Assessing and balancing elder risk, safety and autonomy: decision-making practices of health care professionals.

Diverse professionals assess and manage risk with frail elderly yet no standard practice guidelines are used across the care continuum. This qualitative study provides new understanding of how eldercare workers conceptualize and assess risk with frail elderly clients. Fifteen professionals were interviewed using the Long-Interview Method of McCracken (1988) and Crabtree and Miller (1991). Respondents included home care case managers, visiting nurses and hospital discharge social workers. This paper reports on two key decision-making styles identified through multidisciplinary analysis of transcripts: the "snap decision-makers" and the "agonizers." Labeling strategies are identified that may assist eldercare workers with the dissonance between professional training and the realities of practice. Variable thresholds for risk tolerance among diverse professionals were found. These findings suggest that risk assessment often reflects the values of the individual practitioner's profession and agency culture. Standardized training and ethical practice guidelines are needed to reduce extreme variability in professionals' judgments; and to better assist staff with assessing and balancing elder risk, safety and autonomy.