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Navigating Sexual Consent and Dementia

By Noah C. Hagan posted 06-29-2015 08:33

  

In April, an Iowa jury acquitted a 78-year-old former state legislator of sexual abuse for having sexual contact with his wife, who had Alzheimer’s disease. Nursing home staff had apparently warned him that she was unable to consent.

The case highlights the thorny issues surrounding standards for nursing home care, respect for the sexuality of people with Alzheimer’s disease and dementia, and prevention of elder abuse. Gayle Doll, director of the Kansas State University Center on Aging, advocates for “broader interpretations of functional competence.” That means listening to people with dementia instead of assuming that they are unable to consent to sex. Practically speaking, this means that nursing home policies must require discussion of sexuality in care plan meetings and sensitivity training for staff and family members. Sometimes, the efforts to protect people with dementia prevent them from experiencing their best life possible, Ms. Doll says.

NPR reported that the Hebrew Home, a nursing home run by RiverSpring Health, in Riverdale, NY, has had a “sexual rights” policy since 1995. The policy “recognizes and supports the older adult’s right to engage in sexual activity, so long as there is consent among those involved.” Where the older person has Alzheimer’s disease or dementia, clinical staff must conduct an assessment using the home’s “Assessing Consent to Sexual Activity” guidelines. The guidelines include assessing the person’s ability to express choices and consent, even where the person is unable to verbalize choices, and consideration of the person’s quality-of-life choices “in the here and now.” The CEO of RiverSpring Health asserts that the policy protects residents while also recognizing that intimacy can be a good thing for people with dementia.

Even with written policies, it is not always easy to ensure valid consent. For example, what if one partner mistakenly believes that the other partner is her spouse but in fact he is not? Is her consent valid then? What if it seems clear to nursing home staff that both parties are consenting to sexual activity, but family members object? How much say should family members have in such intimate decisions?

The answers may not be clear. But a nursing home policy that acknowledges the sexuality of older adults with Alzheimer’s disease and dementia at least opens the door to the conversation, and that’s a start.

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