The National Center for Assisted Living (NCAL) has created a checklist to help assisted living communities address issues regarding sexual consent among residents. The checklist aims to strike a balance between resident confidentiality, rights, and safety and includes considerations for state requirements, ability to consent, employee awareness/training, appropriateness of the relationship, family, harassment/bullying, and special considerations for inappropriate relations between employee and resident.
The factors associated with physical intimacy and sexual consent among residents in long-term care can present themselves as endless. From the ascending scale of intimate acts (beginning at handholding and ending with intercourse) to the cognitive impairments that can muddle sexual consent, a black and white policy could not begin to accommodate all conceivable scenarios.
“It’s much better, in my opinion, that you not have a policy that tries to fit or address every situation. Instead I think that if a procedure can be put in place that would give some guidelines for how the staff should handle [physical intimacy among residents], I’m all for that,” says Craig Fukushima, MBA, NHA, former nursing home administrator and a partner in The Fox Group, LLC.
He also points out that choosing an overreaching policy to dictate such unpredictable events could potentially create more problems for the facility. “If you write a specific policy and the health department comes in on a survey or complaint, they’re going to hold you to that policy.”
Instead, educating staff about how to handle intimacy among residents appropriately can increase facilities’ quality assurance and customer satisfaction when this knowledge is applied correctly.
If staff notice that residents have started to become intimate with each other or with a visiting significant other, Fukushima suggests addressing the situation by following these three steps:
- Speak with the resident(s) to determine their level of cognitive impairment and the possible effects intimacy has had on him or her. Evaluate: Is the resident happy? Is the resident acting violated and confused?
- Consult the resident’s physician for professional information regarding his or her cognitive and physical state. Is it safe for the resident to participate in sex and is he or she able to make that decision?
- Discuss the situation with family members, particularly the member assigned as the resident’s power of attorney.
Some family members may feel very uncomfortable (if the resident is a parent) or even devastated (if the resident is a spouse who has become intimate with another resident). It’s important for staff to approach the subject with empathy and understanding, while always keeping in mind what’s best for the resident (which may not necessarily be what’s best for the “well” spouse).
Staff can also recommend that the family member(s) talk to a social worker or psychologist, or join a support group if they’re having trouble coping with or understanding the situation, says Kerry Mills, MBA, a dementia coach for Engaging Alzheimer’s LLC. “Make these conversations as least awkward as possible and bring it back to how this affects the well-being of the resident,” she says.
Determining how best to address intimacy in a long-term care setting is prominent today and its relevance is only expected to grow with time. “People living in long-term care now are traditionally the same people who have been married for 40 to 50 years and have never been divorced. Their whole lifestyle is different from the lifestyle of the people we’ll be caring for in ten years,” says Mills.
She is referring to the complex culture changes transforming our nation in the form of a sexual revolution. Residents entering long-term care 10 years from now will be accustomed to a much wider social acceptance regarding sexuality—an acceptance that doesn’t always translate to thoughts of the elderly. This form of ageism discredits physical intimacy as a core individual right that carries on into old age.
“Everyone has a part in removing the misconceptions and taboos about this subject,” says Fukushima.