Hot Topic: Nursing Homes for Sex Offenders & Violent Offenders

How Iowa case could change elders' sex rights

4-24-15 Iowa:

Iowa — A 78-year-old Iowa man's sex-abuse trial should prompt serious discussions about addressing the sexual needs of the elderly while preventing those most vulnerable from abuse, state and national experts said.

"You've got all this attention on this — so now is the time to make changes," said Gayle Doll, director of the Center on Aging at Kansas State University.

A jury on Wednesday acquitted Henry Rayhons, a retired farmer former state legislator, of sexual abuse for allegedly having sex with his wife after staff members at her nursing home in Garner, Iowa, warned him her Alzheimer's disease had left her unable to consent. He denied any wrongdoing. The unusual trial drew extensive national media coverage and debate.

Doll said the case highlights the need for care centers to set clear, specific policies on the subject, and to talk in detail with families about the issue.

Too many adult children still don't want to admit that their elderly parents have sexual desires and needs, even if short-term memory and other brain functions deteriorate, Doll said.

"There was a freak-out factor in this case," she said.

Doll is a member of the Leadership, Aging and Sexuality Consortium, a national group that encourages improvements in such policies. She said research increasingly shows that many elderly people retain a desire for intimacy, including sex, long after other functions have declined.

"With dementia, you lose so much," she said. "Shouldn't you be able to keep this one thing that fulfills a need?"

Rayhons testified that his wife, Donna, continued to show interest in what she termed "play," which included fondling him. He denied from the witness stand that they had intercourse at the nursing home. He told a state investigator last summer in a secretly recorded interview that he did try to have intercourse with her at least once, but he testified that the agent induced him into making false statements.

Doll said there are situations when it would be inappropriate to have sex with a person who has dementia. For example, she said, people who are catatonic obviously could not give consent.

Those in earlier stages of dementia can generally show displeasure, she said. For example, they can indicate they don't like the taste of food. Most should be able to show they don't like certain touches, she said.

ASKING UNCOMFORTABLE QUESTIONS

Des Moines geriatrician Yogesh Shah said he plans to start asking more specific questions on the subject as a result of the Rayhons case.

Shah, who also teaches medical students at Des Moines University, said the conflict in the Rayhons family might have been avoided if medical professionals had talked in depth to Donna Rayhons about the issue before her dementia worsened.

A doctor could have asked her specifically about her desires and whether she wanted her husband to continue being intimate with her as long as she wasn't suffering physical or psychological harm, Shah said.

Such discussions might be uncomfortable, he said, but that shouldn't be a problem for medical professionals, who discuss all kinds of uncomfortable things.

Shah did not testify in the Rayhons trial, but he said he agreed with defense experts who said standard tests of short-term memory don't measure other functions, including the ability to consent to sex.

"They're really in different centers" of the brain, he said.

He added that conflict is probably more likely if a situation involves a couple such as the Rayhonses, who married each other after their longtime spouses died.

Families are less likely to have qualms about a couple continuing to be intimate if they've been married for many decades, he said. That's why he considers it especially important to have an in-depth discussion with families of elderly couples in second marriages.

THE RIGHT TO INTIMACY

Shah and Doll both said nursing homes should do more to respect their residents' need for privacy so they can be appropriately intimate. Doll said more nursing homes should shift toward putting as many residents as possible in single rooms, although she acknowledged it would be difficult and expensive to retrofit existing facilities with double rooms.

Shah said care centers also could set up other private spaces where couples can be alone. "We have quiet places for chapel or meditation," he said, so why not for intimacy?

Elizabeth Barnhill, executive director of the Iowa Coalition Against Sexual Assault, said care centers have a tough job balancing the need to let residents be intimate with the need to protect those who are vulnerable from unwanted advances.

But Barnhill said she believes many nursing homes could do more to ensure residents, families and staff members understand the boundaries.

Barnhill cited her own family's experience. Her father died of Alzheimer's disease, and her mother now has dementia and is living in a care facility. Staff members have talked to her about all kinds of issues, including what type of activities her parents would be interested in.

"But in no place in the many, many, many documents I've signed, have I ever been asked about this," she said of the issue of sex.

PROTECTING THE VULNERABLE

Barnhill's mission is to prevent sexual abuse, and she believes that Iowa could do more to protect vulnerable residents, including those who unwittingly live in care centers with convicted sex offenders.

Nursing home staff should step in if they see signs that someone is having sexual contact with a person who doesn't want it or who is clearly incapable of deciding, she said. But staff members shouldn't limit residents' legitimate right to have appropriate intimate contact, she said.

"They shouldn't assume that every time they see someone having sex, it's an assault," she said.

Better staff training and frank discussions with residents and their families could help clarify the issue, but she's unsure if such steps could have prevented the situation in Garner.

"I have empathy for the families on both sides of this case," she said. "It just sounds excruciating." ..Source.. by Tony Leys, The Des Moines Register

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