Sometimes we have to meet the minutes, yet a patient strongly refuses. How do I advocate to the supervisor to not treat?
Answer
This is such a loaded question. You need to first look at the payer source. If you need to meet certain minutes according to a care plan, you might need to split your treatments, rather than doing an entire 60 minute treatment at once, you split it into two or three sessions throughout the course of the day. Maybe you do not treat the patient that whole time. Maybe you as an OT do part of the session, the COTA does another part of the session. I think there are some ways of meeting those minutes. If the patient really is refusing, do they understand what your goals are? Have you made your goals meaningful and functional for the patient? If you have done everything possible, then I think you do need to go back to your manager and to say, “I do not believe that this treatment plan is the most effective one for my patient. Here is their level of dementia, this is everything I have tried, and here are my goals". I think you need to go back and give a lot of justification and explanation. If someone came to me with all this reasoning, I would say, “Okay. Well let's look at changing this RUG level or changing the minutes that you schedule for this patient.” We need to do our homework and use due diligence. Try every avenue.
Kathleen Weissberg, OTD, OTR/L
Dr. Kathleen Weissberg, (MS in OT, 1993; Doctoral 2014) in her 25+ years of practice, has worked in rehabilitation and long-term care as an executive, researcher and educator. She has established numerous programs in nursing facilities; authored peer-reviewed publications on topics such as low vision, dementia quality care, and wellness; has spoken at numerous conferences both nationally and internationally, for 20+ State Health Care Associations, and for 25+ state LeadingAge affiliates. She provides continuing education support to over 17,000 therapists, nurses, and administrators nationwide as National Director of Education for Select Rehabilitation. She is a Certified Dementia Care Practitioner and a Certified Montessori Dementia Care Practitioner. She serves as the Region 1 Director for the American Occupational Therapy Association Political Affairs Affiliates and is an adjunct professor at both Chatham University in Pittsburgh, PA and Gannon University in Erie, PA.
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