Sex in a Nursing Home? A Dementia Care Unit? ALF?

While it may be a difficult subject to address, sex in a nursing home or other long-term care setting for seniors is more common than you might think. This blog post discusses the ethical, moral, and legal issues surrounding sexual activity among dementia patients.

Sex in a Nursing Home? A Dementia Care Unit? ALF?
Sex in a Nursing home

Nobody thinks about it until it happens: sex in a nursing home! But it’s not just nursing homes; senior living sex could be any long-term residential setting for seniors like a board and care home, assisted living community, or a dementia care facility.

A recent article in, author Brian Gruley describes a growing trend of older adults in care facilities or with dementia continuing to be sexual active. However, with Alzheimer’s, reason and discretion are no longer reliable. Dementia sufferers are merely following their instincts, and for them sex is no less a craving than say, sweets. Some still want to experience sexual relationships. Remember, a person suffering from dementia may still have long term memory, as well as experience disinhibition.

Studies show that even people with dementia have a need to be touched and have intimate encounters. Here is a visual that gives you an overview of the baby boomers and sex in the aging years, even in residential aged care facilities. Take a look at this research from Bloomberg and the New England Journal of Medicine: Let’s talk about sex in a Nursing Home.

Sexual relationships of nursing home residents

The first issue that needs to be addressed is that the nursing home industry is not, but should be prepared for this issue. It is not a new problem. Sex in nursing homes has been occurring for years. There is always one little lady or elderly gentleman in every home that the staff will find in someone else’s bed, fondling another resident or even kissing. The staff tries very hard to keep these residents apart and is usually distressed at being unsuccessful.

There should be a right to have consensual sex between two consenting adults, even those with dementia.

More on Sex in a Nursing Home

I have met some spouses that actually divorced their spouse with dementia, because they resident with dementia no longer remembered they were married and had found a new love in a nursing home. In fact, Sandra Day O’Conner actually divorced her husband of 50 years after she placed him in a dementia unit. He no longer remembered her and their life long relationship, and actually fell in love with another resident at the dementia care unit. But Mrs. O’Connor didn’t divorce out of anger; she did so to free both of them to live their own lives.

I have also had experiences when family members have moved the dementia patient to another home to avoid this type of situation. I think the sad thing is, so many family members have a difficult time addressing the topic of “sex” let alone “sex” in the aging population with dementia. People don’t understand that it’s really not about sex; it’s about touching someone, being touched by someone, having a person acknowledge that they exist. Sex may be the end result, but you could bring up the issue with the parties and they wouldn’t know what you were talking about.

This is a difficult subject that needs to be addressed with every family, in every nursing home in the country. There are ethical, moral and legal issues that are facing the nursing home industry. It is a problem that is not going away. There are patient rights given to every resident as they are admitted to a nursing home. This paper work should include a Sexual Rights Consent, as well. This is a subject that should be addressed upon admission and continued to have those ongoing discussions as needed.

In fact, if the time comes when I need a nursing home, I hope I will be able to be admitted to the Hebrew Home in Riverdale, NY. Here are the set of guidelines they offer to the residents regarding sex and intimacy. Here is the copy of their sexual assessment and consent

I am not making light of this subject. Dementia robs an individual of their short term memory, their impulse control but may not rob their need for touching and intimacy. It is time that this issue is addressed and taken seriously .The Hebrew Home addresses this issue with grace and dignity. Other facilities should take notice. This issue is not going away and is going to be a growing problem.

You may read the entire article here

More on the sex lives of seniors

Helping People with Dementia Meet Sexual Needs

People with dementia have sexual needs, just like everyone else. It's important to acknowledge that sexuality contributes to a person’s identity and sense of self, making it critical to person-centred dementia care. For many people with dementia, maintaining or developing a sexual relationship can enhance their wellbeing.

However, there is often confusion around appropriate and inappropriate sexual behaviour, which varies depending on the values of staff and relatives. When identifying problems with sexual expression in dementia patients, it's best to first find out what's really going on. Sometimes, these problems stem from other people’s prejudices, preconceptions or misunderstandings, which unfortunately get imposed on those with dementia.

These are my parents. This photo was taken Christmas and even though my mom squeamishly refused to kiss my dad, my dad took the opportunity and this photo was the result.
Senior Living Sex may be more about intimacy 

For example, some younger people may assume that nursing home residents don't have sexual needs or that engaging in sexual behaviour is abnormal. This is not true. Many older people are sexually active and may only be less so due to a lack of a partner or health problems.

It's also important to avoid judging the appropriateness of a person’s behaviour based on our own personal preferences or standards. For instance, religious beliefs may view homosexuality as ‘wrong,’ but we cannot let that view lead us into condemning a person’s natural sexual preferences as inappropriate. We need to be open-minded and inclusive always.

Sometimes a person with dementia will have genuine problems with sexual expression caused by the disease. A person might have difficulty in judging what is acceptable and what isn’t, resulting in acting on their sexual desires without regard for where they are or who they are with.

However, sexual expression in dementia patients may also occur because of other needs, such as a need for closeness, comfort, or boredom. Identifying these needs communicated through apparently sexual behaviour is essential as this helps us identify ways to address these needs.

If you suspect that a person with dementia lacks the mental capacity to consent, you should raise concerns with social and health care staff. However, even with dementia, the person should be assumed to have the capacity to make decisions. This means that existing and new relationships should be allowed if the person has the capacity to consent.

Therefore, it's crucial to talk to people with dementia and their partners about sexual matters with open-mindedness, non-judgmentalism, and total respect for their privacy.

If we have concerns about a person’s sexual behaviour or their ability to avoid exploitation, we may need to engage in a multidisciplinary discussion with other professionals and carers who are involved in the person’s welfare.

Sex lives of seniors 

Having a healthy sex life in a nursing home or dementia care unit is not only possible, but it can be important for both the physical and emotional wellbeing of residents. However, there are certain legal and medical repercussions to consider before engaging in any sexual activities with another resident.

When discussing senior living sex in a nursing home or rest home, it is important to remember that all sexual activities must be consensual. Residents should not feel pressured into engaging in any type of sexual activity that makes them uncomfortable. It's also important to remember that the staff and other residents may be affected by the presence of two people engaging in sexual activities, so appropriate boundaries should be set.

In addition, it is important to consider the medical implications of engaging in any type of sexual activity. Residents should speak with their doctor or healthcare professional about any concerns they may have about engaging in sexual activities so that appropriate precautions can be taken.

Lastly, keep in mind that different nursing homes and rest homes will have varying policies regarding residents' sex lives. Make sure to check with the facility administrator or staff to make sure that any sexual activities are compliant with local laws and regulations.

Addressing the Complexities of Sexuality in Nursing Homes

Sexual Activity Among Elderly Residents: A Growing Reality

The topic of sex in nursing homes and long-term care facilities remains a delicate and often taboo subject, yet it is an undeniable reality. According to the National Poll on Healthy Aging, sponsored by AARP and the University of Michigan, approximately 40% of individuals between the ages of 65 and 80 remain sexually active. This statistic challenges many preconceptions about sexuality in the elderly population.

The situation becomes particularly complex in the context of residents with dementia living in Residential Aged Care Facilities (RACFs). Staff members often find themselves in a difficult position, trying to balance the rights of residents to express their sexuality with their duty of care. This balancing act is complicated by the fact that current legislation offers little guidance, especially regarding the consent of residents with dementia.

Proactive Approaches in Facilities

Some facilities, such as the Hebrew Home in New York, have adopted proactive measures to support the romantic relationships of residents. Understanding that intimate relationships are a right, they facilitate private spaces and adopt privacy-centric policies. This approach is not only humane but also respects the dignity of residents.

Continued Spousal Relationships

Research, like that published in the journal Topics in Geriatric Rehabilitation, has shown that spousal relationships can continue to thrive even when one partner is institutionalized, defying common assumptions about the end of marital intimacy due to institutional living.

The Need for Policy and Training

The lack of formal policies and training regarding sexuality in nursing homes is a significant issue. As Gayle Doll, director of the Kansas State Center on Aging, notes, sexual expression can range from compliments to physical intimacy. Facilities are increasingly recognizing the need to help residents navigate these aspects of their lives in a comfortable and safe manner.

Mental and Emotional Benefits of Intimacy

Intimacy, including sexual relations, does not have an expiration date. Geriatric psychiatrist Ken Robbins emphasizes the importance of social connections and human touch in warding off depression and loneliness, which are common in old age and institutional living.

Complexities with Dementia

More than half of nursing home residents suffer from Alzheimer's disease or other forms of cognitive impairment. This raises complex questions about consent and appropriate behavior, especially in cases where dementia leads to disinhibition.

Family Dynamics and Emotional Impact

Relationships in nursing homes often involve more than just the two residents. Family members, including non resident spouses and adult children, frequently have a say in these matters, leading to emotional complexities and ethical dilemmas.

Institutional Bias and Staff Attitudes

Institutional bias and personal attitudes of staff members towards sexuality among the elderly can lead to the suppression or discouragement of sexual expression. This can result in a lack of appropriate responses to situations that require delicate handling and understanding.

The Way Forward: Compassion, Creativity, and Conversation

Facilities like the Hebrew Home at Riverdale have pioneered policies that address sexual expression among residents, emphasizing the importance of whole-person care and compassion. This involves not only acknowledging the sexual needs of older adults but also providing appropriate accommodations and staff training to support these needs.

In conclusion, the issue of sex in nursing homes encompasses a range of complex factors, including consent, cognitive impairment, institutional policies, and family dynamics. Addressing these challenges requires a compassionate, informed approach that respects the rights and dignity of elderly residents. As society evolves and our understanding of elderly sexuality becomes more nuanced, nursing homes and long-term care facilities must adapt to meet these needs in a sensitive and respectful manner.

Have more questions? Check out the Frequently Asked Question section of the website. You will find a lot of different questions answered directly.
Do you need help caring for a loved one?

Our Resources section can help you find the information and tools that you need. We have courses, videos, checklists, guidebooks, cheat sheets, how-to guides and more.

You can get started by clicking on the link below. We know that taking care of a loved one is hard work, but with our help you can get the support that you need.

Click here to go to Resources Section now!