Sexuality

Principles

• People have a right to express and experience their sexuality, provided it is legal and does not harm others.
• Feelings connected with sexuality should be validated just like other feelings and actions.
• Privacy should be provided rather than restricting sexual activity. Knowing people well, through individualised care, means staff can check whether a particular sexual activity is welcome or not.
• Regular assessment and attention to boredom, loneliness and need for touch can reduce sexual acting out.
• The need for touch can be addressed by massage, dance or other less sexually explicit physical activities.
• Masturbation may reduce sexual behaviours that involve other people.

Strategies for sexual and sensual expression

• Develop policies on practices and procedures relating to sexual expression.
• Promote staff awareness and recognition of coercive or unsafe sexual behaviour.
• Think about older people’s sexuality a routine part of life.Watch for cues regarding needs for intimacy or sexuality to help support these needs as appropriate.
• Include measures to protect against inappropriate sexual behaviour, for example public masturbation. Such actions reflect unmet need; help people to address this in an appropriate way.
• Assist sexual expression by providing privacy, appropriate furnishings (for example, a double bed), and permitting overnight stays.
• Guarantee an environment conducive to sexual expression, for example provide ‘Do not disturb’ signs for doors.

Strategies for intimacy between residents

• Describe and document what someone is doing in objective terms. Ask ‘Is this a problem and if so, for whom?’
• If it is a problem for the person with dementia, family member or facility, identify what triggers the actions.
• Develop and use a care plan and evaluate its use.
• Focus on people’s needs.
• Educate and counsel staff and families, where appropriate, to help them understand older people’s need to express intimacy and sexuality.
• Establish a process for discussion so staff can voice concerns about close relationships among those in their care.
• Provide opportunities for families concerned about individual intimacy and sexuality to discuss their feelings.

Strategies for staff training and awareness

• Run a staff workshop on sexuality.
• Include intimacy and sexuality as topics for staff orientation and continuing education programs.
• Develop procedures for difficult incidents involving sexual expression.
• Accept such incidents can be complex and may have no easy answers.
• Use a case example of a real sexual incident to help staff explore their feelings.
• Encourage staff to voice their anxieties and discuss ideas and attitudes to reduce stress and respond reflectively.
• Encourage supervisory relationships open to issues of older people’s sexual needs.