INTIMACY IN LTC
Lisa Pezik
RN, BScN
Clinical
Educator
OBJECTIVES
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Engage in our own beliefs via fact vs. myth survey.
Define terms of intimacy and sexuality.
Discuss barrier to holistic care implementation.
Evaluate consent vs. risk.
Discuss appropriate interventions.
LET’S DEFINE
 Sexuality
 What does it mean to you?
 Defined as “the way someone is attracted to another being.”
 Defined as the “quality of being sexual.”
 Intimacy
 What does it mean to you?
 Defined as a “close, familiar and usually affectionate or loving
personal relationship.”
 Sexual Behavior
 What does it mean to you?
 Defined as the “manner in which humans experience and express
their sexuality.”
LET’S WATCH
 The Jordan’s seven year story about a devoted husband who
deals with his wife’s worsening Alzheimer's.
http://youtu.be/16at-Zi8fUs
LONG TERM CARE
 What kinds of sexual behavior do we see?
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holding hands,
kissing and hugging
self-stimulation
exposing oneself during personal care
Pornographic materials
Boyfriends/girlfriends that are not spouses
Sexual activity
 What do we know?
 Residents need assistance with making decisions.
 Dementia symptoms are defined by having a change in judgments and thinking.
 What are we tr ying to learn?
 Residents express themselves in an attempt to find meaning and security in an
unfamiliar and confusing environment.
LET’S WATCH
 Clip from the movie “Away From Her.”
http://youtu.be/AqKpGR4EocU
CHALLENGES IN LTC
• Resident
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Lack of privacy
Lack of a willing and able partner
Attitudes of family
Adverse effects of medications
Feelings of being unattractive
Physical limitations
Cognitive limitations
Erectile dysfunction
• Staf f
• Personal beliefs
• Cultural values
• Legalities and practice standards
WHAT IF…..
 …..It was normalized.
 …..There were consistent policies, practices, and procedures.
• "Sex is a natural, wondrous experience; it should be open to
everyone.”
~ Anne Abbott, a Toronto artist who has cerebral palsy.
• “When people are fed and clothed, then they think about sex .”
~K’ung Fu-Tzu (Confucius)
• “There is hardly anyone whose sexual life, if it were broadcast,
would not fill the world at large with surprise and horror .”
~ Somerset Maugham
LET’S WATCH
 This animated clip attempts to dispel the myth about elders
and romance.
http://youtu.be/6vErM3OZQzA
FACTS
 Statistics in North America ( Messinger & Rappaport, 2003).
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Ages
Ages
Ages
Ages
57-64- 73% are sexually active
65-74- 57% are sexually active
75-84- 26% are sexually active
84-95- 35% reported masturbation
 In LTC
 250 residents in a LTC home, 8% stated they were sexually active and
17% stated they would like to be but lacked the opportunity. ( Hajjar &
Kammel, 2003).
 An increase in libido is reported in about 14% of those elderly with
dementia. (Cummings & Victoroff, 1990).
 42 staff in LTC interviewed and found that masturbation and
exposing of genitals was equal to physical aggression in terms of
staff distress. (Lantz, 2010).
LEGALITIES: CONSENT VS. RISK
http://youtu.be/FZvY890zI0c
 Supporting Documents
 Healthcare Consent Act
 We cannot take away decisions.
 Bill of Rights
 Lifestyle Choices
 ”Every resident has the right to have his or her lifestyle and choices respected."
 Intimacy
 Every resident has the right to meet privately with his or her spouse or another person in a
room that assures privacy."
 Respect and Dignity
 "Every resident has the right to be treated with courtesy and respect and in a way that fully
recognizes the resident's individuality and respects the resident's dignity.”
CONSENT AND CAPACIT Y
 Implied and can be expressed verbally or non -verbally.
 Risk must be monitored and re -directed but not denied unless
unwanted.
 Goal is to reduce any harm.
 A few questions for determining competency in a relationship
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Is the resident aware of who is imitating the relationship?
Can the resident state what they are and aren't comfortable with?
Does the resident realize this relationship may be time -limited?
Can the resident describe how they will feel if the relationship ends?
Is the relationship rooted in any past practices?
http://youtu.be/EdxnFXQId-0
TEAM HUDDLES
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Interdisciplinary team
Develop a care plan
Can be discussed upon admission and “Getting to Know You.”
Discuss:
Description of the event.
Assessment of competency.
Beliefs and Values of resident, family, staff.
Any differences in staff beliefs and is their a compromise to ensure
consistency?
 What are the parameters that the team agrees will occur?
 Discuss specific interventions based on classifications.
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CLASSIFICATIONS AND INTERVENTIONS
 Level I- Intimacy/Courtship Behaviors
 No risk.
 Provide privacy, comfort, assurance to both individuals in the
relationship and the other spouse if applicable.
 Conversation must be had with the family and their level of comfort.
 Level II- Verbal Sexual Talk
 Low level risk.
 Staff must be aware of own discomfort.
 Re-direct in socially appropriate conversation.
 “Hey baby, I’d like to take you behind a bush and put a smile on your
face.”
 “No. Thank you. They have done a lot of landscaping outside and it looks
wonderful.”
CLASSIFICATIONS AND RISK
 Level III- Physical sexual behaviors directed towards self or co residents in agreement .
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Moderate Risk
Observe for signs of unwanted intimacy in a co -resident.
Engage family in comfort levels if resident unable to discuss.
Creative solutions that provide dignity and privacy.
 Level IV- Unwanted, overt physical sexual behaviors directed
toward others
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High risk
Assess the root cause and attempt non-pharmacological first.
Referrals and medication may be necessary.
Behavioral documentation and team meetings.
CONCLUSION
 Re-evaluate values and beliefs
 Questions?