There has been a major clarification regarding the manner in which medicare standards are to be applied to SNF and Out Patient services. It is not acceptable to deny services due to lack of progress. See the whole update at this link.
Strong advocacy by families is need to ensure our loved one obtain care they need and deserve.

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Maintaining strength and functional status are essential for quality of life in the elderly.
Memory loss/dementia makes it more challenging for them to access and utilize therapies. The absence of maintainance and restorative therapies in the frail elderly leads to additional medical complications which result in additional hospitalization, severe limitations on quality of life and early death. Dementia is not life limiting until the end stage. People live many, many years with life altering effects of dementia that they may require assistance to maintain their health. Access to care can not be the determining factor of an elderly person's longevity. It is the patient/family's responsibility through consultation/support of the health care team to develop a realistic plan of care. Every patient's situation is different and requires a thoughtful individualized plan.

Well, since the orders for PT and OT are written by the MD, I think that is where the discussion begins. I would also have a little empathy for a therapist who may be expected to achieve the impossible. I had a knee replaced and made good progress. In rehab, I saw other patients who failed to repeat the exercises in between visits either by refusal or memory losses. They had a hard time and a lot of protracted pain and limping. So where do you draw the line?

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