Unfortunately, you can't "snow" the guy just to get him clean......that is, in effect a chemical restraint, and thus legally (and ethically) squishy. As demented as he probably is, he still has the right to refuse care, and refusal to shower/bathe is an almost universal problem in long-term care facilities.
I'm assuming the interdisciplinary team is involved here and is well aware of the impasse. The resident needs to bathe, because he is at risk for skin breakdown and quite frankly, he's stinking up the joint. However, there are probably as many reasons why demented elderly people don't want to bathe as there are elderly demented people; your job is to find out this
one's reasons and try to modify them so he can receive hygiene without physically hurting someone.
Some of the possible reasons: He grew up in an era when you took a bath on Saturday night, whether you needed one or not, and thus is not used to more frequent bathing. He might have nearly drowned as a kid and is afraid of water. He may not like having water sprayed in his face. He may be cold, and the usual nursing-home shower isn't exactly a warm, friendly place. He may not understand what staff are trying to do to him. He may not like being naked in front of people, especially those of the opposite sex. He may be in pain. He may be embarrassed. He may be fearful of something you don't know about. And, he may just be a mean old dude who needs a boot in his backside to straighten him out---I once had a resident who would shower ONLY when one of us would pretend to be his commanding officer and bark orders at him, just like in his Army days!
Get creative. If there are family members available, they can often give you insight as to where the problem may have originated, as well as what works. Take the carrot-and-stick approach, and offer the resident his favorite goodie if he allows himself to be showered (give him extra if he'll do it without
taking a swing at a caregiver). Bring him a washbasin, cloth, and a towel and cue him to wash whatever he can reach, and use one of those soapy shower caps like hospitals use to get his hair clean. Let him have as much control as possible, but don't ask
him if he wants a shower/bath; the default position is always "NO"!
Hope this is helpful to you. Good luck.......I know one old fella who literally had to be dragged to the hospital and physically placed in one of the Jacuzzi tubs, clothing and all, because his poor little wife hadn't been able to get him into the shower or even change clothes, for TWO YEARS.
They literally had to soak his clothes off.......then, they couldn't get him OUT of there because he found out he liked it! To say the least, it was an APS case from there on out.