Nursing homes are challenged to consistently deliver person-centered care based on residents’ values and preferences. At present, there are limited evidence-based, person-centered strategies to assist nursing home staff in responding to resident preferences that involve risk. This study explored staff perceptions of health and safety outcomes associated with honoring residents’ preferences seen as risky. Findings from focus groups and content analysis reveal that nursing staff perceive negative and positive outcomes for residents and staff when seeking to honor residents’ risky preferences. The results inform future development and testing of person-centered risk management strategies for use in complex nursing home care environments.