Preserving Our Right to Sex in Long-Term Care

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Do you need to put your wishes in writing?

By Kevyn Burger

At age 74, Joan Price likes sex and doesn’t care who knows it.

“I plan to continue to celebrate the sexual pleasure my body can give me. Things may change and I will adapt to them, but I say, sex has no expiration date,” said Price, who calls herself an advocate for “ageless sexuality.”

While prevailing wisdom may suggest that the sex lives of 70-somethings are spoken of in the past tense, Price, a speaker, blogger and award-winning author (Naked at Our Age: Talking Out Loud About Senior Sex, Better Than I Ever Expected: Straight Talk About Sex After Sixty) has her future sex life on the brain.

Sex in Long-Term Care: Unfriendly Policies

Price worries that if she would ever live in senior housing — from assisted living to skilled nursing to hospice — her desire for sexual expression could be thwarted.

“Residents in long-term care get no privacy, so how can they explore their sexuality with another resident or solo when they can’t lock the door?” she said. In fact, many facilities’ policies are “archaic, regressive and even ageist,” according to a 2015 article in Time magazine.

One notable example, Time wrote, was at Hebrew Home at Riverdale (in the Bronx), which drew up a Sexual Expression Policy. Among other things, it “recognizes and supports the older adult’s right to engage in sexual activity, so long as there is consent among those involved.”

Price urges individuals to be frank in stating their intentions.

“It occurred to me that we need to put it in writing, while we are capable to give instructions to our spouses and grown children, about what we want when it comes to exercising our sexual rights,” she said.

‘Advance Directive’ for Sexual Expression

Price created a sort of advance directive to make clear her sexual wishes. It begins with her desire to live in a facility with a sex-positive environment.

“I want my rights respected — the right to close my door and have privacy, the right to have a relationship with someone of my choice or the right to charge my sex toys in my room and use them without being disturbed,” she said.

A few facilities that house aging residents are cautiously beginning to address their lifelong needs and desires as a body of research is emerging on the sexual activity of older adults.

Previously, sex researchers typically stopped quizzing subjects at the age of 60, since prevailing wisdom suggested people were no longer sexually active beyond that age.

Sexually Active Well Beyond 60

But a 2012 study in the American Journal of Medicine found that half the women surveyed (median age 67) remained sexually active, with sexual satisfaction increasing with age. A national survey in the UK became the first to ask people in their 70s and 80s about their sexuality and confirmed that half the men and a third of the women enjoyed active sex lives into their eighth and ninth decades.

“Many service providers for older adults have had their heads in the sand. They refused to acknowledge the sexual needs of their residents. But now the Centers for Disease Control is reporting a high number of sexually transmitted infections in this population, so we know they are active,” said Jane Fleishman, a Massachusetts-based sex educator involved in ongoing research into sexuality in aging adults. “Facilities need to think about a sex policy or directive for their residents’ safety as well as their pleasure.”

Fleishman, 63, regularly consults with older adult service and housing providers. She has noticed that the intimate needs of their clients are starting to be recognized by a small minority of them.

“Sexual well-being lowers depression, social isolation and cardiovascular disease. As lifespans increase, so will people’s ability to have new adventures and relationships later in life,” she added. “Facilities should be constructed so there are private spaces where adults can be their authentic selves.”

What to Do About Dementia

Being open about older adult sex is not without its complications. With the cognitive impairment that often accompanies aging, questions can arise about whether an individual is capable of giving consent, even if he or she had previously stated an intention to remain sexually active.

It’s a dilemma that can create liability fears for administrators who run senior housing facilities and are charged with making sure their residents aren’t mistreated or exploited.

“Adult children may have the expectation that their parents are not sexually active, and administrators have seen that there will be hell to pay if the wrong two people start getting it on under their roof,” Fleishman said. “But deciding if someone can provide consent should come in a clinical assessment. It’s a question for a geriatrician, not a family member.”

Professor Gayle Appel Doll, a gerontologist and director of the Center on Aging at Kansas State University, noted that an advance directive can’t anticipate how individuals might change with age and the onset of cognitive impairment.

“When people have dementia, we see changes in their libido leading to less interest in sex. But we also see personality changes that go the other way,” such as the straitlaced older woman “who now wants to kiss men who look like her husband,” said Doll, author of Sexuality & Long-Term Care: Understanding and Supporting the Needs of Older Adults.

Building for Privacy

In her research, Doll surveyed developers who build senior housing to see if they considered resident sexuality in their planning. She found few retirement or nursing home developers accommodating the privacy needs of future residents who want opportunities for intimacy or conjugal visits.

But Doll thinks that’s changing, due to demands of the boomers and new federal policies.

“Facilities are under pressure to let their residents make their own decisions,” she said. “Mandates coming from Medicaid and Medicare require a personal care plan that lets residents say what they want for their lives and gives more weight to their preferences.”

Doll suggests that adults speak frankly about their sexual intentions to those whom they name to carry out their stated instructions.

“Creating the elements of an advance directive gives you the opportunity to talk to the people close to you and let them know what you want. I recommend having a conversation about your sexual desires in a general way with someone who might be your durable power of attorney,” she said.

But Doll admits that she doesn’t practice what she preaches.

“This means you have to have that awkward conversation with your kids, because that’s who’s going to be in control of you. And talking about the sex life you think you will want as you age is not easy,” she said. “I’m 63, and have I talked to my two grown sons about this? No.”

Persistent Silence on Sex

The lack of communication about older adult sex underscores society’s deep discomfort with acknowledging the intimate needs of the aging population.

“Even those who work in the field can’t get over what I call the ‘ick’ factor, their disgust with even the idea of wrinkly people having interest in sex,” said Price. “I’d like to see us talk out loud about lifelong sexuality without embarrassment, guilt or shame.”

Even if they don’t choose to formalize their sexual desires in a written document, Price urged people to ask questions about sexual policies as they evaluate older adult living situations.

“This is going to be your home, not a prison, so it’s incumbent on you to explore which facilities would respect your privacy and which ones would take it away,” she said.

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