Playing More than Bingo in Nursing Homes
Putting that secret code on your door to alert your roommate. Finding late-night common area nooks. Snuggling in the library. For some of us who lived in a dorm during our college years, the effort of finding rendezvous spots away from roommates and friends may be a distant — but vivid — memory. Combine these experiences with commonly held notions about the sex drive of men and women in their late teens and early 20s, and you’ll find few people who assume that current college students in dorm are living chaste lives. Put a group of people in a building for a living situation, give them copious free time, and what do you expect?
Yet, in the U.S., we house nearly two million older folks in nursing homes, and somehow expect that the next bingo or family visit is at the forefront of their minds. While the media have recently debunked common misconception that sexual desire “shuts off” at a certain age, the fact that nursing home residents seek and enjoy physical contact with each other still seems to be a well-kept secret. Renee Beard, a PhD student in San Francisco who focuses on elder care in skilled nursing facilities (SNFs) reports that “Sex happens far more often in SNFs than anyone wants to admit.”
Beard has been conducting research as part of her studies in SNFs for approximately seven years, and in that time estimates she’s walked in on nursing home residents “in full action” around a half a dozen times, with a few dozen of what she describes as “close encounters.” “One couple I knew who had sex often would only shut the door when they wanted privacy, so I’d never attempt to enter if the door was shut.”
Most residents aren’t so fortunate to have such a convenient set-up. “Hey, just because I’m 75, doesn’t mean I don’t want to get laid. But how? There’s no place to go, we both have goddamn roommates,” says William, a Utica, NY nursing home resident on a web site devoted to information on nursing homes. Beard recalls an incident in which a wheelchair-bound gentleman expressed his frustration about lack of privacy. He was considerably younger — in his 50s — than his 80-something girlfriend, but both clearly had the cogency to consent. After the couple had lengthy discussions with the staff, the staff arranged for time for the couple in a private room, where they hoisted the man, fully clothed, onto the bed and left them to themselves. While the couple finally was afforded the combination of privacy and assistance they sought, “it was like scheduling a conference room,” Beard said. “Spontaneity was essentially impossible.”
Spontaneity isn’t the biggest problem that a typical frisky SNF resident faces — for heterosexual female residents, there simply aren’t enough men in the nursing homes. According to a study taken in 1999, approximately 74% of nursing home residents are women, making the pool for eligible heterosexual partners slim. Say a fortunate female resident finds a male partner, and manages to acquire the privacy for intimacy, safer sex supplies are not likely to become part of the transaction. Because staff, family and administration at SNFs assume older people don’t have sex (or turn a blind eye when they see that they do), they further assume that they aren’t at risk for sexually transmitted infections (STIs). In Beard’s experience, typical SNF residents “do not have access to condoms, lubricant or other safer sex supplies, but they also don’t have the education/outreach associated with it.” Furthermore, older patients are still from a generation that generally shies away talking about sex with doctors — and, according to a TIME magazine article from January 2004, many doctors, assuming their older patients aren’t having sex, won’t bring the topic up with them.
With Baby Boomers beginning to reach retirement and beyond, nursing home facilities will likely find that they need to adjust how they understand and allow for sex in the homes. “Most of the staff preferred to pretend [that sexual activity] did not happen or thought it was wrong,” said Beard. “Absolutely no training, in my experience, is aimed at handling sexual activity among residents.” Nursing home administrators may find, however, they are treading a perilous line in acknowledging and encouraging sex between residents.
How can nursing home staff assess whether sexual activity in the home is consensual or not, especially when residents with Alzheimers and other impaired mental states are involved? While Beard estimates that most of the activity in the homes she’s witnessed has been consensual, she notes that “it’s difficult to label consensual activity. If someone appeared distressed, [the situation] was always addressed immediately — although this was managed in-house and families were never informed. And overall, most staff felt such discomfort at finding people having sex that they would simply leave the room without making any such assessment of consent.”
Many American facilities are starting to train workers on how to handle walking in on amorous situations, according to a December 2003 Newsweek article, but the problem remains of discerning whether both parties are consenting. The line between allowing autonomy for the residents and protecting them can be blurred and entail a huge liability for the home. According to the article, a Seattle home paid nearly half a million dollars in settlement to the children of an 86-year-old woman, suffering from dementia, who was allegedly sexually assaulted by a similarly impaired male resident. The result of such litigation may result in facilities explicitly prohibiting sexual activity, or staff simply not reporting it. In Beard’s experience, “most staff I’ve encountered will not report such incidences [even nonconsensual] unless the nonconsenting person is upset or capable of telling others, it is a repetitive thing or someone is seen to be a perpetrator of gratuitous sex with multiple partners.”
The solution to this issue, however, clearly does not lie in SNF staff ignoring the sexual activity they encounter. If SNFs are truly taking steps in setting up policies and training for staff in how to handle sexual activity, that’s a first step. However, for SNF residents to truly enjoy the freedom to explore their desires — as well as protection from sexual abuse in these facilities — their children and doctors need to realize that these older folks still have sexual desires. Parents don’t like to think about their kids having sex when they go off to college, but deep down, they know it’s likely that they are. It’s time to apply that same logic to Mom or Dad at the home.
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