Sexual Expression in Nursing Homes and Care Communities

How can care staff support the right of residents living in nursing homes and care communities for sexual expression? Discussions surrounding sexual expression by residents living in care communities and in nursing homes should occur more often but do not.

Care staff often discovers themselves in embarrassing situations or without knowledge of how to appropriately respond to situations where residents may be engaging in sexual expression.  Is sexual expression a resident’s right?

How might care staff become more informed about the different types of sexual expression and provide support to residents rather than giving dirty looks or making inappropriate comments about “dirty old men”?

A care community founded in 1917 leads the charge with respect to encouraging sexual expression among residents.

A 2013 article in The New Haven Register reports that Hebrew Home in Riverdale, NY broke with industry practice by encouraging sex and intimacy among its elderly residents, including those with Alzheimer’s and forms of dementia.

In 1995, the home adopted a four-page policy supporting sexual expression by residents.³   Attorney Evelyn M. Tenenbaum has also been an avid supporter of the rights of sexual expression and intimacy.

According to an interview with Gayle M. Doll of the Kansas State University Center on Aging, few care facilities have implemented policies or training programs directing staff response to residents’ sexual expression.

A study by AARP reported that 75% of those aged 70 and older reported engaging in sexual activities like kissing, hugging, touching, caressing, sexual intercourse, self-stimulation, or oral sex.¹

An animated video by Terra Nova Films, Inc. called “Backseat Bingo” dispels perceptions about sexual expression and romance among older adults. Click Here to Watch the Video.

Hindrances to supporting sexual expression exist in care communities by way of community design. Shared rooms in nursing homes, care staff walking in and out of rooms without knocking and a lack of private rooms inhibits privacy.

Establishing private, uninterrupted space and time is challenging. The old “hat on the door” trick brings unwanted attention to residents attempting to establish a routine of privacy.

Providing special rooms for sexual activity also brings attention to individuals who may reserve these rooms. Staff and residents’ perception of “we know what you’re doing,” inhibits personal dignity.  Resident gossip creates challenges.  Resident jealousy, especially in communities where female populations are abundant and there are a limited number of men, creates issues in maintaining privacy related to sexual expression.

Remember the competition related to dating the most popular boy in high school? The situations bear similarities. Community gossip spreads no matter how private individuals may attempt to keep personal relationships.

Resident’s rights, the ability to provide consent, and family involvement also pose concerns. For care staff, the concern of honoring rights versus ensuring that residents are not forced into sexual encounters against their will is a concern.

Family members become problematic when asking staff about the sexual exploits of consenting parents because of rules of confidentiality. There are also assumptions that individuals diagnosed with dementia lack the power to make decisions regarding sexuality.

Executive directors and administrators must lead the charge in changing staff perceptions and reactions to sexual expression by residents.  By establishing written guidelines and providing training, care staff will become more comfortable in addressing sexual expression as a matter-of-fact occurrence rather than finding themselves in embarrassing situations or in participating in community gossip about sexual partners.

Mention of sexual expression policies in community admission documents are solutions to address family boundaries relative to the rights of parents living in communities.  Avoiding discussions about sexual expression in care communities will not solve the problem.  Utilizing guidelines established by Hebrew Home may be a good starting point for discussions about supporting sexual expression and residents’ rights.

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References:

1 Cornelison, Laci J. Et. Al. (2012) Management of Sexual Expression in Long Term Care: Ombudsman’s Perspectives. Gerontologist Vol. 53, No. 5. 780-789.
2 Doll, Gayle M. Sexuality in Nursing Homes. J of Gerontological Nursing, 39 (7), 30-37.
3 Gruley, Bryan. (2013) Permitting Sex by Geriatrics sets Hebrew Home Apart. New Haven Register, 7/29/13.
4. Backseat Bingo Video http://youtu.be/6vErM3OZQzA

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