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When Seniors Refuse Care

Refusing CareFamilies often struggle with what to do when their loved ones refuses care. Can a senior refuse care that is ordered from their doctor? Does it make a difference if the senior is in a long-term care facility?

The quick answer is yes, a senior living in any living environment can refuse care. From there the issue gets much more complicated. If the senior is living in a long-term care facility (nursing home), assisted living or residential care facility there are regulations that covers a residents right to refuse. In the Missouri Regulation Manual it says:

19 CSR 30-88.010 (13)

“Each resident shall be afforded the opportunity to participate in the planning of his or her total care and medical treatment, to refuse treatment and to participate in experimental research only upon his or her informed written consent. If a resident refuses treatment, this refusal shall be documented in the resident’s record and the resident, his or her legally authorized representatives, or designees, or both, shall be informed of possible consequences of not receiving treatment.”

Resident’s in long-term care can refuse any treatment. This includes medications, therapy, diet, medical treatment and even doctor’s orders. The most commonly refuse treatment in long-term care is bathing. Resident’s refuse to take a bath more than anything else.

What can be done if a senior is refusing care? First, you need to understand why they are refusing. They may tell you “I don’t like the way the medicine makes me feel”, “it is too painful to exercise”, “the water is too cold or the water pressure hurts my skin.” Once you know this you need to explain the consequences of not getting the care. Your blood pressure could go up and you could have a stroke. You may lose your ability to walk. You could develop bed sores from not being kept clean.

In a long-term care facility there are protocols which must be followed when a resident refuses care. First, they must offer the care twice, then staff have to explain the consequences of what will happen if they refuse the care. Once this is done if the resident still refuses the facility needs to document that they followed the protocol and allow the resident to refuse care.

One example is a diabetic who wants the chocolate cake instead of sherbet. They must offer the sherbet twice, explain what could happen if he/she eats the cake, (your blood sugar could go up and you could go into a coma), and then if they still insist on the cake allow them to have it. The facility must document each step that they took.

A senior living in the community also has the right to refuse. If a family feels their choices are putting them in danger they can call the Department of Health & Senior Services (DHSS) and ask that an assessment be done. If DHSS determines that the senior is in immediate jeopardy they can put them into protective custody and take action.

All individuals make poor choices from time to time that does not mean that their rights should be taken away!