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It’s not just about sex

The basic human need of intimacy does not disappear as we age however in aged care planning it is mostly overlooked and often regarded as inappropriate.

Intimacy in a care home setting is complicated and there should be a better understanding of the intimacy needs of older people (Source: Shutterstock)
Intimacy in a care home setting is complicated and there should be a better understanding of the intimacy needs of older people (Source: Shutterstock)

Couples in aged care facilities are being given little to no privacy in their intimate and sexual relationships, and it’s often the staff who prevent couples from having this intimacy.

A UK study involving residents, non-resident female spouses of residents with a dementia and 16 care staff, carried out last year, found feedback very different from the stereotypical assumption of older people not been sexual. 

Carried out by a research team for the Older People’s Understandings of Sexuality (OPUS), some participants denied their sexuality, others expressed nostalgia for something they considered as belonging in the past, and some still expressed an openness to sex and intimacy.

More recently a New Zealand pilot study carried out by Associate Professor Mark Henrickson, from the School of Social Work, and School of Nursing senior lecturer Dr Catherine Cook explored attitudes to sexuality in aged residential care facilities. 

They found the need for better understanding of the intimacy needs of older people and a significant number of staff, families and residents are managing complex situations without clear processes to protect residents’ rights and safety.

Intimacy in a care home setting is complicated. Issues include querying consent for someone who is in cognitive decline, staff managing adult children who deem their parent’s behaviour as wrong, and a lack of privacy for couples. Plus, there is a stereotype to overcome – for many sex and intimacy is associated with youth, not older people.

“We are a microcosm of an ageist culture,” says Australian expert Dr Catherine Barrett, Director, Celebrate Ageing.

Dr Barrett’s views go beyond a person’s sexuality and importance of sex, believing there should also be a focus on non-sexual physical intimacy. She highlights a study by the University of Queensland where babies were found to recover quicker if they are touched. 

“We need to focus more broadly,” she says. “Some people have sexual relationships because they’re lacking skin on skin touch. Known as ‘skin hunger’ (also known as touch hunger) it is a need for physical human contact, and this can be mistaken as a need for sex.”

She cites one example of a male resident who behaved very inappropriately to any females in the room. “A massage therapist came once a week and he stopped doing what he was doing,” she says. While some residential homes do access sex workers, Dr Barret says in some cases it’s simply for a person to come over and cuddle.

Aged care advocate Anne Fairhall, whose husband of over 50 years is living with dementia and is in a care home says they both missed skin contact. And it wasn’t just between the two of them. “In an aged care home, everyone puts on rubber gloves,” she points out.

Ms Fairhall believes people living with dementia respond very well to love, affection and intimacy. “We’d gone from sleeping in one bed to sleeping in two different locations, and he asked me ‘do you still love me?’; he couldn’t comprehend why I’d put him in a home.” she says. “But it’s not just about holding his hand; it’s about having some privacy.”

“It’s also about eye contact, an arm around the shoulder and stroking his skin. It’s giving him the body language message I’m connecting with him,” says Ms Fairhall. “I’d go in later in the day, sit close to him at dinner and after he’d eaten, get him into his pyjamas, kiss, cuddle and put cheek to cheek.”

Just lying beside her husband is comforting. “Staff are surprised if they walk in and they are a bit embarrassed at first– less so now as they get to know you,” she says.

Dr Barret is calling for more training and education to be given. “We can’t point the finger and say 'not good enough' to aged care homes – we need to be asking how we can help,” she says.

To this end, through the OPAL (Older People And SexuaLity) Institute, Dr Barret has developed a set of tools and resources for service providers and organisations. This includes holding workshops and helping develop policies and procedures around sexuality and intimacy.

After attending one of the workshops, Victorian provider Cooinda is in the process of implementing a sexuality policy template.

“This is an important step forward in what we do and the care we give,” says April Betheras, community support, Cooinda. “We talk a lot about person centred care and we have ideas about sexuality and intimacy, but the big thing is being able to think about the whole picture. It’s about identifying with the person and having the conversation.”

She says there is more communication with residents about the subject now, but acknowledges not all residents want to participate. “While some feel that [sexual] part of their life has gone, there are other ways of being close,” says Ms Betheras. “A partner can participate in aspects of care. This is what keeps them close and feeling connected still.”

Training in sexuality and intimacy is also now compulsory for staff. “Staff feel confident in speaking about and dealing with issues. For instance if someone wants access to a sex worker, what would you do that? Who would you go to?,” says Ms Betheras. “LGBTI is also incorporated so we can consider all particular needs.” 

For more information, visit the Opal Institute website.

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