What the term means
The national falls guidelines say that older people have the right to make decisions that affect their lives, and that respecting those decisions matters even if there is some risk to themselves 1. The Statement of Rights in the Aged Care Act 2024 gives a person the right to make their own decisions and have control over how they live, even if there is some personal risk 42. Under Outcome 1.3 of the strengthened Quality Standards, providers are required to support people to take risks that maintain independence and quality of life 43.
In practice, a resident who wants to walk to the dining room without waiting for staff, and who understands that they might fall, is entitled to make that choice. The job of the people around them is to make the walk as safe as it can be.
Why it is harder than it sounds
A discussion paper from Victorian researchers named four things that get in the way in residential care: residents whose ability to make decisions fluctuates, several people having a say in each decision, a gap between what organisations say they value and what they do, and confusion and fear about the legal responsibilities of care providers 40.
A small interview study of 14 policy makers and guardians found agreement on what dignity of risk involves: the person is at the centre of the decision, life involves risk, people must have choice, and dignity of risk is a continuum of experiences, not a single rule. The barriers they described were balancing autonomy against risk, the way the right answer changes with the situation, and the question of who takes responsibility for a risk 41.
Families feel this tension most sharply. It is natural to want a parent kept safe, and just as natural to feel uneasy when keeping them safe means keeping them sitting down. Both feelings are reasonable, and it helps to say them out loud.
How a decision like this is usually worked through
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Ask the person. Start with what the resident wants and what matters to them. If they are able to make this decision, it is theirs to make.
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Support the decision before replacing it. Where someone needs help to decide, the Standards expect that help to come first. A substitute decision-maker is a last resort, used when the person cannot decide even with support 43.
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Name the real risk. Be specific about what might happen and how likely it is. Most falls do not cause a major injury 4. Some do, and a hip fracture can change the course of a life.
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Reduce the risk without removing the choice. Strength and balance exercise, a review of medicines, good shoes, the right glasses, a walking aid that fits and a clear path all lower the risk while the person keeps walking 1.
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Write it down. Record what was discussed, who was there, what the person chose and why. A recorded decision can be understood and respected by night staff, a locum doctor and the family.
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Come back to it. Review the decision after a fall, after a hospital stay, or when the person’s health changes.
What dignity of risk does not mean
It does not mean leaving someone to fall. A resident who chooses to walk independently is still owed every reasonable measure to make that safer.
It does not mean one conversation settles the matter for good. Health changes, and so do wishes.
It is not a way for anyone to step back from responsibility. The Commission’s guidance places the management of clinical risks, falls included, inside shared decision-making and a person’s right to make choices that carry risk 43.
Sources cited on this page
- 1 Australian Commission on Safety and Quality in Health Care. Preventing Falls and Harm from Falls in Older People: Best Practice Guidelines for Australian Residential Aged Care Services. Sydney: ACSQHC; 2025. View source
- 4 Australian Institute of Health and Welfare, GEN Aged Care Data. Residential aged care quality indicators — January to March 2025. (2,593 services; 220,707 residents assessed for falls: 31.1% had one or more falls, 1.7% a fall with major injury; 19.8% subject to physical restraint, 15.3% through a secure area only.) Reported quarterly; later quarters are available from the same page. View source
- 40 Ibrahim JE, Davis MC. Impediments to applying the ‘dignity of risk’ principle in residential aged care services. Australas J Ageing. 2013;32:188–93. (Discussion paper.) View source
- 41 Woolford MH, de Lacy-Vawdon C, Bugeja L, Weller C, Ibrahim JE. Applying dignity of risk principles to improve quality of life for vulnerable persons. Int J Geriatr Psychiatry. 2020;35:122–30. (Qualitative interviews, 14 participants.) View source
- 42 Australian Government Department of Health, Disability and Ageing. Aged Care Act 2024: Statement of Rights explainer. 2025. View source
- 43 Aged Care Quality and Safety Commission. Strengthened Aged Care Quality Standards (commenced 1 November 2025): Outcome 1.3 Choice, independence and quality of life; Outcome 5.5 Safety of clinical care services, Action 5.5.4. View source
See every source cited across the falls and frailty section →
Written by Dr Josh Hatch, FRACGP. General information only, reflecting his reading of the published evidence as at October 2026. It is not individual medical advice, does not create a doctor–patient relationship, and must not be used to start, stop or change any treatment. Evidence and Australian regulatory and PBS arrangements change — always confirm current advice with the treating GP, pharmacist or specialist.
This is general education, not a clinical protocol. The doctors who practise with Umbrella Aged Care are independent general practitioners, and each makes their own clinical decisions with the resident and family. Your GP’s advice for an individual may differ from what is written here. If it does, please ask them to talk it through with you.