Dealing with Patients with Dementia Refusing Treatment

Question

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.