Resident Rights and Sexuality in Long-Term-Care
Presented by:
Sandra Newbauer and Daniel Tupy,
Regional Ombudsmen for Long-Term Care
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Explore perceptions of aging and sexuality.
Discuss sexual expression as a resident right.
Recognize the challenges residents with
dementia face regarding sexual rights.
Care planning to respect a resident’s sexuality
while addressing inappropriate sexual
expression.
Share resources designed to build skills
necessary to work with geriatric sexuality and
respect residents’ rights.
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“Intimacy and sexuality are basic
human needs that are intrinsic to
people’s sense of self and
companionship, intimacy and love
and yet for older people this intrinsic
right is often denied, ignored or
stigmatized. For older people with
dementia the problem is even worse:
they face the ‘double jeopardy’ of
being old and cognitively impaired.”
The Last Taboo
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A survey was conducted in Minnesota with 139 staff members in both
nursing homes and assisted living settings.
This survey was designed to help participants explore and generate
discussion on their views and attitudes towards geriatric sexuality.
*Alzheimer’s Association Adaptation
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STAFF RESPONSE
CONSIDERATIONS:
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Resident Rights
Accommodations
Safety
Liability
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CONSIDERATIONS:
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STAFF RESPONSE
Quality of Life
Dignity and Respect
History
Rights
Autonomy
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Malevolent/beneficent
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STAFF RESPONSE
CONSIDERATIONS:
“Marriage is not a license for
sex…”
Capacity
to consent –
evident preference to be with
partner.
History
Current relationship
Reaction of resident with
dementia to spouse
 Couple dynamics
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INTIMACY
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The expression of natural
desire for human connection
Emotional honesty and
physical closeness that is:
Non-genital, non-sexual
touching
 Hugging and caressing
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Is not synonymous for sex
although sex often occurs in
intimate relationships
SEXUALITY
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Sexual Contact includes
sexual touch, sexual
intercourse, oral sex and
masturbation.
Sexual Activity includes
sexual contact and other
activities intended to cause
sexual arousal (e.g. viewing
sexually explicit photographs
and videos, reading sexually
explicit text, and phone sex.)
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CONSIDERATIONS:
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STAFF RESPONSE
Prior relationship/
history.
Current relationship
Length? Prior?
 Meaningful & Respectful
 Provides quality of life
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Rights
Vulnerabilities
Safe?
Accommodations?
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Accept and acknowledge that older people with dementia have a
need for intimacy, love and sexual expression
Promote culture of acceptance, dignity and privacy
Provide space and privacy for visits
Respect that not all relationships are heterosexual
Educate staff on sexual and intimate needs of residents
Include sexual history and interests of residents in care plans
Support and facilitate regular visits in and out of facility
Provide counsel, information and support to residents
Monitor and assess capacity and medical status regularly
Adapted from Last Taboo
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STAFF RESPONSE
CONSIDERATIONS:
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History
Values, life long
preferences
Current relationship
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Reaction of resident
with dementia to
spouse
Couple dynamics
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Assess each relationship on an individual basis
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Consider residents may have varying degrees of vulnerability
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Consider the individual(s) needs and preferences when care planning
Understand the nature of relationship
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Cuddling and holding hands
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More intimate
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Sexual contact
Ensure rights and person centered planning
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Autonomy
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Dignity
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Ability to give consent
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Privacy
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Medical concerns
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Protection from harm and abuse
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CONSIDERATIONS:
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STAFF RESPONSE
Extent of relationship
Safety
Health issues
Guardian or other decision
maker
History/prior lifestyle and
wishes of each resident
Quality of life
Rights
Case scenarios: what went
wrong and what went right
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Medical determinations Acts and/or behaviors
between persons who are cognitively impaired and/or
with impaired judgment require clinical judgments
regarding the relative benefits or potential harm
associated with the resident’s sexual expression.
Legal determinations Court proceedings, guardians,
conservators or other deemed decision makers
Rights Rights are not intended to be used to abandon
responsibility to residents; they are intended to provide
quality of care and quality of life
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COMPREHENSIVE BILL
OF RIGHTS
RELATED RIGHTS
Right to be free from abuse
and neglect
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Right to privacy
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Right to share a room with
your spouse
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Right to visit outside of the
facility
Residents have these rights
providing they do not involve
nonconsensual acts, involve minors
or impact negatively on the resident
or community as a whole.
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Home Care
Assisted Living
Nursing Home
Hospice
Protected person
Alzheimer’s
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STAFF RESPONSE
CONSIDERATIONS:
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Define appears
History
Guardian or other
decision maker
Quality of life
GLBT rights
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CONSIDERATIONS:
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Define hypersexual
behavior
Was the issue addressed
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STAFF RESPONSE
Care plan
Medically
Redirection
Rights
Danger to self or others
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ASSESS THE SITUATION: Who, When, Where, What, Why and How
Who
is involved and how are they affected? Residents, staff, family, others.
Who is at risk?
When
did it happen? Time of day, when resident is alone or with others.
When has this happened in the past – day, week, month
Where
did it happen? Dining room, bedroom, outside
What
happened? Describe the actual behavior and form it takes (crying,
touching, screaming, masturbation). What interventions are needed? What
are the consequences of the action and consequence desired
How
did it happen? How could the situation have been handled differently
Why
did it happen? Identify the antecedent (trigger for the behavior and
contributing factors). Is the resident’s type of dementia as well as other health
concerns (competency, recent loss, fear, etc.,) factors?
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Define target behavior and observe
Document, assess, re-assess and re-evaluate
Do not take personally
Show kindness, patience and compassion
Redirect vs. over-react
Praise good behaviors
Set clear limits
Be consistent
Provide safety and dignity
Consider environmental factors
Involve others and resources
Review and update care plan
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Speak clearly
Have good eye contact
Don’t argue or accuse
Use a calm voice
Use “I” statements
Be positive
Be aware of your body language
Understand what the resident is trying to
communicate
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Video Clip:
Freedom Of Sexual Expression
Terra Nova Films
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Care Planning Sexual Expression
My care plan
honors my
history,
preferences
strengths…
Includes relationships,
choices, sexual
expression
I have a
quality of
life as well
as quality
of care
Sexuality impacts sense of
self, self-esteem and how
a person feels about
themselves
I am engaged
in the activities
around me
and enjoy…
I am Peter
Stanley and
my home is
Joy Care
Center
where…
Physiological
changes impact
sexual functioning
Person Centered Planning
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The need for human intimacy for most people lasts until the
end of their life (Kuhn, 2000)
Many people with dementia, particularly in the later stages,
may become less interested in sexual activity. This,
however, may not diminish their need for human affection,
touch and warmth (Bouman, 2002)
The benefits of sexual expression and intimacy for older
people with dementia are often overlooked – evidence
suggests they enhance general health and wellbeing (Kuhn,
2002)
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“Very few care plans address the sexual needs of individual
clients, despite the potential benefits to person-centered care
of this aspect of care planning (Wallace, 2003)
*The Last Taboo, A Guide to dementia sexuality, intimacy
and sexual behavior in care homes
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Sexuality, intimacy and sexual
expression is a normal part of aging.
A normal part of Life!
- It can be comforting!
-It can be wonderful!
-It can be fulfilling!
and it is inevitable.
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OFFICE OF OMBUDSMAN FOR LONG-TERM CARE
Minnesota Board on Aging
PO Box 64971, St. Paul, MN 55164-0971
1-800-657-3591
The Last Taboo
ILC–UK 11 Tufton Street
London SW1P 3QB
www.ilcuk.org.uk © ILC-UK 2011
Our Attitudes on Intimacy and Dementia
Alzheimer's Association
1212 New York Avenue, NW
Suite 800 Washington, DC 20005-6105
tel: 202.393.7737 e-mail: [email protected]
Link to Minnesota Department of Human Services
Bill of Rights website: http://www.health.state.mn.us/divs/fpc/consumerinfo/otherlang2.html
Freedom of Sexual Expression /Terra Nova Films
9848 S Winchester Ave Chicago, IL 60643
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