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Sex in the Nursing Home

Sex in the Nursing Home


In Kentucky nursing home, an aide discovers an unmarried couple in the same bed together, naked.

In a dementia-care unit in Minnesota, one man loves fondling residents. No one has done an assessment whether the women are being assaulted or invite these advances.

Meanwhile, in Iowa, a woman complains that the husband of her roommate, not from the facility, climbs in to snuggle and have sex with his wife.

As if it was not painful enough to move aging parents into a facility for long-term care, now there is this to deal with. Children of parents in care homes are getting called about their sex lives.

Eager to avoid any liabilities, facilities are coming up with guidelines to preserve the right of residents to privately pursue sexual pleasure. This has come up in the wake of many prominent cases. At the same time, the guidelines were created to protect residents from abusive, unwanted or unsafe situations. So far when it came to facilities, only a quarter of them have policies about sexual or intimate behavior. This is according to a 2013 survey done by the Society for Post Acute and Long Term Care Medicine, or the AMDA. About fifty percent of the facilities claimed that they were in the middle of an uncertain policy or one that was still being planned.

Compared to any other field, nursing homes have higher regulations. However, when it comes to sexuality, there are almost no rules. Anything from sex, touching or compliments can be forms of sexual expression. More facilities are getting clear about the fact that this is an issue that people think about. Perhaps it is time to find methods that help people become more comfortable.

Indeed, there is no expiration date when it comes to sexual relations. This could include fondling, flirting, hugging and attraction. At this point people go back to romance as they knew it in their twenties. You generate excitement out of life without having to go bungee jumping, so to speak. Human touch and social connections help ward off loneliness and depression that institutional living and old age brings.

According to the Alzheimer’s Association over half of the residents in a nursing home have a form of cognitive impairment including Alzheimer’s disease. Sometimes, people that suffer from dementia lose their inhibitions. Other times, there is a lack of inhibitions in those that are suffering from front temporal dementia before other issues of cognition are revealed. Thus, individuals can still think well. In a not-too exciting place, they might be trying to find ways of having something to look forward to each day or how to have fun. For example, flirting with the gent at the dining hall or with the new lady in room 260.

If a person can barely speak or balance a checkbook, are they able to consent to sex? Or is sex a pleasurable appetite like eating that enables a person to indulge. Who decides what is appropriate or safe? Dementia is the reason most minor dilemmas develop in full blown issues.

Personal and Institutional Bias

Sometimes, staff members are repelled by or disapprove of thinking about older adults having sex in the nursing home. Often, administrators decide whether it is easier to actively discourage or ignore sexual expression. In a case that happened in 2011, a Minnesota care unit called Keystone Communities involved a man fondling six women. Rather than assessing whether the event was consensual, they banned all nudity, caressing and kissing. The facility was cited by the state for not being able to report potential abuse and not having policies in place or staff training.

It is not appropriate to simply disallow something. It is equally not appropriate to state that this is not complicated. The situation simply needs to be evaluated in one way or another.

For behaviors such as innocuous cheek kisses, there is a warrant for guidelines. If people that get kissed don’t feel comfortable, there is an issue. This is according to a Kentucky care-based center called Trilogy Health Services.

Family Emotions

In a nursing home, couplings involve more than just one couple. Many times, adult children and spouses not in the facility can make decisions for their elderly relative. Family members might not agree on what is best for mom. Most don’t even want to think about the sexuality of their parent. When they don’t like what is going on, they are usually the ones that voice their opinions.

In 2014 at the Garner, Iowa Concord Care Center one sad case unfolded. Seventy-nine year old Henry Rayhons, former representative of the state was charged with sexual abuse in the third degree for having sex with Donna Lou, his wife. According to the care center, she was not capable of giving consent due to her Alzheimer’s disease. Her daughters echoed her claim. A week before her husband was charged, she passed away. The family stated that when continuing his marital relationship was called a crime, this seemed quite unnatural and illogical as well as very emotionally trying. The Rayhons were found not guilty by the jury in April.

New Changes in Conversation, Creativity and Compassion

Riverdale, New York’s Hebrew Home was the first to create a policy for sexual expression in 1995. Many administrators are inspired by this. They are the pioneer for changes that are being implemented today.  Here are a few of their changes:

Assessments done on a Case to Case Basis

The guidelines of the Hebrew Home distinguish between inappropriate sexual activity in the nursing home like hyper sexuality in someone with dementia, sexual abuse and crime as well as a real relationship. In denying a relationship, cognitive impairment is not automatically considered a reason.

Usually, homes apply a few principles when determining how appropriate contact is with someone that has dementia. The most widely used standard is used and this is called ‘substituted judgement.’ In this type of judgement you look at the previous decision-making style and values that a person previously including whether or not they had extramarital affairs. Another method has to do with using what dementia experts and ethicists call ‘best interests,’ considerations are then made for what is best for the person at the moment, taking into account how dementia can change personalities dramatically and at the same time ignoring past values.

Alzheimer’s patients sometimes develop a beneficial, comforting attachment to another resident and forget about their spouse who is not in the facility. Another example is a gay man who has denied his sexuality his entire life and suddenly begins a gay relationship with someone in the facility after dementia has developed. He seems fulfilled but his children and wife withdraw and become confused. What then happens when the interests of the family collide with a resident that has his or her cognition impaired? Usually, care homes go with what the families want. The final say really does come from the family as they have power of attorney and have final say.

Whole Person Care- What it Really Means

Policies made with compassion acknowledge the sexual needs that older adults still have. These include the need for touch, which is a very basic human need.

Consistent Staff Members

At the Hebrew Home, there is a consistent group of staff members that have given residents care year after year. This way, the staff members get to act as their advocate and can tell whether someone nonverbal is happy or in distress. This way, the patient’s consent can become determined better.

Assistance and Accommodations

An example of assistance and accommodations include a double rather than two single beds for a couple that is married. Mattresses can be placed on the floor with signs that say ‘do not disturb.’ Some caregivers tell of providing porn magazines, personal lubricants or filling out Viagra subscriptions. Before entering a room, the staff is taught to pause and knock.

Training the Staff

It works miracles to address these hush-hush topics, even just for one hour. Staffers are eager to know what to do and even want to discuss other issues such as LGBT. Some staff training topics include being able to determine whether to let someone participate in a relationship or knowing they are able to consent to this by creating a decision tree.

Educating the Family

It helps to involve the family. Even if this is one topic they probably want to avoid. Family orientations done at the very beginning of accepting someone new into the facility help open the door for discussions if something comes up later on. After all, it shouldn’t always be a shock for the rest of the family when something like this occurs.

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[1] Comment.
Lonjev On Jul 4, 2017

Great article on a topic that seems to be ignored too much. Training the staff is such an important one! Glad you highlighted the important issue on consent and how the staff can play such an important role. It's also important to implement privacy policies for the residents and make sure that the staff is on the same page. We wrote an article about implementing guidelines and privacy here: We hope everyone will continue this important discussion.

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