Is a physical therapist allowed to stop physical therapy on someone who cannot follow directions because of their dementia?

There has to be an ability for a patient to follow instructions. You can't force a patient to do stuff while they are screaming and hollering and fighting you, which happens because the family is pushing for it so hard. Sometimes they don't understand what is going on and so cannot participate enough to have any sort of carryover or return to improve functional activities. When this happens they DONT get better. When is enough enough? There is a line healthcare workers shouldn't cross. Even if fam members are desperate for help. If you have never worked with these kinds of patients you don't really understand what it takes to rehab them back to function again. It doesn't mean the facility has something against your loved one.

When my Dad was sent ti the first rehab they were obviously not equipped to handle his PT needs. He was very weak and could not walk or even hold a spoon to feed himself. After a week or so he was sent to another rehab that was much bigger and better staffed. The difference was night and day. It was at the suggestion of the first place that we decided to transfer him but I know we could have requested it on our own.

Just an aside. My Dad liked the first place better because it was quiet and the staff was more laid back. The second place was crowded and busy and they really made him work hard. It was what he needed, but he did not like it.

Good luck.

I asked my PT about the rule change that Medicare had brought is as of Jan 2014 about progress. The PT said it didn't pertain to me but just to people with long term problems like Parkinson disease. Just plantar fasiicitis didn't count in the rule. That Medicare does need to see real progress.

Oh! As leverage for them to continue another week or so, I would be all OVER them for not calling me in advance so I could attend sessions with her and, hopefully, be helpful in her progress. (I did that for mom when she broke her hip.)

By Medicare rules, they have to show progress or cannot continue treating your mom. You can be sure that the facility is trying their best to SHOW that progress, because, when/if they stop, they no longer get paid. Thus, they're highly motivated to both get mom to participate in her rehab AND to show that she's making progress.

If mom doesn't understand anymore, if she's noncompliant, if she turns down rehab sessions, there's really not much the facility can do about it.

You might be able to beg/borrow/steal a little more time for mom. If that were the case, I would attend the sessions so I could see for myself what was happening.

One thing that's glaringly missing from these responses is the role of an SLP (speech pathologist) . Within their scope of practice is working with individuals with dementia and using strategies to learn and recall new skills. So...if the PT is working with a patient to do safe transfers for example, the SLP can help teach the recall of the safe transfers.

Pt's with dementia need cognitive cueing and a very consistent PT/OT program to be successful. The Therapist's need to be confident in their ability to work with Pt's with Dementia. All of the literature speak to the benefits of PT/OT (until end stage dementia). It is clear to me it is not easy work---but--it is critical to support functional status of patient's.

Glad you did the right thing -my husband was not allowed to go to the NH we were using for rehab-they send recruiters to hospitals-because he was a pain-they said it was because the meds cost too much-the next year they begged for him to be at their place but I found a better NH with a social worker that actually worked with me -so I said no.

02is01-
I moved dad from one facility to another when he was in 2.5 years ago. The reason was their care was substandard. He was very uncomfortable and frightened of a male nurse that was not kind to him. So, I spent a day shopping for something he would be more comfortable with. Found it, paid deposit to hold until move, then and only then let the facility know I was moving him.

So, just go shopping. Check out ratings of nursing homes on Medicare's website.

As far as I know bkw is right and yes you should be able to transfer her to another facility -I would visit other facilities and talk to the social worker there -they are in business to make money and having a good censes helps their bottom line. Sometimes you need to make noise to get the benefits you need-keep us posted we help each other by our experiences.

sorry....that last response was suppose to be a question

PT indicated she could not work with my mom because she wasn't familiar with her case. I told her...at the very least could she work with her on sitting up. Her response was "they were short staffed for the day." Mom got no PT yesterday and most likely will not today. Mom has been here less than a week but as a family we would like to have her transferred to a better skilled nursing facility. Is that within our right and how do we go about it?

As of Jan 2014 Medicare has clarified that Lack of progress is not an acceptable reason for stopping services to patient's--for more information see the Center for Medicare Advocacy or CMS web cite for more detail.

It is important to note that a therapist can always discharge a patient if they feel progress is not/cannot be made. That can be a necessary decision made on the patients' behalf. If the therapist cannot convince the patient to follow the guidelines for rehab they set, then the patient may injure themselves, or more likely, simply will not improve.

As riley0213 correctly pointed out, Medicare insists on progress. They are not interested in maintenance. My recommendation is to ask another therapy practice in the area if they can try to treat your mother. At the very least, ask if they can evaluate her condition. If she does need rehab (which I'm sure she does), then it's worth trying to find another therapist that can work with her.

When medicare or medicaide will no longer pay for the services the nursing home or rehab or home care can no longer offer these because they will not get paid. Most nursing homes do not have staff available to assist residents with PT -but you can have PT teach you some things to do yourself for example standing up from a chair that you can help them with when you visit and can encourge excercise when visiting them that will help to keep them mobile longer.

I am an Occupational therapist and very capable to answer this question. There is a defined level of participation and progress that Medicare,Insurance and Medicaid require. That trickles down to PROGRESS! A pt. receives services when there is a defined goal or objective to meet AND the pt.can demonstrate ability to participate. That being said, when a pt. has made progress , then they tend to remain at a certain level of activity or ability to perform/walk a certain distance etc Then therapy is provided to teach a caregiver or family how to 'maintain' the pt. at that level, supervise exericise and so forth as THERAPY IS NOT APPROPRIATE TO MAINTAIN FUNCTION;IT IS DESIGNED TO ATTAIN A NEW LEVEL OF FUNCTION.

In my state Medicare PT can be stoped for many reasons one of which is the pt. has reached a place where they can not do any better and not being able to follow instructions is another reason one of the N.H. did really do everything they could and did give the residents lots of chances before PT was stopped

Hi Bev,

If the therapist finds there is not enough carryover of instruction, then yes, they can discharge due to lack of rehab potential.

Lindsey
The AgingCare.com Team

Lilliputa: your words rang VERY true with me. The therapists in a rehab center should be able to 'handle' dementia patients as well as they would handle a stroke victim!! I love your statement: Get to the bottom of it, by going to the top!

Bev45: Don't allow 'bully tactics' from ANY staff member if your mother is not getting the care/treatment she needs. See to it that ALL of the necessary personnel are involved in your discussion. Insist on a 'care management meeting' immediately!

Our involvement in their care cannot be passive. We must take an ACTIVE role in their care!

God Bless.

Rehabs call it something like "failure to cooperate." It is mostly because of behavioral issues. If your mother is not being belligerant, violent, or purposely refusing, then there is no reason why they cannot provide a staff member, who works with dementia patients, to work with her and the PT to help "translate."
Every patient in a rehab has a care management "team." There is a leader of the team. Contact him or her. Let them know that your mother is there to get better and part of getting better is PT. I cannot believe that this is the first dementia patient they have worked with.
When my Mom was in rehab, her doctor really wanted her to work on swallowing issues. The therapist saw Mom for a few minutes and said that she "couldn't do anything for her." I called the team leader who had her come back, but she was still a jerk to my Mom. So I asked for a new therapist.
The people who work at these places cannot simply "cherry-pick" who they want to work with.
I would get to the bottom of it by going to the top.
good luck.