Birds and bees alive in care homes

Ageism gets some of the blame for the discomfort many feel when confronted with sexual expression in seniors’ facilities

Sex and sexuality among seniors in continuing care homes is not easily or commonly discussed. For many, such talk likely ranks below root canal and a naked polar plunge in terms of enjoyable things to do.

Yet sexual well-being is part of aging well, and addressing it in the context of seniors’ residency in lodges and care facilities deserves greater attention, says Julia Brassolotto, health solutions chair in rural health and well-being at the University of Lethbridge.

There are no Alberta policies or common guidelines regarding sexual expression in continuing care homes but the desire for intimacy extends throughout life, even if its form or frequency change.

Brassolotto and fellow researcher Lisa Howard undertook a study to see how the topic is navigated in the absence of policies. They spoke with facility managers, ethicists and social workers, as well as residents of long-term care facilities.

They found concerns about residents’ autonomy and privacy, as well as issues surrounding communication about sexual matters with staff and residents’ family members.

“Continuing care homes aren’t exactly sexy environments,” Brassolotto said during an aging well presentation at the U of L.

However, sexual expression takes on new importance in continuing care because failure to acknowledge it infringes on human rights, dignity and the opportunity for residents to feel good in and about their bodies.

Older children of seniors’ home residents will often belittle their parents’ relationships. “Dad has a girlfriend at the seniors lodge, isn’t that cute,” is one example. Brassolotto said diminutive language sometimes allows people to be more comfortable discussing senior sexuality.

“A lot of the research does show that family members are more supportive when it’s an instance of romantic affection and less supportive if it’s got any erotic undertones,” she said.

“So people are OK with their parents having a crush on someone or someone having a crush on them or holding hands at mealtimes … but the idea that their parent might then go visit that person in their bedroom in the evening is something that they’re much less comfortable with.”

Why? Ageism is part of it.

“I do think we don’t as a western culture expect older adults to have sexual desire in the same way. I don’t think we expect it from people with disabilities or chronic health conditions either.”

Sexual expression takes many forms among care home residents, ranging from physical appearance and grooming to reading romance novels, physical touch, use of sex toys and marriage while in continuing care.

In terms of autonomy, Brassolotto found that choices about appearance, clothing and who to sit with at mealtimes are important to care home residents. Ability to do those things brings feelings of empowerment.

Financial independence also helps with sexual autonomy. With reliable internet, seniors can buy lubricants or sex toys in a discreet manner or watch pornography in a private space.

Further to privacy, Brassolotto noted the limited availability of privacy in care homes, some of which have doors that don’t lock.

Lack of clarity about where residents are entitled to privacy is also common. Staff entering rooms without knocking or opening the bathroom door while a resident is showering are examples of such issues.

Staff can intrude on residents’ private or romantic lives by teasing or otherwise embarrassing them. Inappropriate questions such as “did you poop today” are asked in public spaces as staff members seek to do their jobs and manage seniors’ health-care needs.

Brassolotto’s research revealed general lack of communication about sexual expression in continuing care and lack of clarity about expectations and responses.

“Usually, it was only spoken about when it was a problem. There were lots of euphemisms,” she said.

Recommendations arising from the research are threefold:

  • Develop system-level standards to support safe, healthy and dignified sexual expression.
  • Address the need for a principles-based, sector-wide policy on resident sexual expression, as well as site-specific guidelines.
  • Expand nursing and health-care-aide education related to sexual expression for residents in continuing care homes.

Brassolotto said results of the study were presented to the province’s continuing care branch so the matter is now “on the radar.”

“We’ve heard that some conversations are changing but we haven’t seen policy change yet.”

She acknowledges that a one-size-fits-all policy is not the answer.

“I do think that staff need to have conversations together because no one we interviewed — health-care professionals, residents or families — ever said staff should all end up being on the exact same page in terms of holding the same views, same values.

“We’re not looking for a homogenous perspective. It’s OK to have different views, but just to reflect on how it informs your care work and where do your own views bump up against the health-care needs, the activities of daily living of the people you are supporting in their home.”

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