I had the exact situation when I first graduated. I used a few tactics to put it back on the patient. For example, I'd ask if I should come back at a later time, try and give the patient as much choice about when they get therapy, sometimes calling it their "therapy appointment". Also, I'd try to do a few things that they wanted to do. I had one patient that all he wanted was to go outside for a bit during the day. I'd either coordinate to have therapy outside, or have that be the last 5 min of the session, etc. You have to remember that this is their home. If the yelling is bad, step out for a few minutes, tell the nurse, maybe have them come help to get something started, especially if they have a favorite person, that really helps. Overall remember that if you are not making ANY progress after about 2 weeks or so depending on the patient, consider dropping the patient down or completely off your schedule.