Legalities Of Forcing A Resident (who Has A Poa/guardian) To Change/shower

I am a unit manager on a memory care unit. We have a resident here who was independent up until he walked into traffic and was hit by a car and now has a debilitating TBI. He has a POA and guardian who is telling us to force him to change and shower.

We have sent him to be evaluated for all of this and our local podunk hospital does nothing. But he will not shower. He will go a month without taking a shower and refuses all interventions. In the last few weeks he’s refused to wear a brief but will have bowel movements and urinate in his pants. Not let us change him. And then will be sitting in cloth chairs and walking around contaminating everything. It smells so bad back here it’s actually causing behavioral issues in two of the residents.

Our DON called a nurse consultant and they said we cannot force him to change his clothes and then told us to send him to the ER. This nurse consultant is not an attorney. I also called and spoke with an on call doctor at the hospital who laughed at the idea of sending him to the ER for this, but then agreed we cannot force him to change his urine and feces soaked clothes.

My question is where do his rights end and others begin? Our other residents deserve a clean living environment and not be subjected to this constant smell. It’s just straight ammonia and it’s making one of them sick and another one fight with everyone (claiming that everyone stinks). Not to mention the infection risk to himself and to other people.

I’ve tried absolutely everything. Tried having other people approach him, tried different approachment techniques, I had his mom and his sister talk to him on the phone. Our nurse practitioner even tried sedating him with Ativan at one point (which is also questionable). We’ve tried everything on my shift except physical force and I’m just at a loss. I know others have used physical force on their shift but we are told that isn’t legal.

It’s gotten so bad our social worker just sent referrals out to every facility within 200 miles as they are wanting to kick him out. But we already know that no facility in their right mind would take this patient with the long history of behaviors and then this hygiene issue.

I just can’t see how not forcing someone to change and shower when they’re in this situation isn’t neglect.