When Residents Refuse Care: Protecting Their Rights and Your License

Hey boo hey 💜

If you’ve been in long-term care long enough, you’ve seen it — the resident who refuses therapy, refuses care, and refuses every safety intervention you try to put in place.

As the Director of Nursing, you’re left worrying every time they walk across the room, knowing a fall could happen at any moment.

It’s one of the hardest parts of the job — wanting to protect your residents while honoring their right to make choices, even risky ones.

I recently read a post from a new DON asking for help because her resident had fallen multiple times and continued to refuse assistance.

It reminded me of my early days as a DON — the sleepless nights, the “what else can I do?” moments, and the fear of being cited for something beyond your control.

But here’s what experience has taught me: you can’t control a resident’s decisions, but you can control your process.

💜 The Worry That Keeps You Up at Night

Because let’s be real — as the DON, you’re the one worrying about that fall with a major injury, that wound from refusing care, that stroke from refusing medications, or that weight loss from pushing away every meal.

The list can go on — and guess who knows about it all too well? I do.

This is when your documentation needs to be airtight. It serves no purpose to keep charting “resident refused care” without showing the depth of your follow-through.

You must document the risk versus benefit discussions with the resident and family, the provider notifications, psychiatric input, IDT recommendations, and sometimes even involve your legal team to ensure you’ve covered every base.

Because yes, residents have the right to refuse — but what about when it starts to cause harm? That’s when leadership meets accountability.

💜 1. Educate and Document Every Refusal

When a resident refuses care or therapy, education and documentation become your best protection. Clearly state:

“Resident refused assistance despite education on potential injury and risks of refusal.”

Reinforce this daily. Make sure all refusals are care-planned, documented in the nurse’s notes, and discussed in morning clinicals.

💜 2. Involve the Interdisciplinary Team (IDT)

Bring the team together — therapy, social services, the physician, and NP. Each discipline sees the resident differently. Therapy might recommend adaptive equipment; social work can address behavioral resistance; and the provider can assess medical or mental contributors. The goal? A unified plan that protects both the resident and your team.

💜 3. Care Plan the Refusal, Not Just the Fall

Many DONs make the mistake of continuously updating fall interventions without addressing why the interventions aren’t being followed.

Your care plan should include:

• Refusal to use assistive devices or participate in therapy

• Education provided

• Alternative interventions offered

• Acknowledgment of the resident’s informed decision

This ensures the care plan reflects reality — not wishful compliance.

💜 4. Communicate with Families and Providers

Transparency protects everyone. Document that you notified the family and physician. If the family agrees with the resident’s right to refuse, document their understanding. If the provider supports continued autonomy, request documentation stating that the resident is mentally capable of informed decision-making.

💜 5. Review Environment and Risk Factors Weekly

Even when residents refuse, your role is to minimize risk. Check lighting, footwear, and clutter daily. Ensure assistive devices are within reach. This is not just about preventing falls — it’s about showing proactive leadership.

💜 Final Thoughts: The Heart of Leadership

Being a DON means finding balance — between autonomy and safety, compassion and compliance.

You’re not failing when a resident refuses care. You’re leading when you educate, document, and involve your team.

That’s what true leadership looks like — calm in chaos, confident in process, and consistent in follow-through.

And that’s exactly why I created resources like the DON Planner and the Director of Nursing Training Program — to give you the systems that help you lead with clarity and confidence, no matter what situation comes your way.

💜 Lead with Love,

YourFavNurseLeader | Bilquis Ali

#ButDidYouFollowThrough