Sex and the Nursing Home

11-23-2008 National:

Charles Bukowski once said that having sexual intercourse was like kicking death in the butt while singing. But for many older Americans in nursing homes, that joy is often hindered both because of the lack of privacy at some facilities and the negative attitude from staff on the topic of sexual activity among the elderly.

Before joining AAHSA, I can honestly say I never thought about the issue of sexual activity in nursing homes or how staff members deal with sexually active residents. But after reading a new study from Kansas State University, I say let’s make nursing homes more comfortable and private places for older adults to have safe, consensual sexual intercourse. After all, many of us may spend some time in one at some point in our lives.

For that to happen, says Gayle Doll, author of the study and director of the university’s Center on Aging, nursing home staff need to be educated on how best to accommodate the sexual needs of residents. Many nursing home staff do not receive education in this area, which, the researchers say, tends to cause a dismissive attitude toward residents’ sexual needs.

“We just want people to start talking about these issues,” Doll explains. “Once you start talking about it with nursing home staff, everyone has a story.”

For their research, which was presented in at our 2008 Annual Meeting in Philadelphia, Doll and colleagues surveyed staff from three Kansas nursing homes about their attitudes toward sexuality. Their goal was to find ways to make nursing home staff more comfortable accommodating the sexual needs of residents.

Majka Jankowiak and Laci Cornelison, research assistants at the Center on Aging, found that after a workshop on the topic, survey participants showed a notable change in their attitudes.
“Part of it is that American society is not supportive of older people and sex. It’s been a taboo, and it’s an even bigger taboo in nursing homes,” says Jankowiak. “After the presentation, the participants felt more confident talking about it and dealing with sexual expression of residents.”
Whether or not the general public likes to think about it, older Americans are engaging in sexual activity. According to a survey published in the August 2007 issue of the New England Journal of Medicine, roughly 53 percent of respondents aged 65 to 74, and 26 percent of respondents aged 75 to 85 years of age said they were sexually active.

However, some concerns exist about sexual activity in nursing homes. For example, the issue of consent is one that needs to be addressed as many residents live with Alzheimer’s or dementia. Beyond the possibility of these residents being victims, those conditions can alter the brain, causing a person to act in a sexually inappropriate and, sometimes, a sexually aggressive manner.

Because of that, many nursing homes err on the side of caution, Daniel Engber, an editor at Slate, writes in his article Naughty Nursing Homes. According to Engber, “The most liberal institutional policies on sexual contact (pdf) call for psychiatrists or social workers to review each situation and decide whether the participants are capable of saying no. Another approach uses a standardized test of mental state, with a minimum score required for consensual sexual activity.

As a result, a patient with advanced dementia can summarily lose her right to have any sex whatsoever.”

In the film Freedom of Sexual Expression: Dementia and Resident Rights in Long-Term Care Facilities, Dan Reingold, executive director of Hebrew Home for the Aged at Riverdale, says, “It’s absolutely critical that long-term facilities have written policies and procedures regarding sexual expression, particularly dealing with residents who have dementia because there are so many ethical issues that arise in connection with persons with dementia.”

Focusing on the education aspect of the issue, the Kansas State researchers suggest that staff must be able to deal with both appropriate and inappropriate sexual situations “without residents feeling embarrassed.”

According to Doll, the researchers are advocating for federal guidelines to help all nursing homes deal with sexuality in a positive way. In addition, they are developing materials to help family members deal with questions about their parents’ safety or how a new relationship will affect the family or their inheritance.

Education efforts like these, along with a little Viagra, perhaps, will allow America’s nursing home residents to kick death in the butt, while singing…as much as they like. ..Source..