What can you do if a care home resident refuses personal care?

Personal care can include assistance with eating, drinking, washing, dressing, shaving, applying creams and going to the toilet. It is an extremely common form of care, however, it is also very intimate. Sometimes a person refuses personal care, even if they need it.

Why might a care home resident refuse personal care?

The reasons a person refuses personal care are personal to them. Factors including their personality, self-esteem and their current state of health can all contribute to their decision.

Reasons can include:

• It is too intimate and they feel violated or embarrassed
• They feel undignified or infantilised
• If they are new to their care home or they have memory problems, they may feel distrustful, afraid or simply not comfortable enough with the staff yet to accept personal care from them
• They think they can still manage these tasks themselves, unaware that they are not doing as good a job as they think. This is more likely to happen to someone with dementia
• They fear that once they accept support for personal tasks, they will lose the ability to do them altogether

What are the risks if someone continuously refuses personal care?

Often, a person who refuses personal care at first is simply not ready and becomes more comfortable with it in time. If somebody continuously refuses though, it can lead to problems with their health and wellbeing, including:

• Risk of malnutrition
• Not eating enough can lead to feeling weak and general malaise
• Risk of dehydration which can lead to delirium
• Becoming smelly or visibly dirty, which impacts their dignity
• Higher risk of infection
• Unwashed skin can become very itchy and uncomfortable
• Negative effects on their self-esteem 
• Feeling socially isolated, they might feel too embarrassed or too physically weak to join in with activities and social opportunities

Can care home staff force a resident to accept personal care?

Many people in care homes are assessed as not having the mental capacity to make decisions alone. This means that due to dementia, a mental health issue or something else, they cannot retain information, weigh up pros and cons and make an informed decision.

While even residents who have been formally assessed as not having mental capacity are encouraged and supported to make their own choices as much as possible, their choices can sometimes put their welfare or dignity is at risk.

Care UK’s Head of Nursing, Care and Dementia, Suzanne Mumford shares her expert opinion on what care home teams can do in a situation where someone is refusing personal care. 

What can care homes do if a resident refuses personal care and has the mental capacity to make this choice for themselves?

Ms Mumford says: “This can be quite common, after all how many of us would have someone, we don’t know well, or have a relationship with someone involved in supporting us with our intimate personal care? Most of us are very private, and the same is true for the person living with dementia, they want to be able to stay in control, and often believe they can still do all the things they used to, unaware of, or not wanting, to acknowledge that they now need help. 

“The most important thing we can do is slow down, listen to the person and build a trusting relationship, making sure that when we are able to help it is a warm, pleasant, dignified experience, supporting the person in the way we would want someone to support us if roles were reversed.”

What can care homes do if the resident refusing person care has been medically assessed as lacking capacity to make that decision?

Ms Mumford explains: “When supporting a person with dementia who has been assessed to no longer have the mental capacity to make a specific decision, the law and guidance requires that any decision made needs to be in the best interests of the individual (ideally taking into consideration their past lifestyle choices). 

“The best interest decision making process should involve the person receiving care as well as their chosen representative, someone who knows them well if possible. 

“Because when someone lacks capacity, it doesn’t mean we can force them to do something they don’t want to, it means we must explore ways to help them feel in control, support their independence, and enable them to be involved. This often involves slowing down, building a trusting relationship, carefully choosing the way we communicate – this might be using a combination of simpler language, actions, and pictures to help the person to understand what is required. 

“Knowing the person well, and understanding their likes, dislikes and normal routines can help enormously.”

5 tips if a loved one is refusing personal care

1. Talk to them about why they don’t want personal care

It may take some time and gentle coaxing but try to encourage your loved one to open up about why they don’t want personal care. Do so somewhere private where they feel safe.

Once they have explained what’s troubling them, you can talk to the care home manager about ways to adjust their care to get around their concerns. It could be that they’d feel comfortable having a bath early in the morning while other residents are asleep, that they’d prefer a particular member of staff or that there is some equipment that would help them to feel safe.

2. Support them to make their own choices about their personal care

Think of ways that you can support your loved one to be in control of their personal care. Better still, ask them.

Ideas could be supporting them to:

• Choose their own shampoo and soap
• Decide what time of day they would like personal care
• Follow a previous washing and dressing routine that they feel comfortable with
• Make appointments with a barber, hairdresser or nail salon (many care homes have these on-site)

3. Make personal care as comfortable and dignified as possible

Care homes do their best to treat residents with dignity and respect, and the team will likely have ideas on how to support your loved one with personal care. Speak to your loved one and the staff who care for them about any further changes that could support your loved one to feel more independent and private when it comes to personal care.

If they have any trouble with continence, ask the care home if it’s possible to give them access to a supply of pads or continence pants that they can take from discreetly and/or a supply of soluble laundry bags that they can put soiled sheets or clothing in privately.

4. Help them with a routine

Having routines is good for everybody’s wellbeing and particularly useful for people who live with dementia. Your loved one can be supported to follow a daily personal hygiene routine as part of their care plan. It may be best to follow one that is as close as possible to their routine before they moved into a care home.

To remind them of their schedule, environmental changes could include:

• Put familiar objects in their care home room to remind them of how they used to look after themselves, such as their toothbrush pot from home or a favourite hairbrush. Most homes allow residents to bring their own furniture, so if space allows, you may be able to get their wardrobe and even a dressing table in.
• Use colourful signage and posters. Not necessarily a poster saying ‘you need to have a shower’ but some artwork off someone in a bubble bath might remind them.
• Try out having a checklist of personal care tasks on their wall, that staff at their care home can support them to ensure they’ve completed.

5. Go shopping with them

If possible, getting some new things can help them to feel confident in having personal care and excited for a new routine, particularly if they choose the items themselves.

Your shopping list could include:

• Nice soaps, shampoos, conditioners, shaving foams, moisturisers, deodorant and creams
• Flannels, towels or loofahs
• New clothes and underwear, this can give them more to choose from and increase their confidence and pride in their appearance
• A laundry basket
• A new razor that they feel safe and comfortable using
• Make-up, hair products, perfumes or aftershave
• Products to help people who live with dementia with day to day living. There is a range here.