Need or right: Sexual expression and intimacy in aged care

Abstract

This paper explores how the residential aged care sector could engage with residents' sexual expression and intimacy. It is informed by a study of 19 aged care staff members and 23 community members, and initially designed on the principles of Appreciative Inquiry methodology. The data were collected through focus groups and interviews and analyzed using discourse analysis. We found that staff members mainly conceptualize sexual expression as a need to be met, while community members (current and prospective residents) understand it as a right to be exercised. We conclude that the way in which sexual expression is conceptualized has critical implications for the sector's engagement with this topic. A 'needs' discourse informs policies, procedures and practices that enable staff to meet residents' needs, while a 'rights' discourse shapes policies, practices and physical designs that improve residents' privacy and autonomy, shifting the balance of power towards them. The former approach fits with a nursing home medical model of care, and the latter with a social model of service provision and consumption.

Organisational enablers and barriers to the recognition of sexuality in aged care: A systematic review

“…Meeting care needs related to the expression of sexuality while promoting the older person's dignity (Roach, ) might include assisting with grooming, attending to hygiene and avoiding restraint use (McAuliffe et al, ). Facilitating access to sexuality‐related services ranging from beauty services (McAuliffe et al, ) to condoms (Tarzia et al, ), sex workers (McAuliffe et al, ; Rowntree & Zufferey, ) and pornography (McAuliffe et al, ) are other enabling strategies.…”

“…F38: Provide staff education (Chandler et al, 2004) [US] F39: Staff training should include sexuality (Bentrott, 2012) [US] F40: A staff education program is helpful to understand and accept sexuality (Lichtenberg, 2014) [US] F41: Staff require education about sexual health in older people (Barrett, C. M., 2011) [C] F42: Provide information regarding disease, fertility, consent and choice (McAuliffe et al, 2007) [C] F43: Have basic information readily available to educate clients (Syme, 2014) [C] F44: Aged care facility staff should provide support and education (Roach, 2004) [C] F45: Practical risks of sexual behaviour can be mitigated by providing education (Tarzia et al, 2012) [C] F46: Education can help family understand sexuality and resident needs (Lichtenberg, 2014) [US] F47: Provide family with education (Chandler et al, 2004) [US] F48: Lack of education is a barrier to responding to expressions of sexuality (McGrath & Lynch, 2014) [C] F49: Education can help staff recognise and accept expression of sexuality (Heron & Taylor, 2009)[C] F50: Lack of education and support leads to inadequate responses to sexuality in aged care (Roach, 2004)[C] F51: Education should recognise historical sex discrimination against minority groups (Crameri et al, 2015) [C] F52: Lack of knowledge on sexuality prevents staff assessing and meeting sexual needs (Milspaw et al, 2016) [C] F53: Include recognition and acceptance of older LGBTI people in staff education (Hurd, 2015) [C] F54: Educate stakeholders to increase visibility/improve facilitation of sexuality (Rowntree & Zufferey, 2015) [C] F55: Staff should develop skills in normalising sexuality (Rowntree & Zufferey, 2015) [C] F56: Include LBGTI needs in staff education (Taylor, 2016) [C]…”

“…F88: Spouse/ family presence in assessment/ care is a barrier to sexuality discussion (Mellor et al, 2013) [C] F89: Consult family regarding sexuality in residents with cognitive impairment (McAuliffe et al, 2007) [C] F90: Make time for family expression of concern about resident's personal relationships (Chandler et al, 2004) [US] F91: Accept same-sex partners as representatives for older adults (Hurd, 2015) [C] F92: Accept same-sex partners/friends as representatives and decision makers for older adults (Taylor, 2016) [C] F115: Staff need training in taking a sexual history/assessment (Milspaw, Brandon, & Sher, 2016) [C] F116: Using a safe and private space facilitates discussion of sexuality with older clients (Syme, 2014) [C] F117: Ensure assessment and care planning is inclusive of sexual minorities (Simpson, Horne, Brown, Dickinson, & Wilson, 2016) [C] F118: Undertaking a sexual assessment increases visibility and improves facilitation of sexuality (Rowntree & Zufferey, 2015) F119: Assessing sexual needs can help ensure those needs are met (Milspaw et al, 2016) [C]…”

“…The documentation system can be used to promote sex positivity through detailing clear biographical information and relationships using LGBTI-inclusive language (Heath, 2011(Heath, , 2012Hillman & Hinrichsen, 2014). Care pathway systems that facilitate sexuality should be established, for example identifying a familiar staff member who is responsible for counselling and support (Mellor et al, 2013;O'Brien et al, 2011;Rowntree & Zufferey, 2015), working with multidisciplinary teams (McGrath & Lynch, 2014) and establishing appropriate service referrals. Auditing can be used in the organisation as a means to both promote sex-positive practices and identify areas for services improvements (Barrett, 2011).…”

Staff's reactions towards partnered sexual expressions involving people with dementia living in long‐term care facilities

“…Similarly, Villar et al. (,) argue that institutions which are more committed to a person‐centred care (PCC) model may be more likely to be supportive of residents’ sexual expressions, since this model emphasizes the preservation of residents’ rights and by extension sexual rights even in the case of PwD (Kontos, Grigorovich, Kontos, & Miller, ; Rowntree & Zufferey, ).…”