By Carolyn L. Rosenblatt, R.N., B.S.N., Attorney AgingParents.com If grappling with the issue of sexual expression in long term care hasn’t come up for you yet, it’s likely that it will. As our population lives longer, more people are living with infirmities, and more people are in care facilities over time. Does the desire for sexual contact disappear as we age? Does it go away when someone goes into a residential care setting? Studies show that it does not. What does this mean for care facilities? Whether it is board and care, assisted living, or skilled nursing, the need for a clear policy about residents’ sexual conduct is essential to good management. Results of a research study on the subject of health care professionals’ attitudes toward sexuality in long term care was presented at the American Geriatrics Society’s scientific meeting in November, 2007. Over 200 professionals working in a large nursing home filled out a questionnaire concerning elder sexuality and general attitudes toward sexuality. Surprisingly, although the average age of study participants was between 40 and 60, with over 20 years specifically dedicated to the care of the elderly, only 30% of them had any formal training in sexuality. Without training of administrators and staff in elder sexuality, formulation of policy in a care facility may be haphazard or nonexistent. When we look around at the care facilities with which we are familiar, we do not see a broad and open policy which might allow those wishing to experience sexual intimacy to have a readily available means to do so. There is little to no privacy. There may be no place to go for a couple wishing to be intimate. Staff attitudes may be negative. Worse yet, family of the elders living in residential care facilities may have their own punitive attitudes, based on a combination of factors. Some may fear that Mom or Dad will fall in love with a partner, marry and their potential inheritance will be endangered. Some may have negative attitudes toward sexuality in general. Others may believe that the parent doesn’t know what they’re doing, and will be taken advantage of sexually. Adult children may try to control their aging parents’ conduct by prevailing upon facility staff to stop the conduct, treating it as if it were a behavior problem. The picture is complicated by the fact that dementias and other mental conditions may lead to disinhibited behavior on the part of some elders, whose sexual conduct is inappropriate. Facilities have a duty to keep their residents safe. This includes the job of keeping them safe from unwanted sexual advances. From a legal point of view, sexual expression is a Constitutional right, included in the right to freedom of association and freedom of speech. Like most rights, it does have limits, of course. A health care setting has the job of monitoring the safety of all residents. Consent is essential. The anticipated behavior must be appropriate, and wanted by the participants. In long term care, it must also be safe. However, unless there is some specific danger to a resident anticipated by sexual conduct, and the resident is competent to consent to sexual behavior, there is no legal reason to deny an elder this right. Those are big ifs. The subject of competency to give consent is a broad issue, too extensive to be covered in this article alone. But, assuming that a resident has sufficient cognitive function, to give consent, he/she should be free to experience opportunities for sexual expression in long term care settings, just as he or she would outside this setting. What is called for is a clear procedural policy for addressing the sexual needs of consenting adults in care facilities. If a resident engages in sexual conduct, a professional assessment may be needed to ensure that no exploitation nor improper conduct is taking place. If there is no reason to believe that sexual conduct is inappropriate, the facility would do well to provide sufficient privacy and support for healthy sexual contact between consenting and capable residents. Some facilities provide a special room that can be reserved. Others encourage and support romance and sexuality by attitude and permissive policy as well as staff education. Facilities which support normal sexual expression are likely in the minority. Sexual expression in aging adults is often ignored or overlooked, if not actively discouraged. We find it disheartening that attitudes are so negative toward elder sexuality. Love, caring and touching should be acceptable in any setting, and between people of any age. Appropriate sexuality can promote a sense of well being, give greater meaning and enjoyment to an elder’s life and contribute to overall good health.