Sexuality and intimacy in assisted living: Residents’ perspectives and experiences

Abstract

The assisted living industry provides residential, medical, nutritional, functional, and social services for approximately 1 million older adults in the United States. Despite their holistic approach to person-centered care and their emphasis on a consumer-empowered, social environment, assisted living providers pay scant attention to clients’ sexual needs. In this article, the authors discuss the realities of sex and intimacy in assisted living from the perspectives of residents, families, managers, and staff, exploring the discourse of sexuality, the impact of institutional structure and the role of oversight on sexual attitudes and behaviors, and the relationship of assisted living industry values to residents’ sexual expression. Also presented are practical recommendations and policy implications for addressing the sexual and intimacy needs of current and future cohorts of assisted living residents. Data for this article were drawn from 3 National Institute on Aging–funded ethnographic studies conducted in 13 assisted living settings over 9 years.

First-person narratives around sexuality in residential healthcare settings: a meta-ethnographic synthesis

“…Regarding data collection, one study utilised focus groups (Stein et al, 2010) and one study used a combination of observation and conversational interviews (Frankowski & Clark, 2009); the remaining studies collected data via semi-structured interviews. The method of analysis varied, although three studies did not specify their data analysis procedures (Frankowski & Clark, 2009;Nay, 1992;Röndahl, Innala, & Carlsson, 2006). Whilst all studies reported aims relating to individuals' experiences of sexuality, research questions varied.…”

“…Two studies (Frankowski & Clark, 2009;Nay, 1992) identified research questions post-data collection; understanding sexuality experiences was not the primary question asked of the data in these studies. Jootun, McGhee, and Marland (2009) argue that the inclusion of a reflexive account should be part of qualitative enquiry to increase the rigour of the research process and add credibility.…”

“…Eight stu dies made reference to the hopes and fears that participants had regarding their sexuality as patients in residential healthcare settings and for the future (Frankowski & Clark, 2009;Jenkins et al, 2010;Lemieux et al, 2004;McCann, 2000;Röndahl et al, 2006;Stein et al, 2010).…”

“…(Bauer et al, 2013, p.303) the lack of opportunity for a partner (Frankowski & Clark, 2009;Nay, 1992), and a general discourse about how residential healthcare settings inhibited sexuality: (Quinn & Happell, 2015b, p.2272.…”

“…"…I still can't feel human enough to be a sexual being in this environment" (Brown et al, 2014, p.250) Eight studies (Brown et al, 2014;Frankowski & Clark, 2009;Lemieux et al, 2004;Nay, 1992;Östman, 2008;Stein et al, 2010;Villar et al, 2014) described participants as having experienced an 'adapted' sexuality; their experiences of their sexuality had changed as a result of their ailment and/or the residential healthcare environment. The shift in how sexuality was conceptualised was described more concretely by participants in residential healthcare settings for physical health needs, for example, aging participants described a shift in associations with sexuality, from procreation and marriage, to intimacy, spirituality and beauty, (Nay, 1992).…”