Refusals

Often therapists try educational approaches and ultimately try sending in the business office or administrator to reason with a patient that is refusing. Most of the time refusals are a symptom of executive dysfunctions and should be handled by an OTR or SLP. A therapist must establish rapport before treating a patient with early Dementia or executive dysfunctions. This time of establishing rapport can be documented as "Skilled graded approach to engage patient participation in full therapy plan of treatment". Another goal might read as "Patient will participate in environmental engagement activities 80% of opportunities indep". Those activities that you use to establish rapport can include something as simple as getting the patient his/her favorite soda or something else that is important to the patient. Sometimes you can interact with someone else at the patient's meal table to demonstrate you are trustworthy. Another way is to join him/her at activities and allow the patient to teach you how to do it. Allowing the patient to be the expert in one area, will go a long way to build trust so the patient will be willing to allow you to be the expert in another area. It's about building trust.