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Sex Among Residents of Care Homes

Posted Jul 24 2013 8:30am

That's a scene from the 2006 movie, Away From Her, with Julie Christie and Gordon Pinsent. She is moving into a care home that day due to her Alzheimer's disease. The story gets more complicated from there but for now...

Let's talk about how old people with dementia and without are prevented from having sex in care homes of various kinds. In fact, according to reporter, Bryan Gruley, writing at Bloomberg.com this week,

Federal and state laws require elderly care facilities to respect residents’ rights to privacy and safety. Married couples in Iowa and 17 other states have legal rights to share rooms or have conjugal visits...”

The only acceptable response to that statement is: What's wrong with the other 32 states and why aren't the laws enforced everywhere?

There is no reason for anyone – federal or local governments, physicians, nurses, care home workers, adult children, etc. - to have a say in any person's sexuality no matter where they live.

But they do and it is another form ageism - prejudicial treatment of old people based on beliefs about how they should and should not behave.

In the first of his two-part report, Gruley relates the story of two residents at the Windmill Manor home in Iowa who were caught by nurses in December 2009, engaging in sex. Greatly abridged, here's what happened:

The encounter appeared to be consensual and when the woman's son was informed as well as the man's daughter, everyone seemed to agree that nothing needed to be reported to the state.

Nevertheless, the state did become involved, the man was discharged from the home, the administrator and the director were fired. The next year, the woman's family sued stating that she had been raped and it got more complicated from there even though both the man and woman died during the lengthy legal case.

Last May, a “veteran Iowa nursing home administrator” told the reporter,

”...the woman was 'confused to the extent that I don’t feel she was maybe realizing what was happening to her or she thought maybe it was her husband.'”

Let us count all the ways this incident is wrong:

  1. Why did the man and woman have no privacy from the nurses who walked in on them?
  2. Why would the staff call the adult children of the man and woman to report they were having sex?
  3. Why were the administrator and director fired over consensual sex of two residents?
  4. Since there is no way the woman's family could know if rape had occurred, why was the lawsuit allowed to proceed?
  5. How could the “veteran administrator” know the woman was “confused”?

These were adults – she age 87, he 78 - engaging in sex. They were deprived of their privacy, stripped of their dignity and forced to never be together again. Both had dementia but during the investigation a psychiatrist concluded that both parties had “the ability to consent.”

Although laws in most states would seem to assure care home residents their rights to privacy, dignity and self-determination, it doesn't necessarily work that way. In a 2009 piece in The Los Angeles Times , psychologist Ira Rosofsky explained why it is hard to remain sexually active in a nursing home:

”First, it's hard to find any privacy in nursing homes,” he wrote. “Doors are always open; a closed one is viewed with the suspicious eyes of a teenager's mother wondering what's going on in there.

“I recently had a resident referred to me for masturbating in front of an aide who had walked into the room. Why did she walk in without knocking? Well, you can't knock on an always open door. And in your room - typically shared with a total stranger after a lifetime of independence - you have only a curtain for privacy.

“When I'm having a session with a resident in a nursing home - even with the door closed - it's quite common for an aide to just walk right in and start making up the bed. The custodian might appear next with a mop, followed by the cable guy fiddling with the TV.

“Unless you're into exhibitionism, it's hard to imagine consenting adult residents having sex under these conditions.”

Here's what I have discovered in my research about many people who are in positions of authority in care homes: they think old people should not engage in any sexual activity and set up rules accordingly. As Gruley reports:

”A 2012 study by two Kansas State University researchers found sex among nursing home residents is often viewed as a behavior problem rather than an indication of an unmet need.”

There are exceptions and one of the best is the Hebrew Home in Riverdale just north of New York City which reporter Gruley writes about in part 2 of his elder sex story that includes this graphic about elders' sexual activity. (Click the image for a larger, readable version)

The Hebrew Home has had a rational, life-giving, respectful attitude toward the sexual life of its residents for nearly 20 years:

”The nurse was frantic,” as Gruley relates the story. “She’d just seen two elderly people having sex in a room at the Hebrew Home at Riverdale, New York. She asked Daniel A. Reingold, then the home’s executive vice president, what she should do.

“'Tiptoe out and close the door so you don’t disturb them,' he told her.

“In 1995, the home adopted a four-page policy - considered the first of its kind - stating that residents 'have the right to seek out and engage in sexual expression,' including 'words, gestures, movements or activities which appear motivated by the desire for sexual gratification.'”

Nowadays, Daniel Reingold is the president and chief executive officer of the Hebrew Home and I had the pleasure to meet him four years ago when I attended a week-long seminar presented by the International Longevity Center in New York City and we spent most of one day visiting the Hebrew Home. I can attest to Reingold's and the Home's enlightened policies throughout.

You can read the Hebrew Home's Sexual Expression Policy here [pdf] which is, as Gruley reports,

”...intended to comply with federal law giving residents essentially the same rights they’d enjoy outside the facility. Sex is as much a civil right as the right to vote, Reingold said.”

Not enough care homes are as enlightened as the Hebrew Home and there is a lot of work to do to ensure elders' freedoms, dignity and rights wherever they live. To not do so is ageist in the extreme.

As a study published in the Journal of Medical Ethics in 2011 concluded about dementia residents in particular but it applies to all:

”...while every effort should be made to ensure that no resident comes to harm, RACFs [residential aged care facilities] must respect the rights of residents with dementia to make decisions about their sexuality, intimacy and physical relationships.

Bryan Gruley's two stories on sex in care homes contain a lot more information and much worth your time to read in their entirety. You'll find them here and here .

There is also a good interview with Bryan Gruley about this reporting at NPR .


At The Elder Storytelling Place today, Sharon Ostrow: Thought for the Day

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