When someone requires high-level support to navigate daily life, every decision carries weight. The balance between maintaining safety and preserving dignity, between protection and independence, creates a constant tension for families, support workers, and healthcare professionals alike. For individuals receiving occupational therapy services under high support plans—whether through the NDIS, aged care programmes, or private arrangements—effective risk management isn’t simply about preventing accidents. It’s about creating a framework that enables meaningful participation in life whilst minimising preventable harm.
The stakes are significant. Recent data from the Australian Institute of Health and Welfare reveals a 78.2% increase in complaints to the NDIS Quality and Safeguards Commission during 2023-24, alongside a 47.3% increase in reportable incidents. These statistics underscore an urgent need for robust, systematic approaches to identifying, analysing, and addressing risks within occupational therapy service delivery. Yet risk management strategies in high support OT plans must achieve something far more nuanced than simple risk elimination—they must support people to live fully whilst staying safe.
What Are Risk Management Strategies in High Support OT Plans?
Risk management strategies in high support OT plans represent a systematic, cyclical approach to balancing safety with client autonomy and meaningful participation. Rather than a single intervention, these strategies form an integrated framework that continuously identifies potential hazards, evaluates their likelihood and impact, implements control measures, and monitors effectiveness over time.
The Royal College of Occupational Therapists emphasises that “occupational therapy should enable individuals to achieve their full potential. If you want service users to reach their chosen goals and to participate fully in life, this requires you to embrace and engage with risk.” This philosophy underpins contemporary occupational therapy practice, recognising that completely risk-free environments are impossible—and attempting to create them often diminishes quality of life.
High support plans typically involve individuals with complex needs arising from significant physical, cognitive, sensory, or psychosocial disabilities. These plans commonly address multiple risk domains simultaneously: falls and mobility challenges, medication management, mealtime safety, behavioural concerns, environmental hazards, and social isolation. Effective risk management strategies must account for how these various risk factors interact within the specific context of each person’s life, home environment, support network, and personal goals.
The risk management cycle recommended by regulatory bodies comprises five interconnected stages: identify risk, analyse risk, address risk, implement plan, and monitor and review. This cyclical process ensures that risk management remains dynamic, responsive to changing circumstances, and grounded in ongoing assessment rather than static assumptions.
Why Is Risk Management Critical for NDIS and Aged Care Recipients?
For NDIS participants and aged care recipients receiving occupational therapy services across Queensland, New South Wales, Victoria, and Tasmania, risk management directly impacts funding, safety outcomes, and quality of life. The NDIS Practice Standards (Core Module 2: Provider Governance and Operational Management) establish mandatory requirements for registered providers to develop documented risk management systems proportionate to their size and scope of service delivery.
The consequences of inadequate risk management extend beyond compliance concerns. Research demonstrates that approximately 30% of community-dwelling people over 65 experience falls annually, with 85% of these falls occurring in the home environment. For individuals with complex support needs, fall risks increase substantially due to factors including balance impairment, reduced muscle strength, cognitive challenges, and medication effects. Research has also shown that occupational therapy assessment contributes to falls prevention, and receiving occupational therapy intervention has demonstrated positive outcomes in reducing fall risk.
Beyond falls, risk management addresses numerous critical safety domains: pressure injury prevention, dysphagia and choking risks, medication errors, equipment failures, behavioural incidents, environmental hazards, and staffing adequacy. The interconnected nature of these risks means that addressing one area often influences others—for instance, improving home lighting reduces fall risk whilst simultaneously supporting medication management and meal preparation safety.
For NDIS participants, comprehensive functional capacity assessments by occupational therapists inform funding decisions, with research showing substantial variances in support recommendations between different assessment approaches. This highlights the importance of detailed assessment in identifying support needs and recommending appropriate, proportionate interventions.
How Do Occupational Therapists Identify Risks in Complex Support Settings?
Risk identification in high support occupational therapy plans employs multiple assessment approaches, combining standardised tools, clinical observation, environmental evaluation, and collaborative information gathering. This comprehensive methodology ensures that risks across person, environment, and occupation dimensions receive appropriate attention.
Person-Centred Assessment
Occupational therapists systematically evaluate individual factors contributing to risk, including physical abilities (strength, balance, coordination, endurance), cognitive status (memory, attention, judgement, problem-solving), medical conditions and stability, medication regimens, communication capacity, sensory function, and psychological factors such as anxiety or depression. This assessment extends beyond identifying deficits to recognising strengths, coping strategies, and protective factors that support safety.
Environmental Assessment
Home-based assessments provide invaluable insight into real-world risk factors. Environmental evaluation tools such as the Westmead Home Safety Assessment systematically identify hazards including trip hazards, inadequate lighting, inaccessible bathrooms, unsafe stairs, cluttered pathways, and poorly maintained equipment.
The value of assessing individuals within their own familiar environment cannot be overstated. Observing how clients actually perform daily activities at home—rather than inferring capacity from clinical testing—reveals specific challenges and adaptation strategies that inform targeted interventions.
Occupational Performance Analysis
Risk emerges not simply from person or environment factors alone, but from their interaction during meaningful activities. Occupational therapists observe clients performing real tasks: transferring from bed, preparing meals, managing medications, bathing, dressing, and moving through their living spaces. This occupational performance analysis identifies where breakdowns occur, why they happen, and what modifications might reduce risk whilst preserving independence.
Collaborative Information Gathering
Effective risk identification incorporates perspectives from multiple sources: the individual receiving services, family members and informal carers, support workers, other healthcare professionals, and previous service providers. This collaborative approach builds a comprehensive understanding of risk patterns, near-miss events, previous incidents, and environmental or situational factors that influence safety.
What Practical Risk Management Strategies Work Best in High Support Plans?
Evidence-based risk management strategies in high support occupational therapy plans encompass environmental modifications, equipment provision, education and training, behavioural interventions, and ongoing monitoring systems. The most effective approaches combine multiple strategies tailored to individual circumstances rather than relying on single interventions.
Environmental Modifications
Home modifications represent one of the most evidence-supported interventions for safety improvement. Critical modifications include installing grab rails, improving lighting, securing trip hazards, ensuring non-slip flooring, enhancing bathroom accessibility, and modifying kitchens for safe meal preparation.
Equipment and Assistive Technology
Appropriate equipment selection, provision, and training constitute essential risk management strategies. This includes mobility aids, bathroom safety equipment, kitchen aids, personal alarms, pressure care equipment, and communication devices. Regular equipment reviews ensure devices remain functional and suited to changing needs.
Client and Caregiver Education
Education forms a cornerstone of sustainable risk management. Occupational therapists provide comprehensive education on falls prevention, safe transfer techniques, proper use of assistive devices, medication management, recognition of warning signs, and emergency procedures, tailored to individual learning needs.
Multidisciplinary Collaboration
The most successful risk management initiatives involve coordinated input from multiple disciplines. Collaboration between occupational therapists, physiotherapists, nursing staff, social workers, general practitioners, and support workers ensures clear communication and effective implementation of risk management strategies.
Positive Risk-Taking Frameworks
Contemporary occupational therapy practice recognizes that positive risk-taking balances benefits and risks. Occupational therapists work with clients to enable informed risk-taking by identifying hazards, assessing potential harm, and developing enablement plans that manage risks to acceptable levels.
How Can Clients and Families Participate Meaningfully in Risk Management?
Client and family participation transforms risk management into a collaborative process that supports individual goals and preferences. Accessible communication, shared decision-making, and involvement of families and carers enrich the assessment and ensure interventions align with real-life contexts. Telehealth services further enhance participation by enabling remote consultations, environmental observation, and ongoing monitoring.
When Should Risk Management Plans Be Reviewed and Updated?
Risk management plans require regular review to remain effective. Scheduled reviews, typically annually, are supplemented by trigger-based reviews in response to incidents, functional changes, or significant events. Regular monitoring by support workers and feedback from families further ensures that plans remain responsive and adaptive.
Moving Forward: Creating Sustainable Risk Management Systems
Effective risk management in high support OT plans demands systematic approaches embedded within organizational culture, supported by adequate resources, and grounded in collaborative partnerships. Occupational therapists balance protection with empowerment, enabling clients to live with dignity while managing risks to acceptable levels. Continuous learning, positive risk-taking, and client-centric practices drive improvements in risk management systems.
Disclaimer: This article provides general information about risk management strategies in high support occupational therapy plans. It is not a substitute for personalized advice from qualified health professionals. Always consult with an occupational therapist or healthcare provider for advice tailored to individual circumstances.
What is the difference between risk management and risk elimination in occupational therapy practice?
Risk management involves systematically identifying, analysing, and controlling risks to acceptable levels while supporting meaningful participation. In contrast, risk elimination attempts to remove all risks entirely, which can limit the ability to engage in valued activities and restrict autonomy.
How often should home safety assessments be conducted for NDIS participants with high support needs?
Assessments should be carried out at service commencement, following any home modifications, after significant functional changes or incidents, and at minimum annually for stable situations. More frequent reviews may be necessary for individuals with rapidly changing conditions.
What role do support workers play in implementing risk management strategies?
Support workers are essential in executing risk management plans. They implement specified safety measures, monitor clients for any changes or emerging risks, and report incidents or near-misses, thereby providing invaluable input that supports ongoing risk assessment.
Can occupational therapists override client choices in the name of safety?
Occupational therapists must balance their duty of care with respect for client autonomy. While they cannot force interventions upon clients, they are responsible for clearly communicating risks, documenting informed choices, and, in cases of serious imminent harm, following legal and ethical guidelines.
How do telehealth services address risk management for clients in regional and remote areas?
Telehealth enables remote risk assessment and management by facilitating video consultations, environmental observations, and demonstrations of safe practices. However, for comprehensive assessments and complex interventions, in-person visits remain essential.
