Discontinuing Services

Occupational therapy services end for many reasons. Ideally, they end when the client and therapist find that they have met their agreed-on goals. The decision to end service is directly linked to a clear understanding of the initial request for service and a mutual understanding of the treatment plan, proposed therapy, and expected outcomes. For this reason, it is often said that preparing for ending services starts at the first visit.

While a seamless plan of care is ideal, the end to occupational therapy service is sometimes unplanned or unexpected. In these cases, an occupational therapist must take care to minimize the disruption and impact for clients.

This guide describes the expectations when ending occupational therapy service; whether planned or unplanned.

The College of Occupational Therapists of Ontario consulted with a group of clients and caregivers who contributed to the development of this document. This group reminds us that clients expect and highly value “partnership” with their occupational therapist. This is especially true when services are coming to an end. Clients and caregivers report that ending services can sometimes feel abrupt and appear “one-sided.”

Clients and their caregivers want to be included in conversations about how, when, and why services finish. They value open and transparent talks about their choices and options. Occupational therapists are to remain considerate about client rights and preferences.

To protect the public, there are rules that health providers must follow when ending services. These are set out in Professional Misconduct (Ontario Regulation 95/07) of the Occupational Therapy Act.

The regulation says that when discontinuing needed professional services, an occupational therapist will consider the following:

1. Reasons for discontinuing the services,
2. Condition of the client,
3. Availability of alternate services, and
4. Opportunity is given to the client to arrange alternate services before the discontinuation.

An occupational therapist must comply with all four parts of this regulation if discontinuing services unexpectedly or before the agreed-upon end of service.

1. Reason for Discontinuing Services
   
   There are many reasons why services may need to end. Some include:
   
   • The client prefers to stop treatment or wishes to work with another occupational therapist
   • There are other service options
   • Funding for service is no longer available
   • A defined allocation of resources e.g., number of approved visits or specific length of stay
   • The client’s goals are not being met, or the service is not benefitting the client
   • The occupational therapist’s practice is closing or changing
   • There is a risk to the occupational therapist’s personal safety
   • There have been boundary crossings in the therapeutic relationship
   • Despite reasonable efforts to work through challenges, there has been a breakdown in trust or communication between the client and the therapist, and the relationship cannot be restored
2. Condition of the Client
   
   Occupational therapists have a greater responsibility to promote a smooth transition for clients who are at high risk for adverse outcomes if services end unexpectedly. For example, to assist with the continuity of care, an occupational therapist may help clients to find alternative services or directly refer the client to another service provider.
3. Availability of Alternative Services
   
   To minimize any disruption, the availability of alternate services available for the client should be taken into consideration prior to ending services.
4. Opportunity for Client to Arrange Alternate Services Before the Discontinuation
   
   Clients are given reasonable amount of time to arrange for alternative services. Occupational therapists are to be considerate of how much advanced notice is provided to the client prior to the end of service. For example, an occupational therapist closing their practice will provide as much time as possible/appropriate to allow clients to find another provider.
   
   It should be clear who is responsible for informing clients if there is a change in the service provider. The clinical record should reflect any transfer of accountability for the occupational therapy service.

The decision to end services with a client can be complex, especially if unexpected or unplanned. Clear and timely discussions with clients and caregivers help ensure a safe end to services. Maintaining professional attitudes and actions help in this transition. This means encouraging clients and their caregivers to ask important questions and make plans for alternative services. While ending services sometimes cannot be avoided, the occupational therapist can play a central role in minimizing disruptions and helping to ensure their clients’ continued wellness.