Sexuality and aged care: Research reveals 'unspoken' blurred boundaries of consent

Blurred boundaries for sexuality and intimacy among intellectually incompetent aged care residents revealed. Photo / 123rf

For the first time in New Zealand new research uncovers blurred boundaries for consent of sexuality and intimacy among intellectually incompetent elderly at aged care facilities. Health reporter Emma Russell reports.

A gay dementia resident was discouraged, by staff, from having any intimacy with his partner.

An elderly transgender resident living with dementia was being given clothing of their birth gender by family, and aged care staff didn't feel like it could be stopped.

A "lovely couple" in their 90s - a woman who was not fully intellectually competent and a husband who was - would hold hands most days and were supported by rest home staff to do so.

All of the above are examples of sexuality and intimacy in aged care facilities with blurred boundaries for consent due to lack of policy and mixed ethical and religious views - some of which have led to legal action between families and aged care staff.

For the first time in New Zealand researchers have explored the taboo topic by surveying hundreds of aged care staff, family and residents across the country since March 2018.

Lead author Massey University professor Mark Henrickson, a trained social worker, said he was alerted to the issue from families and aged care staff who raised it with him at conferences where he spoke about sexuality.

"People would say to me 'this is a real issue but it's never talked about' so I thought this is the time to get people to talk about it," he said.

He joined forces with nursing experts Catherine Cook and Narges (Nilo) Atef, philosophy lecturer Vanessa Schouten and victim support worker Sandra McDonald to conduct the three-year project.

Some of the key findings from the report:

• Out of the 433 aged care staff surveyed, more than half agreed that sexual activity may improve the wellbeing and mood of older persons, and nearly three-quarters of respondents felt that they were able to make ethical decisions that balance residents' rights and safety.

• A third of aged care staff didn't know whether the behaviour of a resident living with dementia can imply consent.

• On the question "Staff should allow residents who are mildly affected by dementia to engage in sexual activity", 107 (24.7 per cent) agreed, 127 (29.3 per cent) disagreed, and 199 (46.0 per cent) were neutral or missing.

• Nearly half of the staff agreed and 81 (18.7 per cent) disagreed with the statement "A resident of an aged care facility should be able to have a casual sexual relationship
with another resident who consents," suggesting that casual sex between two consenting residents would be acceptable to nearly half the respondents.

• Nearly half of the staff agreed that "residential care facilities should provide
rooms to allow residents to engage in sexual behaviour without fear of being watched or interrupted"; 73 (16.9 per cent) disagreed, and 144 (33.3 per cent) were neutral or missing.

As a result of the findings, Henrickson said there was a real need for policy at each aged care facility in New Zealand to create clarity and understanding of what is and isn't okay.

"It's not my place to say what those policies should entail but the discussion needs to be had," Henrickson said.

When there is insufficient staff education, people are forced to rely on their own individual values and beliefs. Some of these beliefs may be shaped by religious attitudes, which can create challenges in the workplace, he said.

"The results show people are widely varied in their attitudes, meaning that the sector needs some decision making on the topics alongside stronger staff education."

Henrickson said it may be, for instance, that a resident with intellectual impairment may not be able to verbally articulate consent, but is clearly enjoying a moment of intimacy with a partner. But if someone has decided that an individual is not able to make decisions for themselves, they may interfere unnecessarily in that moment.

"These decisions will certainly affect a resident's quality of life and their ability to live life fully."

Henrickson said the research also revealed a generational effect on attitudes towards same-sex sexuality. Among older staff, there was less support for same-sex relationships than among younger respondents.

Those attitudes may have been influenced by an era of greater social acceptance, visibility of gender diversity and sexual diversity, and marriage equality, he said.

"We would advise facilities to create workplace policies that, regardless of what people's attitudes are, regardless of their behaviour, what people see at least is consistent in every workplace."

The New Zealand Aged Care Association were approached for comment but a spokeswoman said they did not want to comment without having time to read the full report.