The phone call
The care manager rings: your mother has refused personal care for days, spits out her tablets, pushes her plate away. You are asked what should be done — and the implication is that this is now your decision.
That is where most families take a wrong turn. Start with what the rules say.
Refusing is a right, not a symptom
The Statement of Rights that every approved provider must uphold includes the right to be treated with dignity and respect, to have identity and choices respected, and to exercise control over one's own life — including the right to take risks and make decisions others might consider unwise. That principle has a name in aged care: dignity of risk, and it applies to a shower as much as to anything else.
Capacity is decision-specific. Your mother may be unable to manage her banking and perfectly able to decide she does not want to be washed this morning. Where she cannot make the decision, it passes to her substitute decision-maker under your state or territory's law — who must act on her known wishes, not on what the family finds reasonable. Ask what document the home holds and who it names.
Where this belongs: the care plan
Ask for a care plan review. A resident who refuses at 7am and accepts at 11am does not have a refusal problem, she has a rostering problem — and that is a care planning item, not a clinical one. The Quality Standards are built around care that is person-centred and that supports each resident's dignity and choice.
Before anything else: the three causes to rule out
- Pain. Someone who hurts when moved resists being washed, and with dementia this is not said in words. Ask whether pain was assessed with an observational tool, and when — and note that pain is one of the mandatory quarterly quality indicators, so the home is already collecting it.
- Delirium. Refusal that appeared over days rather than weeks, with fluctuating confusion, is delirium until proven otherwise: urinary infection, dehydration, constipation, a new medicine.
- The situation itself. Unfamiliar hands, cold water, a male carer washing a woman who has never experienced that, the rush of the morning shift. Anyone resists that; it only gets called refusal at 88.
For tablets there is a fourth cause nobody checks: swallowing difficulty. Someone who chokes spits tablets out. That is a speech pathology referral and a question about the formulation, not a persuasion problem.
What to ask for
- A pharmacist medication review, which is fundable and which you can request through the GP. Which of these tablets still make sense? Statins, supplements and bone medications can often stop — and half the refusal problem goes with them.
- Different formulations: liquids, wafers, patches.
- Care delivered differently: a different time, the same carer each time, same-gender care, washing in stages rather than a full shower, telling her before touching her.
- All of it in the care plan, including how often the refusal actually happens. "She always refuses" is usually a memory, not a record.
What not to accept
A sedative "so we can shower her". A psychotropic used to influence behaviour rather than to treat a diagnosed condition is a chemical restraint — a restrictive practice requiring last-resort justification, a behaviour support plan, informed consent from the restrictive practices substitute decision-maker, and review. Ask for the plan and the consent, in writing.
Two staff holding her as routine. That is physical restraint, subject to the same rules.
Medication hidden in food with no plan. Covert administration is treatment without consent; it needs a documented decision involving the prescriber and the pharmacist, not a decision taken on a shift.
When it becomes serious
If the refusal extends to food and fluids and persists, this stops being a behaviour problem and becomes clinical and ethical. Ask for a meeting about the goals of care, and bring her advance care directive if she has one — in most states a valid directive refusing treatment is legally binding. In advanced dementia, tube feeding generally neither extends life nor improves it.
If nothing changes
- A written request and a care plan review, with the agreed approach documented.
- The provider's complaints process, in writing.
- The Aged Care Quality and Safety Commission, for whom restrictive practices and consent are core compliance matters. You can ask for your name not to be given to the provider.
- The Older Persons Advocacy Network, free and independent — and notably an advocate for what your mother wants, which in this situation may not be what you want.
And if the problem is the home
Someone who resists needs time, continuity and the same hands each morning. A home with high turnover and a thin morning shift cannot provide those — and then calls it refusal. Check the care minutes and the star rating alongside what you are being told.
If you reach that conclusion and do not have another round of calls in you, that is the part we do. Tell us the area, your parent's care needs and what is not working, and you get a shortlist worth calling, for A$109. If you don't receive at least 3 homes matching the area and criteria you gave us, we refund you in full. Start here
This article is general information for families, not legal or medical advice. Capacity, substitute decision-making and advance care directive rules differ by state and territory, and aged care rules change over time. Curalune does not allocate beds and does not guarantee availability.