Right to refuse?

High school age, wheelchair-bound student with incontinence, unable to physically reposition self in chair during school day. Prior to this year, the student was being changed once or twice a day by two trained school staff with use of a manual Hoyer lift to a padded trainer table in a private bathroom area. This year student has started refusing being changed. Student states discomfort with lift sling and also denies need, as sometimes student is not wet or not very wet at scheduled time of changing. Physical therapist has brought concerns to me about skin integrity and sitting in power chair all day with no pressure relief of skin and possibly wet skin for good part of the school day. PT has asked me to do weekly skin assessments for skin integrity and breakdown prevention. Student does have a gel pad on the power chair seat.

How do I validate the student's right to refuse and also fulfill my requirement to assess skin integrity and provide interventions to prevent breakdown at school?

Parent seems OK with student's refusal and parent changes the student's incontinence brief at home before and after school. Is this enough? Can I document this and ask that parent will bring any skin concerns to my attention? What do I tell the PT?

I believe part of the refusal is also related to the student's age and general teenage rebellion/embarrassment about being changed. Also the student likely is not drinking enough water/liquids in order to not be wet or very wet though the day. The student rarely has a BM at school.  (I am the only nurse in the district and am not in the high school building daily, so I have trained paras to assist with this student's ADL's)

Thoughts.....