Why Nursing Homes Need to Have Sex Policies

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No one wants to talk about sex in nursing homes.  The need for sex doesn’t disappear with age, yet many facilities have no policy on sex and only acknowledge that it happens when there’s a problem.

“We’ll ask them about their religion, the music they like, what kind of food they want to eat.  We don’t dream of asking them about their preferences around sexuality and intimacy,” said Dr. Cheryl Phillips, a senior advocate at Leading Age.

The risks of ignoring residents’ sex lives are real.  The issue came to light in Iowa, when Henry Rayhons, 78, was charged with sexually abusing his elderly wife, and Alzheimer’s patient, while she was living in a nursing home.

When Dr. Philips was a practicing geriatric physician, she dealt with sex often.  In one case, two residents in a nursing home who both had dementia had begun kissing and holding hands, even though they were both still married to spouses who lived elsewhere. The nursing home resident’s believed the other was their spouse. After consulting with family, the nursing home decided to allow the budding relationship to go forward, since it was bringing the two so much happiness. “The lesson we took out of that is it is good to talk with families and be open about values and preferences,” Phillips said.

Elder advocates, physicians and nursing home experts say that there is no national standard of best practices for how nursing homes should accommodate residents who are sexually active.  The policies that do exist are archaic, regressive and even ageist.  They do not acknowledge that nursing home resident could happily have consensual sex with each other.

One exception is the Hebrew Home in Riverdale in the Bronx, which is a leader in progressive policies on sex. The Hebrew Home has a Sexual Expression Policy, which “recognizes and supports the older adult’s right to engage in sexual activity.”

The question of whether the elderly should be having sex is most troubling when it comes to dementia. But experts and elderly advocates say people with dementia are capable of consenting to sex, that they are able to express that consent, and that sex and touch can be good for them, which makes it difficult to know when it is appropriate to set limits. Hebrew Home’s policy is explicit that patients with dementia and Alzheimer’s can give consent to sex, either verbally or non-verbally.

Nursing homes must establish policies and must be comfortable talking about sex with residents and their families, advocates say.  “People want to have sex.  That doesn’t change merely because you have gray hair.” said Roberta Flowers. “We have got to be willing to talk about it.”

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