What We Learned: Safety Matters. So Does the Right to Live.
10.27.26 Transformation TuesdayTell Their Story, Protect Their Rights: Honoring Residents' Rights Month with Ruth Minnema
When does keeping someone safe become a way of taking away their freedom?
It's a difficult question, particularly when the person we're trying to protect is older, vulnerable or living in a long-term care community.
We want to prevent falls. We want to avoid injuries. We want to protect people from harm.
But what happens when our efforts to eliminate risk also eliminate the experiences that give life meaning?
That was the central question at Gray Panthers NYC's October 27, 2026, Transformation Tuesday, “Tell Their Story, Protect Their Rights,” featuring Ruth Minnema, a longtime long-term care leader and founder of Perspectives Coaching.
In recognition of Residents' Rights Month, Ruth challenged us to rethink the relationship between safety, autonomy and dignity. Drawing on decades of experience, primarily as a director of nursing, she shared real-life examples of what happens when institutional responsibility collides with personal choice.
Her message was both practical and profound: To protect residents' rights, we must first understand their stories.
Residents' Rights Month Began with Residents Speaking Up
Gray Panthers NYC President Michelle Arnot opened the program by reminding participants that Residents' Rights Month grew out of advocacy by nursing home residents themselves.
In the early 1980s, residents attending a national conference called for a special observance dedicated to their rights. Their efforts helped launch what eventually became the monthlong recognition we observe today.
Michelle recognized the National Consumer Voice for Quality Long-Term Care for its decades of leadership and advocacy.
She also connected the day's conversation to Gray Panthers founder Maggie Kuhn, who believed older people had both the right and responsibility to challenge injustice and make their voices heard.
More than four decades after residents first organized for this recognition, the challenge remains: How do we ensure that the people living in long-term care communities are treated as individuals with histories, preferences, values and rights, rather than simply as people who need to be managed?
1. Risk Has an Upside, Too
Ruth began with an unexpected question:
“What's the riskiest thing you have ever done?”
Participants responded with stories of courage, creativity and conviction.
One participant joining from Kyiv, Ukraine, described the risks taken by older volunteers who continue serving vulnerable nursing home residents despite the dangers of war.
Another recalled traveling to St. Augustine, Florida, in 1964 to participate in civil rights activities when the Ku Klux Klan was active in the area.
A third spoke about the risks inherent in choosing a creative life and continually pushing boundaries.
The examples were different, but they illustrated Ruth's first important point: Risk is personal.
What seems dangerous or unacceptable to one person may be essential to another person's identity, purpose or sense of freedom.
Ruth then shared a video featuring geriatrician Dr. Bill Thomas, who distinguished between two kinds of risk.
Downside risk is the possibility that something will turn out worse than expected.
Upside risk is the possibility that something will turn out better.
In long-term care, the focus is overwhelmingly on preventing downside risk: falls, injuries, accidents and other adverse outcomes.
But in the process, opportunities for upside risk can disappear.
A walk outdoors might result in a fall. It might also bring sunshine, conversation, exercise, independence and joy.
A social outing might involve uncertainty. It might also create connection and purpose.
When we eliminate every possibility of harm, we may also eliminate the possibility of something wonderful.
What we learned: Risk isn't automatically good or bad. The goal should be to understand and balance its potential consequences, including the benefits that make life meaningful.
2. Safety Without Autonomy Can Become Paternalism
Ruth introduced another important concept: paternalism.
Paternalism occurs when one person or institution restricts another person's freedom on the assumption that the decision-maker knows what is best.
In long-term care, paternalism can arise from genuine concern.
A family member fears a fall. A nurse worries about an injury. An administrator considers liability. A physician recommends restrictions.
Everyone may have good intentions.
But whose preferences ultimately matter?
Ruth recalled working in a community with beautiful outdoor patios. Residents on the first floor could access them freely, but patio doors on the upper floors remained locked because of a frightening incident years earlier.
A decision intended to protect residents had become a longstanding restriction affecting everyone.
The potential dangers of outdoor access had been considered. The benefits of fresh air, sunshine and freedom had largely been overlooked.
Ruth also described how nursing homes once used symbols and labels to communicate residents' risks and care needs.
One resident questioned why a leaf symbol appeared inside her closet. When Ruth explained that it identified her as someone at risk of falling, the woman recalled that a previous facility had used a star.
She preferred being a star.
It was a small exchange with a larger lesson: A system designed to communicate safety information can unintentionally reduce a person to a diagnosis, limitation or risk category.
What we learned: Protecting people should never mean losing sight of their humanity. Safety practices need to be evaluated not only for the harm they prevent, but also for the freedom and dignity they may restrict.
3. A Care Plan Should Tell a Person's Story
One of the most memorable exercises involved a photograph of an older woman walking outdoors with a cane and handbag.
Ruth asked participants what risks they saw.
The answers came quickly: uneven pavement, inappropriate footwear, potential falls, getting lost and other hazards.
Then Ruth asked everyone to look again.
What were the possible benefits?
This time, participants saw sunshine, independence, movement, freedom, familiar surroundings and the pleasure of being outdoors.
The woman became known as “Risky Ruth.”
Ruth then gave this fictional resident a story.
She had walked the same road for 80 years. It was familiar and beloved. She understood the risks and wanted to continue walking for as long as possible.
She was willing to make certain compromises, including wearing a safety belt and occasionally allowing someone to accompany her. But she did not want her daily walk taken away.
Suddenly, the discussion changed.
The question was no longer simply whether walking outside was dangerous.
It became: How can we honor what matters to this person while working together to reduce the risks?
Ruth explained that this is the purpose of a structured risk conversation.
Rather than imposing a blanket restriction, the resident, family members, caregivers, physicians, social workers, ombudsmen and other relevant participants come together to discuss concerns and possible solutions.
The resident's voice should remain central.
And when the resident cannot participate directly, someone should represent their wishes, ideally using the person's own words.
The outcome is not simply a list of clinical instructions. It is a documented plan that reflects the person's history, priorities, choices and agreed-upon safeguards.
What we learned: A care plan becomes more meaningful when it tells us not just what a person needs, but who that person is.
4. Sometimes Dignity and Safety Present Heartbreaking Choices
Ruth's most powerful example involved a nursing home resident who loved bacon.
The woman had grown up on a pig farm. Bacon had been part of her life for as long as she could remember.
But she had severe swallowing difficulties, and eating bacon presented a serious choking risk.
The staff wanted to protect her. She wanted to keep eating something she loved.
Her two sons disagreed about what should happen. One supported her choice. The other feared the consequences.
Rather than simply forbidding bacon, the care team engaged in a structured discussion, assessed the risks and documented the resident's wishes.
The woman agreed to reduce the amount she ate and accept other dietary modifications. But she would not give up bacon entirely.
Tragically, she eventually choked on bacon and died.
Ruth did not minimize what happened.
She described the emotional toll on the nursing staff, the guilt and anger that followed, and the investigation that ensued. She explained that the documentation and care planning were reviewed, and no deficient practice was cited.
Still, the experience was deeply painful.
Ruth acknowledged that she could not definitively call the decision right or wrong, although she believed the team had done the best it could.
This story captured the complexity of genuine person-centered care.
Respecting someone's wishes does not guarantee a happy outcome. Nor does a difficult outcome automatically mean that the person's wishes should never have been honored.
Every requested risk should be accepted. These decisions require serious assessment, thoughtful negotiation, appropriate safeguards and a willingness to recognize the resident as a person with values that may differ from those of the people providing care.
What we learned: Respecting autonomy can be difficult, especially when the consequences are serious. But eliminating personal choice carries consequences of its own.
5. Conversation Is More Powerful Than Conflict
Throughout the presentation, participants raised the practical questions that make these situations so challenging.
What about lawsuits?
What happens when family members disagree?
How can staff honor a resident's wishes when they lack the authority to change an order or policy?
What happens when regulatory systems measure falls and injuries more readily than happiness, dignity or satisfaction?
Ruth did not suggest that these concerns could be dismissed.
Instead, she emphasized the importance of structured, documented conversations that bring different perspectives to the table.
Risk negotiation, she explained, does not mean allowing residents to do anything they want without safeguards.
It means identifying what matters to the resident, evaluating the possible harms and benefits, and working toward a solution that balances personal choice with the responsibilities of the care community.
She also encouraged participants to seek help when disagreements become difficult to resolve.
Long-term care ombudsmen and ethics committees can help facilitate discussions, particularly when staff members feel caught between competing demands.
The objective is to move away from confrontation and toward collaboration.
One important insight emerged from the discussion: A resident who feels heard may be more willing to negotiate than someone who feels controlled.
In the bacon example, the resident agreed to reduce her portions. That compromise came through conversation, not prohibition.
Ruth argued that respectful negotiation has the potential to improve relationships and support safety while preserving dignity.
What we learned: The answer to competing concerns is not always another rule. Sometimes it is a better conversation.
6. The Person's Wishes Must Remain at the Center
Another moving story illustrated how much a resident's freedom can mean to a family.
Ruth described a woman who sometimes left her long-term care community and became lost.
The situation understandably raised serious concerns.
Instead of immediately moving her into a locked setting, the care team held repeated risk conversations over several years, continually reassessing the situation and looking for ways to support her safety.
After the woman died, Ruth received a simple thank-you card from her daughter.
It read:
“Thank you for not locking up my mother.”
Those seven words captured the importance of the entire process.
The daughter understood that there had been risks. She also understood what her mother's freedom had meant.
The story reinforced a distinction that is easy to lose in institutional settings: A person's need for assistance does not erase their identity or automatically eliminate their right to participate in decisions.
Even when cognitive or decision-making abilities change, the person's wishes, preferences and remaining abilities still matter.
Ruth emphasized that these conversations are not necessarily one-time events. They may need to be revisited as circumstances change.
What we learned: Good care is not simply about preventing the worst possible outcome. It is also about preserving the best possible life.
7. We Need to Rethink What We Measure
An audience question raised a particularly important systemic challenge.
Long-term care facilities are evaluated through quality measures that track outcomes such as falls and other safety concerns.
But how do we measure joy?
How do we measure the value of a familiar walk, a favorite food, an afternoon outdoors or the freedom to make an independent choice?
These benefits may be less visible in regulatory reports, but they are central to residents' quality of life.
Ruth suggested that respectful risk conversations can improve relationships and potentially improve safety outcomes as well.
Her point was not that safety measures should be abandoned.
It was that safety should not become the only measure of good care.
A resident may be physically protected and still experience a profound loss of independence, identity or purpose.
This raises a larger question for long-term care leaders, policymakers, families and advocates:
Are we measuring what matters most to the people receiving care?
8. The Right to Take Risks Doesn't Expire with Age
Near the end of the conversation, Michelle Arnot offered a thought that brought the discussion full circle.
She observed that we often spend the first half of our lives taking risks and the second half trying to avoid them.
It's a familiar pattern, but it also reveals something about how society views aging.
Risk-taking in younger people may be celebrated as adventurous, ambitious or courageous.
In older people, similar choices may be viewed primarily as dangerous or irresponsible.
Yet the desire for independence, exploration, pleasure and self-determination does not disappear with age.
Neither does the right to make meaningful choices.
The challenge is to recognize that risk tolerance varies from person to person, regardless of age, and to resist the assumption that growing older automatically makes someone less entitled to decide how to live.
This is where Ruth's message connects so clearly with the mission of Gray Panthers NYC.
Ageism is not always expressed through openly discriminatory attitudes. Sometimes it appears in well-intentioned policies, institutional routines or family decisions that quietly take away an older person's voice.
Challenging ageism means questioning those assumptions and ensuring that older people remain active participants in decisions affecting their lives.
What Can We Do Differently?
Ruth's presentation offered lessons for residents, families, caregivers, advocates and long-term care professionals alike.
We can begin by asking better questions.
Instead of asking only, What could go wrong? we can also ask, What might be lost if we say no?
Instead of assuming we know what matters most to someone, we can ask them.
Instead of treating a person's medical history as their whole story, we can learn about their relationships, routines, pleasures, accomplishments and values.
Instead of allowing disagreements to become battles between families and care teams, we can create opportunities for structured conversations, shared understanding and thoughtful compromise.
And instead of defining successful care solely by the absence of harm, we can recognize the importance of autonomy, dignity, connection and joy.
None of this makes difficult decisions easy.
But it offers a more humane way to approach them.
Tell Their Story. Protect Their Rights.
Residents' Rights Month reminds us that people living in long-term care communities are not simply recipients of services.
They are individuals with histories, identities, preferences, relationships and rights.
Their lives did not begin when they entered a care facility. Their right to be heard did not end there, either.
Ruth Minnema's presentation reminded us that the stories we tell about people shape the choices we make on their behalf.
When we see only the risks, we may overlook the person.
When we listen to the person's story, we begin to understand what is truly at stake.
Maggie Kuhn challenged us to confront systems that diminish older people's voices and to insist that aging never become a reason for exclusion or loss of dignity.
That challenge remains as relevant as ever.
Because protecting residents' rights means more than keeping people safe. It means respecting their right to live a life that still belongs to them.
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This article is based on Gray Panthers NYC's October 27, 2026, Transformation Tuesday, “Tell Their Story, Protect Their Rights: Honoring Residents' Rights Month,” featuring Ruth Minnema of Perspectives Coaching, with facilitation by Gray Panthers NYC board member Ron Roel.
Watch the full Transformation Tuesday recording and explore more conversations about ageism, dignity, residents' rights and social justice at Gray Panthers NYC.
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