Navigating Tensions About Resident Sexual Expression in Alberta’s Continuing Care Homes: a Qualitative Study of Leaders’ Experiences

Abstract

Introduction In continuing care homes, resident sexual expression is complicated by interpersonal, physical, and social features that are part of congregate living. Little is known about how managers navigate the complexities of these features. Methods We undertook a descriptive, exploratory study to pursue this line of inquiry. We conducted in-depth interviews with 28 participants from a network of managers, clinical ethicists, geriatric specialists, and social workers in Alberta, Canada.Results We present our findings as three dynamic tensions: 1) the tension between how sexual expression should be supported and how it is addressed in care homes; 2) the tension between private and public space in the care home; and 3) the tension between a medical model of care and a conceptualization of sexual expression as an activity of daily living. Conclusions These tensions are connected with sexual rightsspecifically, with the rights to equality and non-discrimination, privacy, and autonomy and bodily integrity. Sexual expression can also have physical, social, and emotional benefits for continuing care residents. Thus, the tensions surrounding resident sexual expression ought to be navigated with an approach that acknowledges sexual rights and best upholds them. Policy Implications We suggest that in order to realize the benefits and prevent the harms associated with resident sexual expression, there is both need and opportunity for a coordinated, multi-level approach.

Not in the Brochure: Porneia and Residential Aged Care

“…In general, the literature has found that expressions of sexuality and intimacy, particularly between opposite-sex residents (or residents and their non-resident opposite-sex partners), have become more acceptable in RAC, or at least RAC staff have found it more difficult to avoid the questions. Other expressions remain less acceptable and even unspeakable (Howard et al, 2019 ). We address our findings on same-sex intimacy elsewhere.…”

Dementia and sexuality in long-term care: Incompatible bedfellows?

“…While these types of legislation were not explicitly implemented to restrict positive sexual expression of persons living with dementia, they pose a significant barrier to such expression by reinforcing ableism and ageism (Fischel & O'Connell, 2015;Goldberg, 2018;Peisah et al, 2021). In the context of the risk-averse culture of RLTC, such legislation legitimizes the default practice of restricting sexual expression of people with dementia based on the belief that it is unintentional and/ or not consensual, and thus always harmful (Howard et al, 2019;Sandberg et al, 2020).…”

“…Despite the benefits of sexual expression and its importance in the lives of people living with dementia, research demonstrates that there are multiple barriers to its positive expression (e.g., pleasurable and free of coercion, discrimination, and violence) in RLTC homes, both at the micro (e.g., negative attitudes and practices of healthcare professionals) and macro (e.g., cultural stigma, professional standards, and public policies that do not recognize importance of positive sexual expression) levels. For example, research on nurses’ and other direct care professionals’ perceptions and responses to the sexual expressions of residents with and without dementia found that they tend to respond to the sexual expressions of persons living with dementia with expressions of disgust, denial, and discouragement ( Cornelison & Doll, 2013 ; Howard et al, 2019 ; Roach, 2004 ; Ward et al, 2005 ). When confronted with overt sexual desires or activity, many professionals report feeling shame and discomfort, as well as the need to intervene in the sexual expression ( Roach, 2004 ; Shuttleworth et al, 2010 ; Villar et al, 2018 ).…”

The Institutional Remains: Transinstitutionalization of Disability & Sexuality

“…These conditions provide limited opportunity for spontaneity, community, and intimacy. For instance, in one long-term care home, a resident wanting to watch pornography was told he would need to give at least 24-hours of notice to staff and 51 Including Homes for Special Care (Marrelli, 2018) roommates (Howard et al, 2020). However, even after following all the steps, the resident reported being walked in on by staff while masturbating (Howard et al, 2020).…”

“…Within long-term care facilities, staff surveillance of sexuality is often triggered by diagnostic label (Howard et al, 2020). This need for surveillance is made apparent in an Ontario municipal long-term care home guide on the "Best Practices & Approaches to Intimacy and Sexuality" (2007).…”