5 Tips You Need to Know When You Have Patient Refusals in Occupational Therapy | OTflourish.com

5 Effective Tips for Patient Refusal of Care in SNF

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

What do we do?

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

So let’s dig into:

  1. why do patient refusals happen
  2. what to do about it and
  3. how to document it

What is it Called When a Patient Refuses Care?

When a patient refuses care or declines to receive medical treatment, it is commonly referred to as “patient refusal of care” or “patient refusal of treatment.”

This situation occurs when a patient, either verbally or through their actions, expresses their decision not to undergo a recommended medical intervention, therapy, medication, or any other form of healthcare service that has been offered to them. Occupational therapy practitioners (and all healthcare providers) are generally required to respect a patient’s right to refuse care as long as the patient is deemed competent to make medical decisions, and they have been adequately informed about the potential risks and benefits of the proposed treatment. Proper documentation of such refusals is essential to ensure that the patient’s wishes are respected and that the medical record accurately reflects their decisions as they have a right to refuse medical treatment.

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. 

Dealing with this can indeed be a challenging aspect of our journey as occupational therapy practitioners (OTPs). We often find ourselves navigating a complex web of considerations, from pleasing supervisors and adhering to productivity levels, to truly helping our patients while addressing the ethical dilemmas that may arise.

Why Would a Patient Refuse Treatment or Occupational Therapy Services?

Patients may refuse treatment or occupational therapy services for a variety of reasons, and healthcare providers must respect their autonomy and seek to understand their motivations. Common factors contributing to refusal include:

  • fear or anxiety related to medical procedures
  • past negative experiences
  • cultural or religious beliefs
  • perceived lack of benefit from the proposed treatment
  • lack a full understanding of occupational therapy
  • financial concerns or even
  • personal values may influence a patient’s decision

Clear and empathetic communication is crucial to address these concerns and help patients make informed choices about their healthcare. We should prioritize effective communication to clarify any misconceptions. Ultimately, patients have the right to make decisions about their healthcare, and OTPs should strive to provide information and support while respecting each patient’s autonomy and preferences.

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

1. Split Your Minutes For Shorter Sessions

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 front wheeled walker. 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. Breaking it down into smaller sessions can make it more approachable and acceptable.


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 Goals Collaboratively

Patients often play an active role in setting their rehabilitation goals during the evaluation process. However, when refusal of care occurs, it may be beneficial to revisit these goals with the patient and make sure you have used the correct assessments to help pinpoint their occupational strengths and limitations.

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!

Be flexible in your approach and adapt your communication style to the patient’s preferences, whether it’s a friendly conversation or a more direct discussion using your therapeutic use of self to determine the best approach to review these goals. Each patient is unique, so your approach should be tailored accordingly.

Does the patient respond to a friendly conversation or more of a direct talk about their current situation.

Each patient is individual, so our approach needs to be individualized as well

3. Consider Tag Team Treatments

In environments where multiple OT practitioners or certified occupational therapy assistants (COTAs) are available, consider the strategy of tag teaming 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 approach builds upon the idea of splitting treatment minutes.

Sometimes, introducing a fresh face can reinvigorate a patient’s willingness to participate in therapy, preventing denying services. It’s all about avoiding the overwhelming feeling that may arise from the perceived duration of the session.


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4. Avoid Overwhelming the Patient

Rather than overwhelming the patient with an exhaustive list of tasks for a treatment session, try breaking down the session into smaller, more manageable steps.

Break it down.

Explain one task before moving on to the next, or even break down a task into its individual components using your activity analysis skills. For instance, if a patient is hesitant to participate while in bed, you might say, “Let’s begin by sitting at the edge of the bed and see how you feel.” Once they’re comfortable with that step, suggest the next task or component, gradually progressing from there. This approach, while not foolproof, can be remarkably effective in many cases.

5. Embrace Flexibility and Adaptation

Occasionally, a patient may simply refuse to leave their room for a therapy session. In such instances, adapt by focusing on what can be accomplished within their room while still working towards their occupational therapy goals. This is an excellent opportunity to employ activity analysis and devise creative solutions to address their specific needs. What can you do in their room to accomplish the same goal or possibly work on towards another goal?


#4 works for me! Check out 5 tips to overcome patient refusal of care in occupational therapy. | OTflourish.com


What are 3 Elements of Getting and Documenting a Refusal of Care?

When documenting a patient’s refusal of care, it’s crucial to maintain accurate and comprehensive medical records. Here are three essential elements to include in your documentation when a patient refuses OT services:

  • Patient’s Statement and Reason for Refusal
    • Document the patient’s refusal in their own words or as accurately as possible. Include what the patient said about refusing the recommended care or treatment and the specific reasons they provided for their refusal. Capturing the patient’s perspective is essential for understanding their decision-making process and respecting their autonomy.
      • For example: “Patient stated, ‘I do not want to do OT today because I am so tired from my surgery and I need to sleep,’ when asked about their refusal of occupational therapy services.”
  • Date, Time, and Location
    • Clearly record the date and time when the patient refused care. Include the location, such as the patient’s room or therapy gym, where the refusal occurred. This timestamp is crucial for tracking the patient’s medical history, ensuring proper follow-up, and maintaining an accurate timeline of events. It helps in coordinating care and can be valuable if legal or regulatory issues arise.
      • For example: “Patient refused OT participation on [date] at [time] in Room 204.”
  • The Occupational Therapy Practitioner’s Response and Education
    • Document the occupational therapy practitioner’s response to the patient’s refusal. This should encompass any actions taken, discussions held with the patient, and efforts made to address their concerns. Include information about attempts to educate the patient regarding the potential consequences of refusing care and any alternative options presented. Additionally, note if the patient’s decision to refuse care was respected and if they were informed of the risks associated with their decision.
      • For example: “COTA/L explained the benefits of the prescribed occupational therapy and discussed goals to return home. Patient declined OT despite the explanation of potential benefits.”

Including these three elements in your documentation of a patient’s refusal of care ensures that you have a complete and well-documented record. It promotes transparency, facilitates communication among healthcare providers, and helps meet legal and ethical documentation standards.

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

2 thoughts on “5 Effective Tips for Patient Refusal of Care in SNF”

  1. Great post! As a PT in home health I found many patients lacked understanding of what an OT could do for them. I heard the statement “I don’t have an occupation anymore” a lot. I try to correct that misunderstanding regularly! I learn so much from the OTs I work with!!

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