Unit 16
For many older Americans, entering a long-term care community means giving up their independence, their homes, their livelihood, and many of their favorite possessions. Often adding to these major losses is the perception that the freedom and privacy to express their sexuality has also been lost. Because society tells us that sex is for the young and healthy, it is mistakenly assumed that sexual desire dwindles after a certain age. Sexual expression by residents in long-term care facilities is often misinterpreted as a behavioral problem, but it may be a sign that an important basic need—the need for human touch, closeness, and intimacy—has been overlooked.
Legally, residents of long-term care facilities are entitled to express themselves sexually as long as sexual expression is:
a.) not a public display,
b.) is consensual between residents, and
c.) does not harm the resident or others.
However, barriers remain, and for many residents, appropriate sexual expression may be prevented by lack of privacy, physical and mental health status, lack of institutional policies and procedures, and staff or family intervention.
Responsibility for Residents’ Rights
In response to the often-sensitive issue of geriatric sexual expression, some facilities have established firm policies and procedures to ensure that staff support residents’ rights.
In the early 1990s, the research department at the Hebrew Home for the Aged in Riverdale, NY, decided that it needed to formalize resident rights to sexual expression and created a sexuality work group composed of social workers, psychiatric nurses, therapeutic recreation specialists, researchers, residents’ family member representatives, and religious representatives to establish policies and procedures related to sexual expression and residents’ rights. The current policy specifically outlines residents’ rights to privacy, sexual expression, and intimate relationships, as well as delineates staff and facility responsibilities in upholding these rights. With the aid of a $250,000 grant from the New York State Department of Health, the Hebrew Home also produced a training video, “Freedom of Sexual Expression: Dementia and Resident Rights in Long-Term Care Facilities,” which presents both appropriate and inappropriate sexual expression and has since been sent to all long-term care facilities in New York State. The video introduces the importance of each facility having residents’ rights policies related to sexual expression and the responsibility of staff in upholding them.
Additionally, the health benefits of sexual expression and intimate relationships for geriatric residents are being realized. “As people age, they do not lose their need for intimacy, and in fact, because of losses due to nursing home placement, declining health, and lifestyle changes, the need for intimacy may even be greater,” notes Catherine C. Bradley, MSW, LCSW, ACSW, a long-term care social work consultant for nine years. “An intimate relationship with another resident can enhance self-esteem and well-being.”
The resident’s happiness and quality of life is important. Dessel adds, “Warmth, closeness, and touching with another resident can alleviate the profound loneliness that affects many long-term care residents.”
And, residents are not necessarily seeking only sexual gratification. “They are seeking comfort, companionship, and human touch to combat feelings of loss and isolation,” says Janis Lyons, LCSW, a geriatric social worker at the Motion Picture & Television Fund (MPTF) long-term care facility in Woodland Hills, CA. “This expression is vital for their emotional and mental health. It enhances the quality of the remainder of their life.”