Risk in adult social care: Perceptions and experiences of risk in disability services in Ireland

Abstract

The principles of autonomy, choice, and independence have been prevalent in the rhetoric used to initiate policy change in disability services in recent decades. As part of this rhetoric, it has been stressed increasingly that a rights-based approach to care must embrace risk and view it in a more positive light and that services and social care professionals should facilitate and promote a positive risk-taking environment. While these changes represent an optimistic view and emancipation for service users, this move toward increased choice and risk-taking also means more responsibilities for service users and social care practitioners. This shift in disability services, and social care in general, is informed by ideological visions in which risk and disability become a matter of individual responsibility within markets while the role of the state in protecting and providing for its disadvantaged citizens diminishes. In practice, service users risk-taking leads to tensions, particularly as services and professionals attempt to balance their duty to safeguard service users with a service user’s right to take risks. This situation is further compounded by a growing regulation of disability services and health and social care professions, heightening a perceived culture of blame. As such, professionals seek to avoid liability or being held accountable often through assessing, managing, and auditing risk in a defensive manner. This study investigated varying perceptions and experiences of risk in disability services by exploring the perspectives of ten service users, five social care workers, and five social care managers. This research was informed by a constructivist theoretical framework, which facilitated recognition of participants varying perceptions. Data was collected via qualitative interviews and vignettes, and the descriptive phenomenological research method designed by Giorgi was used to analyse the data. The findings showed that service users, social care workers, and service managers perceive, assess, and manage risks differently and that different perceptions and interpretations of risk can influence how risk is approached in practice. While service users view taking risks as their choice, managers and practitioners are concerned with potentially negative consequences, often driven by concerns over blame and litigation. Within this climate, social care professionals find it hard to do ‘the right thing’, and service users feel that choices are often limited to ‘safe options’, as managers and social care workers try to manage out any potential ill consequences. The findings further indicate that service users are largely excluded from decision-making around risk, which is often solely the preserve of managers and clinical professionals through standardised processes, which do not reflect the individual needs and wishes of the service users. This study has implications for policy and practice and has the potential to inform risk research and social care education.