In the USA alone, more than two million older adults live in nursing homes and assisted- living facilities, and their numbers are only expected to increase. Acknowledging the sexuality of older adults in institutional settings is essential, although the issues surrounding the expression of sexuality in institutional settings are often complex. An overarching theme regarding sexuality within an institutional context is that of stigma and discrimination, in which older residents are assumed to be asexual. In contrast, the majority of nursing home residents who responded to a recent survey report that sexuality is at least moderately important in their lives. A consistent challenge in long-term care is the need to protect individual residents’ rights to privacy and sexual expression with the duty to protect residents from harm. For example, many LGBT elders fear discrimination if their sexual orientation is revealed. Case examples are used to illustrate commonly encountered issues in long-term care related to sexuality including room sharing, masturbation, dating, pornography, and the impact of disabilities such as stroke and dementia. Newly released APA guidelines regarding the assessment of cognitively impaired residents’ sexual consent capacity are highlighted. Recommendations for the management of clearly inappropriate resident behavior (e.g., abuse of non-consenting or non-competent residents or visitors; masturbation in public areas; and inappropriate sexual comments and behavior toward staff) also are offered. Additional topics include the examination of benchmark programs and policies (e.g., the U.S. Nursing Home Bill of Rights) that may lead to a more ethical balance of residents’ rights to privacy and sexual expression, with the rights and safety of other residents and staff.
KeywordsArthritis Depression Estrogen Dementia Schizophrenia
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