Great tips to motivate your patients - especially those with dementia. #5 is my favorite! Plus FREE Quick Reference Guide with 2 BONUS TIPS. Check it out on SeniorsFlourish.com| #geriatricOT

Tips of the Trade to Overcoming Patient Refusals

Mandy Chamberlain MOTR/L Education & Tips for Independent Living 10 Comments

Patient refusals can be very frustrating!

What do we do? There are supervisors to appease, RUG levels to adhere to, patients to help and ethical dilemmas to resolve.

Here are a few tips to help ease the woes of patient refusals.

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1. Split Your Minutes

If you are an occupational therapist working in a SNF, sometimes having minute minimums are daunting. Maybe seeing the patient a few times during the day helps the patient be more compliant.

Example would be to see the patient right away in the morning for grooming and hygiene at sinkside with their FWW. Next, see them at noon for instruction in use of a new piece of adaptive equipment for self feeding. Lastly, have them participate in some prepatory NDT techniques prior to a short chair yoga session.

Many times, the idea of a long treatment session is just too much and they would rather refuse than participate for that long.

Patient Refusals - What do you do when your patient refuses OT but you have supervisor demands, RUG levels to attain and productivity to maintain. Check it out! SeniorsFlourish.com #geriatricOT2. Review Their Goals with Them

I have worked with many patients that help develop goals during their evaluation, then refuse therapy treatment sessions. Sometimes it is as simple (depending on cognitive level of course!) as reviewing goals with the patient and explaining that OT and the patient are a team to achieve these goals.

Also using your therapeutic use of self to determine the best approach to review these goals. Does the patient respond to a friendly conversation or more of a direct talk. Each patient is individual, so our approach needs to be individualized as well

3. Tag Team Treatments

Are you in an environment where you could provide part of the treatment and have another OT or COTA provide the last session? This builds on the above suggestion of splitting your minutes.

Sometimes, a fresh face is all you need to get your treatment session in. Again, it can be an issue of being overwhelmed by how long you will be working with them versus what you are actually doing.

4. Do Not Overwhelm

Instead of talking about EVERYTHING you would like to do during that session, try breaking it down and explain 1 task before moving on to the next. Or even more specifically, 1 portion of the task - crack out those activity analysis skills!

If you have a patient that is in bed and does not want to participate, I have said, "let's just start by sitting at the edge of the bed and see how you feel." After they get there and are comfortable, proceed with suggesting the next task or portion of the task and go from there.

It is one of my favorite tactics and seems to work well (in general - not every time of course :).

5. Be Flexible

#4 works for me! Check out 15 tips to overcome OT patient refusals. SeniorsFlourish.com #geriatricOT

Sometimes a patient simply does not want to go down to the therapy room for a treatment session. What can you do in their room to accomplish the same goal or possibly work on towards another goal?

It's a great time to work on our occupation based goals!

More Tips

For 10 more tips, check out this great article from Monica at Mind-Start.com explaining 10 Tips for Successful Therapy for the Dementia Patient Who Refuses.

Some of the tactics she suggests include: #4 "Consider avoiding the word "therapy"  and #7. "Find the person's good times of the day." Check it out here for the full list.
We must remember that ultimately, the patient has the ultimate right to refuse occupational therapy treatment and we must respect this.
Click here to get your FREE "Overcoming Patient Refusals " Quick Reference Guide Your Content
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What is your best tip to get patients to comply?

If you are looking for other tips when working with the geriatric population, check out the post OTs Reveal Their 35 Top Tips When Working in Geriatrics.

Comments 10

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    1. Hi Anna! A couple things to consider – Is the patient still on caseload? Has the physician placed them on hold? It is actually very important to educate your patient on the importance of activity (even if it is minimal) with pneumonia. You can review and educate the patient on their goals, even have them sit EOB or instruct in safety completing functional transfers or toileting with the health status change. It is actually more important now to re-assess the patient’s current physical status with the new dx of pneumonia and maybe even goals need to be modified or changed to reflect current status.

  1. Splitting the minutes is a very helpful suggestion. The PT & OT had difficulty with my mother after her stroke, because she kept complaining of being “tired”. The therapists told us she was just being lazy. After she had additional strokes, she was finally diagnosed with vasovagal syncope.
    Having the same problem myself, I realized she was trying to tell them she felt “faint” when she told them she was “tired.” Since that time, I’ve also developed anemia and Lipid Storage Myopathy. During a recent hospitalization following colon surgery, I had trouble being as active as they wanted me to be. Finally realized it was because of my anemia (iron supplements were withheld since they can cause constipation). Also, my LSM causes “exercise intolerance”, so I have to break up my exercising into short segments spread out. If your patient is resisting therapy, there could be an underlying physical problem that has not been diagnosed, treated, or accommodations made for it.

    1. Thanks Brenda for the perspective. We as healthcare professionals definitely need to look at the “whole picture” and consider underlying diagnoses. Occupational Therapy is not always black and white.

  2. Hi Mandy,
    Thank you so much for all these great ideas. I face this problem a lot where patients don’t want to participate or they won’t tell you what is meaningful to them. Can you please provide some tips on what to do with those patients who think/feel they are okay, and don’t need therapy.

    1. That is a tricky one definitely Mary! Are you the primary OT that picked the patient up? Are they participating in PT? What setting? If they are in SNF, you may be able to motivate them by going over their goals and explaining they cannot stay in OT or transition safely home. Sometimes I even use the phrase “you need to PROVE to me, your family, the staff, your physician that you can do it if you want to go home and if we find that you can’t, that is exactly what we need to work on to get you there.” Sometimes it is a manner of cognitive level…

  3. Hi
    Any tricks for OT refusal in home care? Many times my patients gets mixed up with what PT , home health aide, RN and OT does in the home care setting.

    1. oooooh. Good question Debbie! That is a completely different scenario isn’t it. Typically if you can get in to complete your evaluation, I would give a handout on what OT is specifically in home care (so they/you can refer to this during subsequent conversations on phone or in person), as well as all the different things we can address in the home – cooking, community mobility, bathing, etc. Emphasize that our job in HH OT is to keep them independent, free from falling and keeping them safe to prevent them from going to the hospital or even having to go to a higher level of care.

      Have them talk about the things in their day to day routines that are hard for them to do (or that they are not doing, such as even cooking as an example – I had a guy that didn’t even eat microwave dinners, he literally ate fridge burritos because he couldn’t even use the microwave or had the strength to do more than 1 step meal prep).

      Sometimes going at the angle of IADLs might be more successful – it is HARD in home care because we are in THEIR home, right?

      But when I did home care, I found if I educated them from the beginning, it was EASIER for them to understand vs trying to explain while you are on the phone with them making an appointment or even scheduling the next appointment right then and there while they understand your role a little more clearly vs a phone call.

      It’s hard. Anyone else have any suggestions for refusals in home health?

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