Deep within the youth-glorifying part of our culture, right next to the expansive real estate of death denial, is a controversial aspect of our humanity subject to the aging process – the physical intimacy-denying part of our collective conception of what is “appropriate” behavior for elders. It might also be part of ageism, but I’m not too sure about that. Last month I attended a continuing legal education program put on by two of my colleagues – Ayo Labode and Mary Catherine Rabbitt. One of Mary Catherine’s short topics was intimacy between residents of skilled nursing facilities. In fact, the topic for this week’s elder law section CLE program at our monthly meeting at the Colorado Bar Association offices is “sexual expression in long term care.” I know it will be well-attended! I thought it was time to bring out this draft of a post I wrote some months back and was waiting to finish.
I recall Roger Angell’s New Yorker article I featured in a previous post entitled “This Old Man.” In fact, I will include a quote from it here:
More love; more closeness; more sex and romance. Bring it back, no matter what, no matter how old we are. This fervent cry of ours has been certified by Simone de Beauvoir and Alice Munro and Laurence Olivier and any number of remarried or recoupled ancient classmates of ours. Laurence Olivier? I’m thinking of what he says somewhere in an interview: “Inside, we’re all seventeen, with red lips.”
Many of us in my field of elder law are familiar with situations that run the gamut of this human need for intimacy that includes sexual expression in old age – whether it is someone’s 85-year-old mother who found her new husband through online dating or is the commonly occurring but not well-accepted sexual intimacy between residents in a skilled nursing or assisted living facility. We are charting a new course for elderhood here! Here’s a link to an article about sexually transmitted diseases and folks enrolled in Medicare. The baby boomers have much to learn from our parents’ generation and many believe that with the burgeoning number of boomer elders, this issue is likely to remain a hot button for many years to come. But let’s face it, in the context of elderhood, few are comfortable with talking about sex or death.
Intimacy is a basic human need for many of us that continues regardless of age and living situation. As the boomers age and the number of assisted living and SNF residents continue to grow, this will be a challenge that will need to be addressed on a strategic or big picture level. Here’s a short piece written by a long term care Ombudsman on this topic. There are many sources from the psychological and medical community which address the benefits of intimacy for elders living in an institutionalized setting. A newsletter for Geriatric Care Managers featured a story on Sex in the Nursing Home.
Beyond the ageist factors that can tend to make elders invisible and simply “too old” to merit sexual expression, the mental capacity issue here looms in the background in at least some segments of the population who are residents in long term care or similar type living arrangements. Who determines the level of capacity required for consensual sex and what are the boundaries? Australian authors Laura Tarzia and two others published a paper entitled “Dementia, sexuality and consent in residential aged care facilities. You can read it here.
A related issue involving consent concerns sexual abuse, but most of those cases involve assault by staffers on residents, although there has been well-founded concern raised when registered sex offenders are residents of long term care facilities, particularly when residents and families are not notified due to the fact that there is typically no notification requirement, but some states are working on ways of keeping such residents out of the “general population” at a skilled nursing facility.
If you think it’s not so controversial, read this post about staff members at an Iowa nursing home who lost their jobs in the wake of sexual relationship between two residents with dementia in 2009. A recent blogpost on this topic features a video clip from a doctor addressing some of the difficult issues. The sex taboo in SNFs is going to have to change. Read an interesting post here by an assisted living staffer about the large number of sexually-active elders and elders’ rights to “sexual self-determination.”
I will be writing more on this topic and I anticipate it will becoming much more mainstream as we look more closely at many of our ideas about how we age. Stay tuned.
©Barbara Cashman 2015 www.DenverElderLaw.org