It happens often: a senior falls ill, has an accident or undergoes a successful operation and the prognosis is optimistic for a full recovery. However, upon discharge from the hospital, they decline treatment in a rehabilitation facility.
Many caregivers are frustrated when their loved ones demand to go home instead of participating in crucial inpatient therapy programs. As a member of your loved one’s healthcare team, you have an obligation to enable and encourage them one to recuperate as fully as possible. But what can you do when they (and possibly other family members), do not see the value in rehab? Here are a few steps you can take to help a senior understand the importance of rehabilitative care and persuade them to participate.
Explain Why Rehabilitation is Necessary
Help your loved one realize how imperative rehab is for their full recovery and long-term health. This stage of treatment is meant to bring greater outcomes for the future. Research shows that patients develop more independence and a greater quality of life when they go through the necessary rehabilitation process following a surgical procedure, illness or injury.
Since most caregivers are not medical professionals, the brunt of this communication should fall to the senior’s doctor. Make sure that the physician is clearly explaining the recovery process and listening to your loved one’s concerns. A study published by the National Institutes of Health showed that, on average, a doctor allows a patient to talk for about 12 to 18 seconds before interrupting them. If the doctor is speaking too quickly or in terms that are too complex, or they are not engaging in two-way communication, request that they simplify their explanations or ask for a longer appointment to allow for an in-depth discussion. A few fundamental questions that should be addressed by both parties include:
- What results is the doctor hoping to see?
- What goals does your loved one have for their recovery?
- What does achieving a full recovery require of your loved one?
- How long will the recovery process take?
Try to Understand Their Emotional Position
As a caregiver, you have special insight into your loved one’s situation and feelings. Be aware that their reluctance to begin or continue rehab may actually have nothing to do with the rehab itself. From their perspective, this inpatient stay is yet another part of a long series of painful and emotional events. When a patient hears he or she is going to rehab instead of finally returning home, it creates a great deal of disappointment and concern.
Try to remind them that this stay is intended to be temporary. If they truly commit to their physical, occupational and/or speech therapy, they will be able to return home in a certain time period. Rather than ordering them to participate, level with them. Rehabilitation of some kind is a normal part of healing for people of every age. Gently remind them that their condition is more complex, so they require extra attention more frequently.
An inpatient facility is a better alternative to hopping in and out of the car multiple times each day for the next month in order to get them all the professional assistance they need. Furthermore, a sole caregiver is incapable of providing skilled medical care around the clock at home.
Sometimes the desire to refuse treatment and return home is rooted in fear. Your loved one may be worried about their pets, their home’s security or mounting financial obligations. They may also be concerned that once they enter a skilled nursing facility, they’ll never return to living in the community. By opening a discussion that welcomes their input, you can work with them and their healthcare provider to devise solutions and ease their concerns.
Determine if Physical Symptoms Are Influencing Their Decision
Another common reason why seniors may refuse to stick to their rehabilitation is pain. Many older patients tend to downplay their symptoms or put on a brave face during doctor’s appointments. If your loved one is not forthcoming about their physical challenges, you may need to share accurate information with the doctor. Tell them if your loved one complains about the pain or discomfort they experience during some of their therapy sessions and any other issues they are having. This conversation can accomplish three things.
- Their healthcare provider is able to empathize with them while explaining that short-term discomfort is often necessary for improved function and a successful recovery.
- If pain is the issue, then their physician may be able recommend alternative therapeutic methods that cause less distress or discomfort. They may also be able to suggest additional or alternative methods for drug-free and/or pharmaceutical pain management to facilitate the healing process.
- In some cases, pain may indicate an undetected condition that needs to be examined further, such as a fracture or an infection. An in-depth discussion with the doctor should be able to eliminate the existence of other underlying conditions.
Remember, their doctor will not be able to prescribe the best possible treatment plan of care if they do not have complete or accurate information to base decisions on. Encourage your loved one to be honest, or you may need to step in to make sure the doctor has all the facts.
Explain the Implications of Refusing Treatment
Everyone has a legal right to refuse medical treatment. However, if you have HIPAA authorization, a healthcare provider can discuss with you their health concerns and the financial consequences of a loved one turning down prescribed treatment or leaving a facility against medical advice. If you understand all of the implications, you will be better equipped to persuade your loved one.
First and foremost, it is important for the senior to understand that this intensive therapy is being prescribed by a doctor who has decided it is medically necessary. Should they choose to disregard this recommendation, their life may never be the same. For example, a person who refuses rehab may never regain the ability to walk unassisted following a fall or hip surgery or be able to independently complete activities of daily living after a stroke. Regardless of the specific health conditions that necessitate rehab for your loved one, a physician has determined that, without skilled nursing and physical, occupational, and/or speech-language therapy, their health, quality of life and level of independence will decline.
The other side of this decision is that refusing rehab or leaving early can have a serious financial impact. Coverage for inpatient services can be limited to begin with, especially when it is provided through Medicare or Medicaid. For example, if your loved one has Medicare Part A and refuses this treatment outright following a qualifying 3-day hospital stay, then any coverage is immediately forfeited. If they change their mind or their condition worsens, they’ll have to incur another qualifying hospital stay that necessitates rehab or pay for this care privately. Leaving early against medical advice can affect their future coverage as well. Sometimes seniors respond better to monetary explanations or consequences than hypothetical medical implications, so this information may help put things into perspective.
Bring in Reinforcements
If all of the previous information and discussions have still been unproductive, it may be time to call in others to help. Ask a trusted friend, an adult grandchild, a religious leader or someone else whom they respect to speak with them about this important decision. A former patient who experienced a similar health issue and plan of care could also speak with your loved one about their experience.
It may be beneficial for you to open up a discussion with the medical staff as well. Is there a nurse, activities director, or volunteer who has established a friendship with your loved one and could offer insight into their concerns or reasons for refusing treatment? “Through collaborating efforts, a caregiving team can uncover fears, frustrations, or misunderstandings that often lead to refusing rehab,” says Kevin Bingham, PTA, of Copper Ridge Healthcare.
Despite caregivers’ best efforts, seniors may still insist on returning home. Simply do whatever is in your power to inform, understand and support your loved one throughout this process. If they suffer from cognitive issues and you are appointed as their power of attorney for health care, then you may need to intervene. Otherwise, the only thing left to do is accept their decision and try to make alternate plans for their safety and care at home with support provided by a home care agency. Sadly, they may end up needing to make a permanent move to an assisted living or skilled nursing facility sooner than they would have if they had completed their rehab. But if they are of sound mind, then their choice must be respected.
