On admission to residential aged care, new residents undergo a lengthy period of needs assessments. For example: nutrition and hydration requirements, toileting and continence care, mobility and dexterity, and so on. One need however, that is rarely assessed, is the client’s sexuality, i.e. how the resident expresses themselves sexually; be it by their physical acts (cuddling, kissing, intercourse), their grooming and dress style, or their gender identification and sexual orientation.
Whilst some resident’s physical capability for sexual expression may face limitation due to frailty or medical co-morbidities, desire to express one’s sexuality in other ways is still very much present, and this also includes those with dementia.
There is no evidence to suggest that the need for intimacy and sexuality immediately stops when a person turns, say seventy years of age, or when they enter a nursing home. So why is this area of need often neglected?
This is the stereotypical belief that old people are ‘past it’, debilitated, they don’t think about sex, or that that part of their life is over.
Yes your facility does have processes in place to address sexual assault, but even those with dementia can consent by allowing their hands to be held, by smiling at their new friend or walking in the gardens with arms linked.
It can be difficult for nurses not to judge sexual behaviour between residents based on their own moral ground, or make judgments and think things like, “What if that was my grandmother?”. Additionally, staff may think the family would be horrified if they learnt that Mum had a new boyfriend, or that the facility allowed ‘this sort of thing to happen’.
Staff may have never expected to encounter sexual intimacy between residents in their work, and therefore not know what to do or how to broach the subject with the resident and/or family, or even other staff members.
In addition to the above, the guidelines we have in place to assist us to provide a high level of care to our residents only allude to resident’s intimacy needs. For example, the Australian Aged Care Quality Agency details in Schedule 2 – Accreditation Standards, Part 3 – Care Recipient Lifestyle, 3.6 – Privacy and Dignity (2016), that “each care recipient’s right to privacy, dignity and confidentiality is recognised and respected,” and 3.9 – Choice and Decision-making (2016), that “each care recipient…is enabled to exercise choice and control over his or her lifestyle while not infringing on the rights of others.”
(Aged Rights Advocacy Service Inc. 2016)
A useful tool for gauging how well your facility meets the intimacy and sexuality needs of residents has been developed by the Australian Centre for Evidenced-Based Aged Care. The staff answer sixty nine questions covering areas such as: facility policies, staff training, family support, physical environment, safety and risk management and so on. Responses are given an overall score, which provides a clear picture of what your facility can do to improve this aspect of the resident’s being (Bauer et al. 2013).
If you work in aged care, the completion of this assessment tool and actioning the results provides a great opportunity for your required evidence of continuous quality improvement, not to mention immeasurable benefits to the resident, as this need is recognised and supported. This basic need is life-long and part of the fabric of our identity.