Sexual Expression in Long-Term Care*
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From an American culture perspective, older adults are often considered asexual, particularly if they live in long-term care settings. However, older adults have been found to be sexual throughout the lifespan, including in nursing homes and assisted-living facilities.  While quite a lot of attention has been focused on problematic expressions of sexuality, less has focused on appropriate and necessary expressions of intimacy and sexuality. The literature pertaining to sexual expression in nursing homes demonstrates that clear policies enabling healthy sexual expression are lacking, and this appears to be concurrent with relatively poor staff sensitivity to resident sexual expression.

In a recent publication, Cornelison and Doll (2013) investigated sexual expression in long-term care setting based on ombudsmen interviews. 31 in-depth interviews were conducted in six states.  These cases involved ombudsmen interventions in conflict situations. 29 of the 31 ombudsmen interviewed reported that in the course of their work, they intervened in conflicts related to sexual expression. Sources of conflict tended to be clustered around five basic themes: general risk to residents (safety of residents involved), specific risk associated with residents with dementia (vulnerability to abuse due to cognitive impairment), limited knowledge about normal sexual expression and residents’ rights (pertaining to facility staff, residents, and their families), lack of privacy for intimate contact, and a clash of values around sexuality and sexual expression (staff, residents, their families).

The authors conclude that residents need advocates to support their rights in terms of sexuality. Furthermore, workplace training and education of staff are imperative in order to protect residents.  Finally, a focus should be placed on formulating standards of practice to deal with ethically complex situations in long-term care facilities as they arise. 

We would add that safeguarding sexual expression, by creating safe and private opportunities for intimacy, is consistent with person-centered care and resident voice. From this perspective, nursing homes and assisted living facilities should continue to evolve such that they resemble one’s home, not institutions.

* Cornelison, LJ & Doll, GM. (2013). Management of sexual expression in long-term care: Ombudsmen’s perspective. The Gerontologist, 53(5), 780-789.