Sexuality in an Assisted Living Facility

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Years ago, I worked in an adult care facility as a medical social worker. We admitted a woman in the middle stages of Alzheimer’s. She was a widow but had no memory of her husband’s death. One day, the woman met a dashing gentleman whom she believed to be her husband. She began holding his hand and curling up against him when they sat on the couch watching television together. This quickly progressed to caressing and kissing.

The staff’s opinion was pretty equally divided. About half thought that the couple was cute. The others felt that expressions of love between older people were disgusting. The woman’s daughter thought the male resident was taking advantage of her mother, even though the mother was clearly the instigator. The daughter eventually moved her mother to another facility.

A study from Georgia State University reported in The Amateur’s Guide to Death and Dying found that assisted living facilities tended to put barriers in the way of sexual freedom. Most facilities have no clear, written policy dealing with resident sexuality. Deliberately or subconsciously, staff and administrators often keep romantic pairs apart. They may forbid the couple from going into a private room, for instance. Or they may steer members of a couple into different activities.

According to an article in The New York Times, the first assisted living facility to develop policies about resident sexuality was The Hebrew House in the Bronx. The policy, initiated in 1995, emphasizes that physical and romantic intimacy are “natural aspects of life.” The Hebrew House trains staff to avoid “personal bias” and support consensual sexual behavior. In some cases, the administration has even provided residents with private rooms, condoms and Viagra.

Dementia and Consent

One troubling issue when it comes to older adults and sexuality is dementia. A person with cognitive impairments might be forced or tricked into sexual contact. A person with dementia might also make choices that they would never have made were it not for the cognitive impairments.

For instance, the daughter of the woman in our facility claimed that her mother was incapable of thinking clearly and thus could not give consent. “She thinks she’s with Dad,” her daughter said. “She would never act that way with a total stranger.”

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And dementia does make the issue of consent more complicated. What’s more, it can sometimes lead to hypersexuality or sexually aggressive behavior. For this reason, many assisted living facilities train staff to assess the behavior of cognitively impaired residents for warning signs of discomfort or depression. But this is not the case everywhere.

In fact, few assisted living facilities have policies on sexual contact between residents, according to Ann Christine Frankowski of the Center for Aging Studies at the University of Maryland. Staff evaluate relationships on a case-by-case basis. Often, family input or staff attitudes takes precedence over what the romantically linked residents want.

If you or a loved one is entering an assisted facility, ask the administrator if the facility has a policy about sexual relationships between residents. If not, ask how the facility usually handles these issues. Many adults are sexually active long into old age. You want to be certain that the residence you choose will honor your or your loved one’s needs and desires.