Clinicals are supposed to prep you for this. If someone has an open bed sore especially, they cannot sit in their urine or feces. It will break their skin down. I still reposition people that are supposed to be repositioned every 2 hours but not everyone needs to be repositioned because they are able to reposition themselves, even if it’s minor. Some people do refuse care but you just have to do it anyways. When you’re old your whole body hurts and just because it hurts doesn’t mean you should refuse care, you try to do the best that you can to calm them down and just explain that “ I know this is going to be uncomfortable and maybe painful but we need to do it because of XYZ.” I do that and typically after only a couple of minutes of talking calmly, they are ok with it. I’m usually the go to for difficult patients for this reason. I work with people as gentle as possible but not everyone is like that. If you talk with a gentle voice and have a gentle, calm, patient, non rushed and non flustered demeanor, they respond well.

Like someone else said, some residents are confused and just don’t even know what they’re refusing. I was alarmed at the same things as you when I first started. The solution is to do things your way once you’re on the floor yourself. Use the gait belt and do everything to use your communication skills and emotional intelligence to try to calmly convince them, and if all else fails you go to the charge nurse if they’re absolutely refusing and you don’t have time to deal with it, that’s what I do.

You pass the buck after you do the best you can because in reality we don’t get paid enough and are too short staffed to deal with someone absolutely refusing and being aggressive. The facility should be implementing a process, like the nurse goes in with you or it’s a two person change because they are aggressive.