska`s rules for assisted living do not specifically define a negotiated or managed risk agreement, but there are two sections regarding the recognition of risks and responsibilities in decisions, which is consistent with the intent of NSAs, which are defined in other states. An executive at this institution felt that a lump sum declaration of renunciation should not be signed upon admission, but a limited waiver was appropriate in the event of „problems“. This establishment also distinguished itself from the others, using RNAs only for cases of non-compliance typically related to diet and medication. While no other institution we visited had NRA forms with waiver of liability, as mentioned above, one facility contained standard language in its NSAs regarding the risk of hiking, falls, skin collapses, and loss of personal property. The integration of this general language into an NRA appears to be an attempt to approximate a general waiver of responsibility in these areas. Views on the purpose of RNA are polarized. The 15 states that refer to NRAs or similar processes in their assisted housing rules and the majority of proponents believe that NRAs have several objectives by providing: (1) a risk identification and reduction tool, (2) a communication tool to discuss risks and set expectations, and (3) a method of supporting residents` rights, To make decisions that involve risks. Some states and proponents also view SINs as a method of assigning liability and limiting vendor liability.

The negotiated risk process is an individualized planning process that has been designed to maximize a resident`s ability to make their own decisions by facilitating the discussion and analysis of decisions provided by a resident when those decisions create a level of risk that is normally unacceptable to the resident. The negotiated risk is not a waiver of liability of the offeror under the obligations incumbent on it under the rules in force. The State defines negotiated risk as the process by which a resident or his representative can formally negotiate with providers the risks that each is willing and unwilling to take in the provision of services and the living environment of residents. The provider shall ensure that the occupant and, where applicable, the residents` representative are informed of the risks associated with those decisions and of the possible consequences of taking charge of those risks. It also defines an NRA as a binding agreement describing the conditions or situations that may expose the resident to a risk of harm or injury and describing residents` agreement with the institution on how to deal with those conditions or situations. `Where experts threaten public sanctions [because of the lack of human resources and services necessary to meet the needs of residents], cite the institutions [NRAs] to justify the right of residents to opt for inadequate care while exempting institutions from liability for any damage that may be caused to the resident as a result of such a lack of care, as noted above, Negotiated Risk endangers the health and safety of residents. 38 experts and stakeholders did not know if or how assisted housing providers would assess residents` capacity. Most believed that a combination of methods and sources of information, most often informal, would likely be used, including the assessment and observation of a physician or other health care provider by the resident`s family and staff. Some have found that capacity can vary depending on the time of day as well as physical and psychological factors.. . .