How do I deal with hygiene, sitting in their own urine and feces when he won't clean up or refuses to have an assistant?

Have you told him that his behavior means that he must move?

I am pretty sure that APS will intervene when someone sits in their own waste. Obviously he has a mental deficit or he would not be doing this.

I think that I would call 911 and report that he is a danger to himself and get him baker acted and refuse to bring him back.

That is a deal breaker for me. Having an accident is one thing, willingly pooping your drawers and refusing to clean up, well that means that you need to live somewhere else.

I hope that you can get him help soon. For both of your well being he needs to be hospitalized and then go to a facility.

When I was called & told my relative was apparently sitting in their home, in a chair, unable to get up or clean themselves up etc I called EMS.

I don’t know his backstory as to his physical condition but assuming he can still follow simple commands I would get him involved in making him participate getting on and off a toilet or commode as a daily exercise. Try to get him on some sort of routine.
Up and on the commode/toilet at 9a, 3pm, etc. Change pull ups and inspect his skin.

If this doesn’t work perhaps hire someone 3 mornings a week to assist. M

If he still can’t change his habits or awareness of sitting in a soiled pull up for hours consider LTC where they will establish the routine which will include a change of pull ups and a skin inspection.

If this continues he will develop skin breakdown which is a whole other animal with potentially dire end results.

You can only do your best for him but need to consider what works for you as well as your & draw your own “line in the sand”. Eventually this becomes a situation where no one wins.

Being 'resistant to care' in the hygiene/continence area is one of the barriers to remaining in a home setting cared by only one person.

In a facility setting, aides just get it done - by trickery, distraction or by just outnumbering.

Does this friend suffer from a dementia or mental illness?

As Country Mouse asked - is this a new thing? Has there been a medical review of behaviour/health/meds lately?

When I worked in Elder Care, fecal incontinence was a absolute deal breaker. I had a DH at home who had just had a liver transplant and I was NOT bringing home some awful virus/bacteria.

Our company did pretty good training in changing out a client who refused or was unable to control the bowels. You really need quite a bit of room to move around in--esp if the person is a 2 person transfer.

Is he aware of what a diffifcult situation you've put him in? Is he capable of understanding?

Like with babies--feces sitting next to the skin for very long will cause irritation and breakdown of the skin. And 'diaper rash' in an elderly person actually comes on much more quickly--thin skin and more foods to cause irritation.This isn't one of the aging issues you can ignore.

Good Luck with 'the talk'.

There is obviously more to the story here than what is in your profile.
(Countrymouse how did you get the other info?)
You have few options.
If he will not allow an assistant, caregiver or other help then you will have to clean him, change him and change bedding or absorbent pads on furniture.
Or
Tell him if he wants to continue living in your house he will have to permit help that will come in, change him, clean him and do light housecleaning for his care.
If he does not agree to these conditions I would tell him that he has to leave. Find Assisted Living (or Memory Care) that would be appropriate. Or if he has relatives he could move in with them.
You might want to contact your local Area Agency on Aging for referrals and help

If he has tried all the bladder medications available with no luck, his urologist can try putting botox in his bladder, as that has been shown to be successful in some instances. And if that doesn't help he can have a supra pubic catheter put in(which is a permanent catheter), and then you will only have to empty his bag a couple times a day, and he won't be sitting on his urine.

As far as him pooping, first I hope he's wearing some kind of adult diaper, and secondly, you might want to try putting a bedside commode right next to where he sits, so he doesn't have to travel far, when he does have to go. And having an aide coming to help him would of course be helpful too, even if he doesn't want help.

And if none of that works, then perhaps it's time to part company. You certainly shouldn't be putting yourself in harms way. Good luck.

You have this friend - friend? - living in your house. You have been his caregiver since 2016, and continence has been an issue for a long time. You say he has fired three agencies because their workers/aides have tried to bully him verbally into accepting care: "state the law to him about the spread of disease and infections," as you put it.

Why is he incontinent?

Is this a current situation or an ongoing problem that you're talking about?