Many therapists have worked with patients who are difficult to engage in therapy. The reasons patient give are many: “I’m too tired, my family is visiting soon, I’m afraid I’ll fall, It’s too hard, and I just had therapy, I just don’t want to.” So how do therapists handle these situations?
We all know the OBRA regulations by heart: “A nursing home must provide the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial wellbeing for each resident in accordance with a comprehensive care plan.” OBRA also includes specific patient rights which state under the Clinical Care and Treatment section that, “A resident has the right to refuse treatment after being fully informed and understanding of the probable consequence of such actions.”
First, attempt to determine the root cause of the refusal. Then follow up with changes in how you are engaging the patient in therapy sessions. Potential changes could include:
- Working with the patient to determine a time/schedule that works for them
- Utilizing a different therapist to provide the treatment
- Seeing the patient more frequently, for shorter time periods
- Having someone else with you to stand by (if they are fearful of falling)
- Reviewing your goals – are they graded for patient achievement and success?
- If the patient is uncomfortable with therapy, work with Social Services to have them attempt to determine the issue
- Work with the resident and family to ensure you have created goals that are meaningful to the patient
- Ensure that you clearly communicate the benefits of therapy intervention and the consequences of lack of participation
- Engage the physician as a support for therapy intervention
If after modifications and changes the patient continues to refuse treatment, remember that they do have the right to refuse and manage their own care. In this event, it’s important to respect their decisions and discontinue care.
Billing for services: We bill for skilled services provided that are medically indicated and skilled in nature. The patient has to be engaged and present in the treatment. Time spent in attempting to encourage the patient to participate in treatment is NOT a billable service.