5 Effective Tips for Patient Refusal of Care in SNF

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

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.

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?

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.

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