In the realm of senior living, maintaining residents’ well-being requires a delicate balance between their independence and overall safety. A pivotal approach to navigating this balance is the implementation of Negotiated Risk Agreements (NRAs). These contracts are a collaborative effort involving the facility, the residents, and their families, establishing a mutual understanding of care-related risks and responsibilities.

Purpose and benefits

NRAs are designed to respect the autonomy of residents while simultaneously safeguarding their safety. They are a means for residents to make informed decisions about their care, fully aware of the associated risks. These agreements also serve to delineate liability, making sure that all parties involved are cognizant of the consequences of non-adherence to care recommendations.


When crafting an NRA, it is essential to communicate the potential risks clearly to the residents and their families. For example, the implications of not following medical prescriptions, dietary restrictions, or the use of mobility aids should be thoroughly explained. Assessing the cognitive abilities of residents is crucial to ensure they can comprehend the risks involved. Family members should also be engaged in this process to guarantee their understanding of the agreement’s significance.


The documentation of NRAs is a critical step. A well-articulated written agreement should lay out the specific risks pertinent to the resident’s situation, the responsibilities of all parties, and the terms for the agreement’s reassessment. Learning from the experiences of other facilities that have successfully integrated NRAs can provide valuable insights. It is equally important to consider the perspective of families and address any concerns they might have regarding these agreements.

Negotiated Risk Agreements are not intended to limit the choices of residents but to ensure those choices are made with a full understanding of the risks. They are a testament to the commitment of senior living executives to prioritize the well-being of residents while effectively managing potential risks. Through these agreements, facilities can promote both the safety and autonomy of their residents, fostering a culture of open communication and informed consent.

Additional Information:

  1. A Study of Negotiated Risk Agreements in Assisted Living: Final Report;
  2. McKnights Senior Living, “Negotiated risk agreements may mitigate litigation exposure, experts say”;
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