Researchers in Australia have been putting some serious thought to sexuality in nursing homes, and their conclusions are less than heartening: Nursing homes are cockblocking their residents. A combination of liability concerns, ageism and logistics issues make it well-nigh impossible to get it on in a nursing home, and this, advocates argue, abridges the rights of nursing home residents.
Sex in healthcare settings is something that makes many people uncomfortable. Residents of long-term care facilities, including not just older adults but people with disabilities, are often assumed to be disinterested in sex. In addition, people think they lack the capacity to consent to sex, or the ability to make sound choices about sexuality. Consequently, they’re denied opportunities for healthy sexuality, sometimes even through the use of medications designed to limit libido. Many staff members don't even consider sexuality as an issue they should incorporate into patient care.
The study notes that older adults in their own homes can and do enjoy healthy sexual relationships, but when they move into long-term care, the opportunities dry up, so to speak. One reason for that is worries about legal liability and duty of care; nursing home staff are concerned that relatives might be angry, that abuse might go on during their watch, or that a patient who lacks the capacity for consent might be pressured into a sexual relationship.
There are also more practical concerns about issues like privacy and safer sex. Nursing homes by nature are not very private places, which makes them poor environments for sexuality. Legitimate safety fears also arise when dealing with people who may have disabilities associated with aging, or could be prone to serious injuries.
Ageism plays a key role in all of this, though. The assumption is that old folks don’t have sex, and thus no one’s put any consideration into how to enable healthy consensual sexuality in nursing homes. When patients do develop intimate relationships and want to take them to the next step, staff are often shocked and confused about what to do next, and the response is, by nature, frequently patronising.
Staff get to decide whether an older couple should be sexually active, because they control the environment to a very high degree. And in some cases, staff members argue it’s not safe for a couple to be sexually involved not because they’re worried about capacity and health, but because they think it might be “bad” for the participants. What happens when they break up, say, or what happens when the partners have an unequal emotional investment?
The thing is, these are things people outside nursing homes deal with on a daily basis when they make calculated decisions about sexual relationships and intimacy. Older adults in nursing facilities were once making those decisions on their own -- and if their medical records indicate that they have capacity, they can still make those decisions. Being in a nursing facility doesn’t mean you’re incompetent, and in fact many nursing home residents have full decision-making capacity. Even being in the early stages of dementia or Alzheimer’s doesn’t preclude sexuality.
For residents with dementia, “sexuality is viewed with even greater anxiety, either being labelled ‘inappropriate’ or a ‘challenging’ behavior or as a risk to the resident,” the authors note. But dementia isn’t an all or nothing proposition, and there’s nothing “inappropriate” about people in the early stages of dementia (and Alzheimer’s disease) continuing to be sexually active.
“Grey’s Anatomy,” of all things, tackled this issue with a storyline last season where Richard puts his wife Adele in a long-term care facility because he can no longer care for her at home. Adele falls in love with another patient, and the nursing home staff basically ask Richard to make decisions for his wife about her sexuality. Which, gross. Ultimately, Richard says Adele needs to make her own decisions, and while it pains him to see his wife with another man, that’s what ends up happening.
This kind of scenario rarely actually plays out, though, because there are so many barriers between the realisation that there’s an intimate relationship and the consummation of that relationship. Relatives absolutely are informed about what’s going on, and ultimately, they and the nursing home staff get to decide whether an older adult with the capacity for decision-making is “allowed” to act on feelings of attraction. Usually, the net decision is that it wouldn’t be safe or advisable, and the lovebirds are kept apart. Even though they're grown adults with the ability to make decisions for themselves.
Older adults like to have sex. Sometimes lots of it. It’s an issue that is going to come up in nursing homes, and the current approach of simply dodging the issue clearly isn’t going to work. Instead, long-term care facilities need a framework in place that respects capacity and autonomy, with a clear mechanism for confirming that residents are able to make decisions and are not being pressured or coerced into sexual relationships. And that mechanism needs to include a method for providing space for healthy sexuality -- and for the emotional processing some partners may need, as well.
Because, yes, people break up in and out of nursing homes, and it can stimulate intense emotions. Acting like older adults aren’t capable of handling these feelings or should be protected from them is bull dookie.
Meanwhile, nursing home abuse continues unabated. Older adults are very vulnerable to abuse from patients and other staff, particularly if they have mobility impairments or cognitive disabilities, and sexual assault rates are worryingly high. Concerns have been raised about suspicious deaths among seniors that may be the result of abuse which goes unidentified because no one orders an autopsy.
At the same time nursing homes develop active plans for dealing with sexuality, they should be considering ways to check the rising abuse rates that actually endanger their residents.