This qualitative research study addressed the gap in the literature and lack of clinical guidelines and frameworks for health professionals as they assess and manage risk when balancing the safety and autonomy of community-dwelling older adults. Twelve health professionals were asked in individual interviews how they perceive, identify, assess and treat risk and how they negotiate the safety and autonomy of their clients. Informed by grounded theory methodology, the findings revealed what kinds of decisions health professionals made and how they made them within this clinical context. These findings from the perspective of the health professional contributed to the development of a definition of living at risk, a safety continuum and a conceptual/practice framework to help health professionals, including occupational therapists, make sound clinical decisions as they balance the autonomy and safety of their community-dwelling older adult clients.