5 Effective Tips for Patient Refusal of Care in SNF

Tips of the Trade to Overcoming Patient Refusals

Patient refusal of care can be very frustrating in occupational therapy (OT)!

What do we do?

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

How Would You Handle it if a Patient Refuses Care as an OT Practitioner?


It’s important to respect patient rights and provide quality care, even when a patient refuses treatment. We understand that sometimes a patient may not want to receive occupational therapy treatments, and we strive to provide the best care possible in these situations. We want our patients to feel comfortable and respected, and we will do our best to ensure that they feel safe and secure in our care.

Sometimes refusal of care is not that the patient does not want to receive care per se, it is that we are not listening to their needs, are not educating them on the benefits of intervention or we are not being client centered. 

Here Are 5 Tips To Help Ease The Woes of Patient Refusal of Care

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 deny therapy than participate for that long.


Patient refusal to care: What do you do when your patient refuses OT but you have supervisor demands, RUG levels to attain and productivity to maintain. | OTflourish.com


2. Review Their Goals with Them

I have worked with many patients that help develop goals during their evaluation, then have refusal of care. 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 and avoid refusal of care. Again, it can be an issue of being overwhelmed by how long you will be working with them versus what you are actually doing.


Not feeling confident working with older adults in your OT practice? If you are new to working in SNF or Home Health, we are here to level up your practice! Join the OT Flourish Membership today! | OTflourish.com

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 5 tips to overcome patient refusal of care in occupational therapy. | OTflourish.com


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 focus on activity analysis and work on their occupation based goals!

More Tips Worth Digging Into

For 10 more tips on patient refusal of care, check out this great article explaining 10 Tips for Successful Therapy for the Dementia Patient Who Refuses, including, “Find the person’s good times of the day.”

We must remember that ultimately, the patient has the ultimate right to refuse occupational therapy treatment and we must respect this.

What is your best tip to working on patient refusal of care & help them achieve their goals?


Not feeling confident working with older adults in your OT practice? If you are new to working in SNF or Home Health, we are here to level up your practice! Join the OT Flourish Membership today! | OTflourish.com

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