When “Client Preference” Becomes a Safety Risk
Honouring what matters to the person you support, and designing the “how” so it's safe for everyone.
The people we support know their bodies, their comfort and their routines better than anyone. Often, they’ve spent years working out what works for them, and that knowledge matters. Any care routine that ignores it is a poor one.
But there's a problem when a routine is shaped by preference alone.
Where the risk gets buried
In a lot of services, the routine lives in the person's head. Each support worker is told how it's done: how to position, how to transfer, in what order, with how much force. The person is usually describing how things have always been done for them, which may be years or decades of habit, shaped by the equipment and techniques available at the time.
That can leave a few things unchecked:
Whether better options exist now that the person has never been shown
Whether the method still suits the person's body, or has changed with their capacity
Whether the support workers can safely achieve what's being asked, shift after shift
What happens when a new worker arrives and has to be taught from scratch
None of that is the person's fault. They were never asked to be a risk assessor or to know every option. The gap is in the design, and the provider needs to ensure they close it to protect their workers and those they support.
Preference and method are different things
It helps to separate two questions:
What matters to the person? Comfort, dignity, privacy, timing, how much control they keep over their day. The person leads on this.
How is it delivered? The technique, the equipment, the positioning, the sequence. This needs someone who knows the options, working alongside the person and the workers.
When those two get blended into "do it however the person says," the preferences might be honoured, but nobody has checked whether the method is safe to perform. Concerns that workers raise can read as reluctance to support the person, when they're often about whether the method can be done safely. Workers end up caught between respecting the person and worrying about causing harm to themselves or a client, with no designed routine to point to.
Honouring preference, safely
Done well, designing the routine doesn't take choice away. It keeps what matters and builds the rest around it.
Start with what matters to the person, in their words
Get curious about why things are done the way they are: what truly matters, and what has become habit
Bring in someone who knows the equipment and technique options, so the person can choose from a wider set than they've seen before
Include one or two of the regular support workers, who know what delivering this support feels like
Try it in practice, adjust, and document it so it's consistent whoever is on shift
Often the person's preferences are kept and sometimes improved. A better-fitting sling or a different technique can make a transfer more comfortable and more dignified.
Who carries the responsibility
Under NSW work health and safety law, the person receiving support isn't outside the picture. SafeWork NSW's guidance for NDIS participants says someone is a PCBU if they employ their own workers, receive support in a place they control like their home, or direct how a provider's workers do their tasks. Where that applies, duties are shared with the provider, and each is expected to work with the other to meet them. Those duties are measured against what's reasonable for the person to do. Nobody expects them to be a manual handling expert.
That's exactly why the provider's role matters. Providers have the workers, the systems and access to the expertise, and the guidance says they must work with the person to identify and manage the risks of their situation. A provider can't hand that duty over by saying the person prefers it that way. A designed routine also protects the person, because confirming a provider has sound processes in place helps them meet their own duties.
Under the new Code of Practice, and with s26A now in force in NSW, that shared responsibility is more important than ever. It doesn't make the person's voice less important. It means the job is to take that voice and build a safe routine around it, together.
I'll be talking more about this, and how to put it into practice, in The Practice Just Got Clearer. So Did Your Obligation.
Source links.
NDIS Guidance on engaging your own staff: https://share.google/aKYlCvjq468WmI0uc
Healthcare and Social Assistance Code of Practice: https://share.google/4Tl4yfPYsK5H9FvmW