how to deal with therapy refusals

How to deal with therapy refusals

Know when it’s a clinical indicator or wake up call

Standard in every skilled nursing therapist’s day is dealing with patients’ refusal of therapy. A typical SNF therapist averages 1-2 refusals of treatment each day. That can be 15-20 percent of a therapist’s day that’s canceled! 

Of all those therapy refusals, most are legitimate. But among them, there are some SNF patients who could be motivated to get up and exercise. 

Often, a motivated therapist can cajole a patient to join the scheduled therapy session. But many times, it’s simply easier for a busy therapist to let a tired or distracted patient skip a session. 

And now with PDPM, where SNFs are no longer reimbursed for therapy minutes, therapists have even less motivation to counter patients’ refusals than they once did under the RUG-IV payment plan with CMS.

However, therapy is the key reason patients enter a skilled nursing rehab center, and its centrality to patient care is unquestionably essential. Skilled nursing therapy is key to the healing process and to slowing the physical and mental decline of aging patients. 

PDPM means therapists and SNFs are focused more on quality than quantity, but that still means that a patient who is prescribed any number of weekly therapy sessions absolutely needs to access those sessions in order to achieve the best outcome. 

The responsibility lies on the therapist to make sure refusals don’t stand in the way of accessing therapy.

3 underlying reasons skilled nursing patients refuse therapy

Patients will have a whole host of reasons for refusing therapy, and most of them are absolutely legitimate. It’s up to you as a therapist to consider how the patient is responding and determine the source of the refusal. This way, you can determine if the reason is something you can work around or if it’s a sign of a bigger issue. And sometimes, refusals just might mean that you have work to do to make therapy sessions more worthwhile.

 

Reason #1: Patient isn’t feeling well 

Patients may be adjusting to a new medication, still healing from a recent procedure or have any number of clinical challenges that can make therapy more difficult. Speak to interdisciplinary team members to see if they have also received concerns and what subsequent actions have been taken

Reason #2: Patient has concerns outside of their control 

Skilled nursing care has to be integrative for therapists to successfully treat patients. This means letting the care team know when a patient doesn’t get enough sleep because of a loud roommate or a patient didn’t eat because the food got too cold. Be an advocate for the patient if action has not been taken to address concerns/complaints. 

Reason #3: Patient is apathetic

Sometimes patients will refuse therapy without a specific reason. Statements like “Maybe tomorrow?” or “I don’t want to do it today” can mean that the patient isn’t seeing the value of the therapy sessions.

 

Reassess your approach to skilled nursing therapy for apathetic patients

If you are unable to identify the source of why your patient is refusing care, it’s time to ask yourself some hard questions.

We as therapists are taught the therapeutic use of self approach. This means we use all our faculties to meet our patients where they are, with empathy, and bring them to where we want them to be for the session. We use our creativity, attitude, and effort to make patients feel positive, motivated, encouraged, and successful. This is how we gain their trust and ensure they feel empowered.

7 questions therapists should ask when facing refusals 

  • Are you offering a care approach that has meaning to the patient?
  • Are you offering a care approach in which the patient believes they have the opportunity to experience success?
  • Can you grade your approach to gain trust and agreement?
  • Are you conveying enthusiasm and excitement in your approach or are you going through the motions and thinking about the end of the day?
  • What is your strategy to motivate? 
  • Can you modify the environment to one that will promote a more successful experience?
  • Can you modify the intended activity based on the fluctuating physical and cognitive ability output of your patient? 
Health visitor and senior

Therapists’ methods to deal with refusals

Once you’ve taken some time to ask yourself the hard questions above, you are poised to better address therapy refusals. The following are some steps you can use.

Step 1: Show empathy to patients’ needs

Your first reaction to therapy refusals should always be empathy. Most patients have legitimate hesitations to therapy, such as overall weakness, pain or emotional struggles. Of course, therapy can improve the physical and mental state of patients, but it’s a long process, and the journey can be hard. 

Listen well to your patients’ concerns and repeat what you hear them saying to you to validate their concerns. If the patient is refusing to exercise because he is in pain or needs an improvement to his care, you may need to advocate for him to the interdisciplinary team.

 

Step 2: Use a person-centered approach for therapy

One obvious solution to refusals, of course, is to have a more person-centered approach. Provide therapy on the patients’ schedule, when he is at his best. This is obviously harder to coordinate, but if it reduces refusals to offer a late sleeper a later therapy time slot, then you will have more luck cajoling him to exercise. 

It also helps to offer the patient something engaging she wants to do. Get to know her interests and goals and relate the therapy back to those goals. Your patient wants to walk her granddaughter down the aisle? Remind her that it starts with working on standing for two minutes.

Don’t be afraid to get family members involved in what a patient enjoys. Therapy is a great time to jump on a Zoom call with a patient’s loved ones. This makes the family feel connected, increases transparency, motivates the patient and helps you get to know more about the patient. This is why we included a video-conferencing tool right within our RESTORE Skills therapy gaming platform.

 

Step 3: Make therapy fun and engaging

Armed with the latest technology that makes therapy interactive, engaging and even fun, therapists can significantly reduce refusals. As the Chief Clinical Officer of RESTORE Skills, where we’ve created just this kind of therapy gaming platform, I see examples every day of patients actually requesting to play our therapy games. They are motivated by the fun they are having skiing, golfing or playing the slot machines, as well as the results they see as they improve their game scores.

To add to the joy, we are known for an “I hit the jackpot with RESTORE” t-shirt for those patients who hit “Wild, Wild, Wild” on our slot machine game. We are constantly hearing about patients relentlessly playing this therapy game until they win. Meanwhile, they are actually winning at therapy, as they push themselves to reach and stretch farther.

The right attitude, approach, and activity can make therapy easier and reduce refusals, but sometimes you need added help

 

Refusals can feel personal. Most therapists have developed conscious and subconscious defense mechanisms related to these remarks. However, simply shielding yourself from the impact is not necessarily best for your patient or your professional growth and development.

Even the most passionate and creative therapists will still face regular refusals on the job. This is where innovative technology can fill the gap. Having access to a variety of interactive treatment content and the ability to connect loved ones for added encouragement and participation is the perfect compliment to an empathetic, positive and motivating therapist’s approach. Hope these strategies help you realize better outcomes with less refusals.  

Home Safety Scenarios

New “Safely Home” Game Supports Hazard Awareness

After several requests from therapists, we are so excited to launch our newest game designed to help players identify and resolve hazardous scenarios in & around their homes. "Safely Home" allows players to interact with different areas of the home in order to identify and reduce a variety of hazard risks in a fun, engaging, and meaningful way. 

Home SafetySafely Home 

Players work to recognize safety hazards they may encounter inside or outside of home. To play, move the controller to the hazard to activate solution options. Choose the best solution to resolve the safety hazard, until all hazards in the room are corrected. The player will use attention/concentration, safety recognition, problem-solving, judgment, and decision making skills to manage the hazards in the household.  The game addresses balance, activity tolerance/endurance and can be played seated, standing.

 

Home Safety

Adapting one’s home to accommodate the needs of seniors is vital for independence, happiness, and longevity. Therapists can launch "Safley Home" as a means to engage in important conversations with their patients, while players build upon the critical skills needed for a safe discharge. 

We love hearing from you!

We were built by therapists for therapists. In fact, our most popular game "Jackpot" was suggested to us by an OT in Colorado. Be sure to share your thoughts on the game "Safely Home", including any suggestions you have for additions to the game.

Our team is always looking to improve our existing games & create new ones to address the skills you target in your sessions. So, please don't be shy! Send your tips, fixes, or ideas to info@restoreskills.com!


Follow RESTOREskills on Facebook & LinkedIn for updates on our platform, new game announcements, testimonials, tips, and much much more! To schedule an obligation free demonstration of our on-demand therapy platform with our team, please contact us at info@restoreskills.com or call (330) 968-2879. We look forward to supporting your goals!

 

in room therapy

Keep Patients Active with an In-Room Session! 💪👟📈

Our customers are reporting 90% of therapy treatment sessions are now being delivered in patients’ rooms. A major shift from 95% of therapy sessions occurring in the gym prior to the pandemic. Now is the time to enhance your own devices! Take advantage of RESTORE’s portability to keep residents active, happy, and healthy in their rooms.

Take advantage of RESTORE portability, engagement, and FUN

  • Laptops/Tablets access RESTORE through internet connection and webcam
  • Follow center guidelines for cleaning if planning to remove from the room once brought in - but consider dedicating a device to an isolation room for the duration of isolation precautions
  • Using RESTORE on one device does not limit simultaneous use of RESTORE on other devices

Build Skills Anytime, Anywhere!

RESTORE offers a full skill-building platform to address mobility, range of motion, coordination, cognition, activity tolerance, life-skill readiness, & much more!

Therapists can simply bring their laptops to the patient room to stay on track with a treatment plan, address functional skills, & teleconference patients’ families for encouragement and education. Devices can be used on a bedside table or stand to accommodate patients whether they’re lying in bed, sitting on the edge of the bed, sitting in a chair, or standing.   

 

The RESTORE Difference

RESTORE games/activities promote player engagement and are a great distraction from environmental barriers and psychosocial factors (such as discomfort, loneliness, anxiety, etc.) Therapists can simply bring their laptops to the patient room to stay on track with a treatment plan, address functional skills, & teleconference patients’ families for encouragement and education. "We had a flu lock down, so people could not come to the gym. We were stuck doing in-room treatments & residents were very bored. RESTORE was an incredible tool for us to have for in-room treatments!" - Elisabeth Gardner, DOR at Elmhurst Rehabilitation & Healthcare Center 

 

Be sure to follow our blog for more tips & examples of how you can set up a meaningful skill-building session right in your patient’s room! 


Follow  RESTOREskills on Facebook & LinkedIn for updates on our platform, new game announcements, testimonials, tips, and much much more! To schedule an obligation free demonstration of our on-demand therapy platform with our team, please contact us at info@restoreskills.com or call (330) 968-2879. We look forward to supporting your goals!

COVID-19

AVOID the Health Risks of COVID-19 Isolation

Now, more than ever, it is imperative to keep your residents active, happy, and healthy! In this series of posts, we will discuss the challenges & health risks that may arise due to patient isolation and restricted visitation in the wake of COVID-19

We know your first priority is the health, safety, and well-being of everyone in your community. During this time, we want you to know we’re here for you! RESTORE can help mitigate the physical, cognitive, and psychosocial risks involved with social isolation.

 

Physical Health Risks COVID-19Physical Risks

  • Skeletal muscle strength can decrease up to 1.5% per day of bed rest → Skill-building with RESTORE can occur bedside in the patients’ room (and may be used by multiple team members simultaneously)
  • Heightened risk of falls with fractureOur games support functional mobility, range of motion, coordination, balance, & activity tolerance
  • Increased risk for skin breakdown & pressure soresFUNctional games turn every patients’ room into a skill-building gym 

 

Cognitive Health Risks COVID-19Cognitive Risks

  • Seniors who suffer from social isolation have a 64% higher risk of dementia → RESTORE helps dementia patients reach their best abilities
  • Potential for a shortened attention span → Games promote cognitive skill-building with attention, concentration, memory, problem-solving, & safety awareness
  • Loss of trust and self-confidence or decreased safety awareness → Players succeed with patient-centered activities individualized to their cognitive level

 

Cognitive Health Risks COVID-19

Psychosocial Risks

  • Increased prevalence of anxiety, depression, & unwanted behaviors → Features include leaderboards so players can compare their game scores with others
  • Heightened sense of loneliness, social isolation → Friends & family can be included during a RESTORE session via video conference with screen sharing
  • Increased thoughts of mortality → RESTORE creates an opportunity for meaningful interaction, encouragement, & education

 

How We Can Help! 

Players can experience the FUN of virtually pulling a slot machine handle to win a jackpot, skiing down the slopes of a world cup race, or controlling the flight path of a plane from the comfort and safety of their room. Enhance your own devices and take advantage of RESTORE’s portability to keep residents active, happy, and healthy from the comfort of their room. 

To help you overcome these challenges, we’ve decided to dramatically reduce the cost of our platform. Now your residents and team members can enjoy RESTORE and connect family members at a special monthly cost.

3-MONTH SPECIAL OFFER*: $199/month (MSRP $495)

*Special offer grants three-month access to a limited version of RESTORE-Skills. Valid until 03/31/2020.

For more details click here or if you have any questions or would like to learn more about our special offer, please email us at info@restoreskills.com. 

Meet the Team!

Meet the Team: Karin

Everything we do here is to support of our goal of creating enhanced experiences for your team, your patients, and their loved ones. In earlier posts, we heard stories from players who had meaningful experiences with therapeutic gamification. But in this next series, we’ll hear from a few of our team members about their favorite moments over the last year! In this post you’ll meet Karin, a senior game developer and graphic designer in our Tel Aviv office.



This fall, I had the chance to travel to NYC to work with our U.S. team. While there, I was able to visit numerous facilities that use the RESTORE platform. I learned a great deal while talking to the staff, therapists, and residents and hearing the insightful ideas they shared with me. It was so exciting to see firsthand how patients love and appreciate our product. Here is one special experience from the trip I’d like to share:

The day of our visit, I observed a therapy session between a therapist and patient who was not feeling great.  She told us she was feeling off and said she didn’t want to stand at all. The therapist said that was okay and she sat and eagerly watched another patient play the game Jackpot (which I developed) and waited for her turn.

The RESTORE Difference

When her turn came, she immediately knew she wanted to play that same game. It was like suddenly forgot her discomfort and agreed to play the game for a couple of minutes while standing! For me, as the game developer, it was amazing to see how something I created help a patient who earlier refused to stand to go on and have fun with her therapy. After she finished playing, she continued to say how beautiful and fun that slot machine was! It moved me to know that something I designed and developed could have that great of an impact on people.

I hope this made you smile like it made me. It’s a story I will carry in my heart as I build more games that create meaningful experiences for all of you and your patients. It’s an honor to know that my day to day job is to make therapy more fun and enjoyable for patients. I look forward to a brighter future where joy, gaming, and therapy are intertwined. 

Follow RESTOREskills on Facebook & LinkedIn for updates on our platform, new game announcements, testimonials, tips, and much much more! To schedule an obligation free demonstration of our on-demand therapy platform with our team, please contact us at info@restoreskills.com or call (330) 968-2879. We look forward to supporting your goals!

Tis’ the Season for Gamified FUN!

Are you looking for a fun way to warm up the residents at your next holiday event? Look no further! To celebrate the most wonderful time of the year, we’re launching holiday renditions of your favorite games. Time to serve up some cocoa, put on some music and spread cheer with a RESTORE Holiday party. Below, you’ll learn all about the three (3) seasonal games launched this week, along with tips for best use. Be sure to log in and play before the holiday magic is gone! 


Elf on the Slope

Elves are so busy running around for Santa in the days leading up to Christmas. In this game, patients navigate through candy cane arches and collect presents for Christmas. See who can receive the most gifts with the Elf on the Slope today! This is an excellent game for players working on lateral mobility as they’ll practice weight shifting, balancing, and squatting. When asked what her favorite game is one patient said, “I loved the skiing game! I didn’t think I was going to be able to do it. I was surprised when I was good at it. I’m going to tell my sister I skied in therapy today!”

 

Holly Jolly Slots

Embrace the excitement of the holidays with Holly Jolly Slots. Players will pull the slots to collect three  (3) matching Hanukkah or Christmas items to win the round! A perfect activity for patients working on activity tolerance or UE range of motion and players love engaging with the virtual slot machine!  When asked why it was their favorite, one player said, “I have to concentrate on it. It makes me change hands too. It’s a great fun game. I love it!” Reminder: If a player pulls a rare “Triple WILD” jackpot, let us know, and we’ll send them a special gift! 

 

Tis the Season for Gamified Fun

Santa’s Sleigh

Santa needs to deliver his gifts on time! Your player will guide Old St. Nick’s sleigh through the night sky by moving their controller either up & down or left & right. Either gifts or coal will drop into the chimneys as you fly by, but be careful not to crash! If you observe a player struggling, use tactile cues to help them complete the desired movements correctly. A great game for testing reaction time, activity tolerance, and functional reach. Players can have fun tallying how many children were “Naughty” or “Nice” based on their delivery! 


 

 

These games are so great; you’ll want to grab an ornament or pull on some mittens and play right away! Set up two or more stations where residents can play individually, as a team, or compete in a group simultaneously. They’ll love the nostalgia of the games and have a great time sharing their favorite holiday memories and traditions. 

 Follow RESTOREskills on Facebook & LinkedIn for updates on our platform, new game announcements, testimonials, tips, and much much more! To schedule an obligation free demonstration of our on-demand therapy platform with our team, please contact us at info@restoreskills.com or call (330) 968-2879. We look forward to supporting your goals!

power of therapeutic gamification

The Power of Therapeutic Gamification

We know it’s not always easy to engage a patient, especially when they’ve had a tough day. We also know that creating fun, interactive experiences can help lead to a better day. This week, we’ll look at another facility to learn about the power of therapeutic gamification and how it can help provide an enhanced patient experience.  

During a therapy visit to New Eastwood Healthcare & Rehabilitation Center, we were so excited to see the impact of the therapeutic activities on patients throughout the gym. The first patient to play during our visit was Mike, who recently returned to the facility from being in the hospital. With his therapist, Mike focused on AROM and activity tolerance while seated. As he played he it was clear he was having a lot of fun! He told us that playing worked out his arms and shoulders and that he was impressed that it made him short of breath! 

The RESTORE Effect

As they progressed through the session, another patient asked to join Mike and play the game Bull’s Eye so they could have a “shootout” competition. So, she set up both players on the same device, selected “Group Play,” and started the contest! The players loved the activity, the second saying, “it’s fun to compete with other patients, but it also makes you competitive with yourself because you want to get better. It exercises your body and mind while having fun!” 

In addition to Mike’s shootout partner joining in on the fun, another patient asked to play! She watched the two men enjoying the friendly and asked if she could play. Although seated during her prior dowel exercise, the therapist referred the patient to stand when playing. So, the therapist placed a ball in the middle of the same dowel turning it into a controller.  The patient stood for 10 minutes and completed too many interactive repetitions to keep track of visually. At the end of the session, the patient expressed how much FUN she had and that she enjoyed not thinking about it being exercise. 

The RESTORE Difference 

Later on, the therapist pulled up the data from the session to show the patient. They reviewed her movement pattern and the heat map of the bilateral movements completed during her entire session. The therapist expressed that this session was far more productive in working towards the patient’s goals than the short dowel sessions alone. The patient added that the 10 minutes of standing flew by because she was having fun!

What started as a single patient playing games quickly turned into additional patients engaging in group play or asking to play on their own. The smiles and laughter generated from the gaming experience caught the attention of other patients working on their personal goals throughout the gym.  From Mike to the final patient, we were able to see first hand the ripple effect therapeutic gamification had on everyone present. 

Follow  RESTOREskills on Facebook & LinkedIn for updates on our platform, new game announcements, testimonials, tips, and much much more! To schedule an obligation free demonstration of our on-demand therapy platform with our team, please contact us at info@restoreskills.com or call (330) 968-2879. We look forward to supporting your goals!

overcoming patient refusals

Overcoming Patient Refusals

Have you ever tried to get a patient down to the therapy gym for their session without success? If so, you know how difficult it is to overcome patient refusals. The reasons given are many: “I’m too tired; My family is visiting soon; I’m afraid I’ll fall; It’s too hard; I just don’t want to.” So what can you do to handle these situations? In this post, I’m going to share a story about a therapist who adjusted her approach to beat this challenge. I hope it encourages you to try something new when overcoming patient refusals.

The RESTORE Difference 

At a recent facility visit, an SLP shared that the patient she was scheduled to see refused to come to the gym. Simply put, he didn’t want to do therapy that afternoon. The therapist shared videos of other patients playing RESTORE games to encourage him to come down to the gym. But, the patient still didn’t want to leave and said he would only be interested in playing if he could play in his room. As long as you have an internet connection and a webcam supported device, you can quickly load games. So, the therapist quickly grabbed a laptop and started a session right in her patient’s room! 

They played games to address sequencing and Pill Skill for medication management.  At the end of the session, the patient expressed how much FUN he had and that he enjoyed not thinking about it being exercise. It was wonderful because we did not have to disrupt the treatment session in the gym in order to bring the technology to another patient bedside. When the therapist decided to think outside of the box by reaching for a new tool, she completed a meaningful 30-minute session with her patient that they both enjoyed!

Let Us Know Your Success Story!

I hope this post illustrates how you can step out of the box to overcome daily challenges. Do you have any stories about RESTORE helping with patient independence? Tell me about it by sending me an email amanda@restoreskills.com. We want to share your smiles, tips, and ideas with all our users.

Follow  RESTOREskills on Facebook & LinkedIn for updates on our platform, new game announcements, testimonials, tips, and much much more! To schedule an obligation free demonstration of our on-demand therapy platform with our team, please contact us at info@restoreskills.com or call (330) 968-2879. We look forward to supporting your goals!

fun group therapy

Can You Participate in 2 Group Sessions at the Same Time?

To wrap up this series of posts, I’m happy to share one more joyful moment from my trip to our MA facilities last month. If you have yet to read my other posts about great customer experiences, you can find them here, but now I am thrilled to share a fun group therapy story with you.

Meeting Diane

This time, we’re back to Cedar View Rehab! On this day, the therapy team had every patient participate in some epic group play. Here I met Diane, RESTORE’s #1 fan, who blew me away when she participated in two group sessions back-to-back! It was truly a delight to see her so eager to engage.

For their group session, the therapists split people into two playing groups. Each station was set up to play Ski Saga where players worked on weight shifting, trunk rotation, squatting, strengthening, and standing tolerance. It was great to see the variety of exercises and controllers used to enhance the session. The whole room was full of excitement players took turns “skiing” to reach their therapy goals.

The RESTORE Difference

In her first session, Diane used a dowel rod to work on standing trunk rotation and upper extremity strengthening. Still energized after soaring through her first session, she joined my group where she practiced weight-shifting, squatting, and balance. Even when a therapist told Diane, “you can take a break and sit down if you’d like” she continued to play, pushing herself to complete each task. 

When she finally agreed to take a break, I showed Diane her playing time.  The smile on her face was undeniable when she realized she played for over 20 minutes! “I feel great,” she said, “I was having so much fun, I didn’t even realize I was playing so long!” The room buzzed with happiness from the fun and everyone seemed to have a better day because of it.

Do you have any fun stories from a RESTORE group play session? Tell me about it by sending an email with your story and a few of your favorite pictures. We can’t wait to share the smiles from all our users! 

Follow  RESTOREskills on Facebook & LinkedIn for updates on our platform, new game announcements, testimonials, tips, and much much more! To schedule an obligation free demonstration of our on-demand therapy platform with our team, please contact us at info@restoreskills.com or call (330) 968-2879. We look forward to supporting your goals!

 

increasing patient independence

“I’ve got this, I don’t need help!”

Thank you for following these posts as I share another happy moment from my trip to our MA Marquis facilities. If you haven’t had the chance to read my first blog post about Maria or the second post about Joe, you can find them here. But now, I am thrilled to share Madeline’s story about patient independence!

Meeting Madeline

Elmhurst Rehab was the first facility I visited during my trip, talk about a perfect way to begin the week. Their therapy team was so excited to get started, and that energy spread to everyone who played that afternoon. During our session, one of the OTs brought in a patient “who was already in love” with RESTORE. Now, if I had one word to describe Madeline, it would be fierce! As she told us, this wasn’t her first time playing, and she was ready to show off! 

The RESTORE Difference

During her session, Madeline worked on a targeted range of motion and strengthening her upper extremities. I was very impressed when she picked one of the toughest games, Ancient Temple, for her session. Now, I’ve played this game myself, and I can tell you that after a few minutes, your shoulders and arms will feel the burn! But with each level, Madeline kept climbing higher and higher. Even when met with a challenge, she pushed through until the level was complete. Having fun helped her independence and pushed her to play unassisted. Even when our Clinical Director, Ian, tried to guide her with a task, Madeline said, “I’ve got this, I don’t need help”!

With all it’s levels, Ancient Temple is a game that can last for over 12 minutes! And Madeline, being the independent person she is, reached the final one! What was even more incredible was the fact that this was only one of the games she played that afternoon. I was amazed by Madeline’s efforts and loved getting to know her fierce personality.

Do you have any stories about RESTORE helping with patient independence? Tell me about it by sending me an email. We want to share your smiles, tips, and ideas with all our users.  

Follow  RESTOREskills on Facebook & LinkedIn for updates on our platform, new game announcements, testimonials, tips, and much much more! To schedule an obligation free demonstration of our on-demand therapy platform with our team, please contact us at info@restoreskills.com or call (330) 968-2879. We look forward to supporting your goals!