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My client today is refusing to change his pull up. The longer he wears it the more agitated he gets and he has refused to get dressed also.

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There comes a point where they no longer have the ability to understand what they need to do, but they get irritated if you just jump in to help. It's a difficult situation. Best to be nice and friendly, remind them that the diaper is soiled and offer to bring them what they need to change it.
Let them start, try, get as far as able. Keep reminding them as soon as we're done were doing something they enjoy (like shopping), it's ok to lie a little on this part if it helps, they won't remember it.
As they are struggling to understand what they need to do, you simply ask if you can help A LITTLE, let them know you do this for a living and are a trained employee, take it over for them in all areas they are struggling with. Keep reassuring them that they are getting changed to do something they enjoy doing.
Hope that helps
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Can you cut it off him with scissors?
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