Perhaps the most useful part of the recommendation is a detailed overview of a process for negotiating such agreements. Many states require negotiated risk or co-responsibility agreements, without providing guidelines on how they should be developed or not. The process recognizes that the supplier has a responsibility to identify consumer preferences and potential risks that may be related to certain behaviours. The process also recognizes that not all options for action are possible or reasonable, but that residents` preferences should be considered even if the supplier does not consider them to be in the best interests of local residents. Oregon is a state that explicitly addresses this issue in its regulations and states that an administered risk plan should not be developed or pursued with or on behalf of residents unable to discern the consequences of their behaviour or decisions. However, it is possible for a resident to sign an NRA and indicate that she wants her to remain in force, even if she is cognitively decreasing and is unable to make an informed decision. RNAs were designed to help assisted housing achieve its goal of providing a residential alternative to institutional care, which provides a housing option for frail and cognitively disabled seniors, that maximizes privacy, independence, choice and maintenance of a normal lifestyle – qualities that are generally lacking in institutional attitudes LTC.5 Advocates of the philosophy of life in charge believe that residents and caregivers are generally lacking in institutional attitudes share the responsibility to develop individual plans to meet the needs and preferences of residents. , including risky preferences, to preserve or improve the quality of life of residents. In principle, an NRA documents a process to ensure that residents retain control over their lives while recognizing the responsibility of the supplier and the state to ensure quality and safety as part of residents` preferences.6 Employees in Oregon and Wisconsin reported that NRAs felt more comfortable responding to difficult situations because they were formal. , written process for uncomfortable discussions. Some said that the possibility of “ridiculing” the requirement of an NRA for regulation or business requirements made it easier to use these rules to address and address risky or problematic behaviours. Other provisions relating to managed risk contracts are clear: Washington State clearly states that entities cannot waive a right of residence: boarding-home cannot ask the resident or residents` representative to sign a contract or agreement, including a negotiated service or risk agreement that claims to waive any resident`s right , or who claims to transfer responsibility or responsibility for loss of personal property or injury to the occupier.
In another section, the rules state that no long-term care facility or care facility may require residents to sign or ask residents to sign waivers of any liability in the event of loss of personal property or injury or to sign residence rights waivers in this chapter or in existing licensing or certification legislation. Burgess, K. (2000) ibid.; Carlson, E. (spring 2003). Sheepskin of residents` rights: behind the rhetoric of “negotiated risk” in assisted housing. NAELA Quarterly: the Journal of the National Academy of Elder Law Attorneys; Lynch, A.A., Teachworth, S.A. (2002). Risky operation: applicability and the use of negotiated risk agreements.
Elderly Journal, 10 (1), 3-29. Only four of the 15 states with RNA regulations explicitly prohibit the use of RNA as non-responsibility in some or all cases.