The people doing the poop cleanings like CNAs in a nursing home do not have the time nor the mental fortitude to deal with an Andy. They would quite likely tell him to fuck off, though not in those words. They barely have time to change the briefs/pull-ups of the borderline paralyzed 50 year old woman who apologizes to you for having to poop in her briefs. A good CNA will kind of feel bad for that person, especially the nice residents who apologize for having to do basic human functions. You throw an Andy into the mix, someone obviously capable of ambulating to the bathroom and who refuses to? And who clearly wants you to touch his dick and butthole multiple times per shift? Nah, you're gonna sit in that shit, buddy. Nobody will care enough (nor get paid enough) to deal with that, no matter what the doctors or admins or supervisors say. You can't force people into rape by deception, even if you're paying them. Despite whatever the fuck Andy thinks, he's at least smart enough to know that he won't get what he wants in a nursing home or psych ward.
Edit: Oh and the nurses/RNs are just there to pass meds, check vitals, and do stuff like cognitive screens after some 90 year old crashes out and slams his head off the floor because despite being a fall risk and you telling him 100 times to sit down he tried to wander away. Point is they are NOT going to be elbow deep in Andy shit, either.