Some facilities I have been to have residents who see us in the halls joking and laughing with other residents and they felt left out so they practically begged to be seen by the therapy department. Once in therapy, they realized all the work that goes into it, began to refuse and were finally discharged until a few months later when the process repeated itself. These are the misdirected patients who see something they do not have, but then realize that to achieve the fun in therapy takes work they are unwilling to do.
The unsolicited patients are the ones who show up to therapy without orders and ask if they can do something to get stronger. When it is explained to them they will have to speak with the MD, they seem put out and think it is a waste of time to talk to the doctor if all they want to do is get a little stronger. When and if they do get orders, they do not follow along with the therapy activity for very long, are often discharged to a restorative program and eventually stop coming.
This seems like a waste of time and resources. Is it? All patients should have the right to therapy services but they should also understand the work involved and commitment it takes to get stronger, have fewer falls and move easier. Initially, patients are gung ho to get to therapy but once they see what it takes to develop skills, some are not willing to invest the time and effort.
Perhaps we should develop a program where the PTA can initiate the activity with the patients and pass the information to the PT, who can make further assessments regarding the patient's abilities and commitment to follow through before an evaluation is done. This might cut care costs and free the PT from doing evaluations and developing a plan of care that only lasts a week or so before the patient decides he does not want to do it anymore.