Samantha Jones of Sex and the City is probably a few decades away from moving into a senior living community. Nevertheless, the topic of sexual expression in senior living communities is a resident matter that should be recognized and addressed from an enterprise perspective.  

As Samantha and the baby boomers begin moving into senior living communities, sexually active residents will become more common, as this generation has experienced greater sexual freedom than previous generations. Therefore, an organization’s policy on sexual expression may become a consideration for boomers when deciding where to live.

A recent New York Times article highlighted the approach of one New York organization, The Hebrew Home at Riverdale, which has had a sexual expression policy since 1995. To help facilitate relationships among residents, The Hebrew Home has sponsored happy hours, organized senior proms and started a dating service. While these activities are viewed as entertaining events for residents, they potentially present associated risks.

The Risks Related to Sexual Expression by Residents 
A specific challenge relating to resident sexual expression involves those with dementia, because what constitutes sexual consent may be ambiguous and questionable. In one situation, a 79-year-old man was charged with third-degree sexual assault for engaging in sex with his wife. The facility and the woman’s daughter from a previous marriage asserted that the resident was incapable of consent because she had Alzheimer’s disease.¹

Resident family dynamics and family member views on sexual expression also represent sensitive considerations that are paramount to address in this setting. Residents with Alzheimer’s disease may form romantic relationships with one another, forgetting their living spouses. A high-profile example involved retired U.S. Supreme Court Justice Sandra Day O’Connor, whose husband fell in love with another Alzheimer’s patient. While O’Connor and her sons were supportive of this relationship, other families may have unfavorable reactions to this situation.²

Organizational realities that cannot be overlooked are staff member and institutional biases. Some staff members may not approve of the idea of sexual expression among elderly residents and they may overtly express their opposition to these relationships. Some administrators may decide it is easier to ignore or prohibit sexual activity within the community. In a 2011 case, a man in a memory care unit in Minnesota fondled six women. In response to this resident’s actions, the organization banned all kissing, caressing and nudity in public areas, rather than assessing and addressing the topic of sexual expression in the community. The state cited the facility for failure to report possible abuse and for a lack of staff training and policies.³

Sex Education is Not Just for Teenagers 
In order to manage risks associated with sexual expression, an organization should institute a policy on resident sexual expression that reflects a variety of needs and safeguards applicable to situations that may make other residents uncomfortable. The policy should consider that residents must be assessed on their ability to make decisions regarding sexual expression and educated on their right to say “No,” as well as require all curtains and doors to be closed during any type of sexual activity between consenting residents. 

Training programs should be developed to help staff members identify signs that a relationship is unwelcome and recognize situations when sexual expressions are making a resident feel uncomfortable. If you are planning on attending the 2016 LeadingAge Annual Meeting & Expo in Indianapolis, participating in the session entitled Sexuality Policies: Managing a Touch Issue may be a good starting point for developing or updating your organization’s policy.

As I have discussed in a previous blog post, frequent, candid communication with residents and their family members is essential to understanding resident needs and effectively managing expectations. Although discussions focusing on resident sexuality may be awkward and uncomfortable for some adult children, an organization’s staff must be trained to discuss this topic in a manner that is respectful of the resident’s privacy and wishes. Through comprehensive training, exceptional professionalism and candid communication with residents and family members, senior living communities can help minimize risks related to this topic.
   

¹ Sex, Dementia and a Husband on Trial at Age 78, The New York Times - Accessed Aug. 2, 2016.
² Judge lost husband to Alzheimer's - and love, The Telegraph - Accessed Aug. 2, 2016.
³ Sex in the Nursing Home, AARP - Accessed Aug. 2, 2016.