Assisted living sex stirs worry

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Assisted living sex stirs worry
living sex stirs worry

By Amy Moss Strong The World
Posted: Saturday, January 28, 2012 7:00 am

Related: Sexuality and dementia

The World

BANDON -- Ernie and Madelyn got married on Valentine's Day. She was 86, he 88. The two, both widowed, had been good friends for many years. Family members and church friends were tickled to see their love blossom.

Bob and Barbara surprised their family by announcing they would be married soon at the church they attend. Both also are widowed and had found love through their church connection.

Louis and Vera, both living in an assisted-living facility, found comfort and companionship when they started eating meals together. Now they share laughter -- and intimate moments.

Sometimes families are supportive, other times upset when mom or dad finds love or intimacy after one spouse dies.

But when that parent has dementia and lives in a memory care facility, it can be unsettling. If a mother hardly recognizes her own children, how can she consent to intimacy?

A recent occurrence at Heritage Place Community Assisted Living Facility and Memory Care Center in Bandon prompted a flurry of phone calls, meetings and even an appointment with an attorney. A staff member walked in on an 86-year-old woman and man, both memory care residents with differing levels of dementia, while they were having sex. When the employee tried to redirect the behavior, she was told by the couple that they were doing what they wanted to do and to leave them alone.

'The resident made a choice to be involved with another resident and it's been hard for the family to accept," said Heritage Place Administrator Susan Lubke.

The family questioned whether their parent was capable of making a decision to have sex. And that's the first thing that must happen after such a discovery, Lubke said. She followed the policies and procedures of the facility, including contacting the family, documenting the activity, interviewing staff members and meeting with an ombudsman.

State law mandates that it must be determined whether the intimacy was consensual. Did one of the people involved feel fearful or threatened? Did they know what was going on? Though one of the partners in a relationship may have a higher level of cognition than the other, that doesn't necessarily mean the sex was coerced, Lubke said.

The staff and administrators determined, in this case, that the sex was consensual, though the family is still grappling with the idea.

'This is normal behavior that happens," Lubke said.

Further, she added, it's not all that uncommon.

According to Lubke, some dementia patients, who, after being put into a facility become sexual - much to the surprise of their family - might be trying to fulfill a need they can't express. They may be craving intimacy and closeness. Seeing a person who looks like, or has the mannerisms of someone they knew might trigger memories of when they were married.

It's hard to know exactly what they are thinking, Lubke said.

'Whether or not someone has dementia, they still have needs, like wanting to be touched," Lubke said, 'maybe even more so. And residents have a choice. We will always try to redirect, but if a resident says leave me alone, then they are not 1,000 percent unaware of what's going on."

Susan Cain, administrator at Inland Point Assisted Living in North Bend, agrees that such behavior is not unusual. Though Inland Point doesn't have a memory care unit, Cain has worked in another local facility that did have one. It's also common for residents in assisted-living to seek each other out, she said.

'Sexuality doesn't end at a certain age," Cain said. 'The basic instinct is still there. People think of sex as wrong or unclean, but it's comfort. It's a kind of connection. And they have a right to have a connection and a relationship."

Unless someone is being victimized, Cain added, staff may try to dissuade the behavior, but they won't prohibit it. Each case must be assessed to determine if it's consensual. Cain said she notifies the family of any 'special relationships," even of residents without dementia, and tries to educate them. Sometimes the family can shed light on a person's behavior. If a man was a womanizer when he was cognitive, he may very well continue that lifelong pattern with dementia. On the other hand, a woman who has not been sexual for years may suddenly show a keen interest.

'These often are just adults seeking companionship, and that's not a bad thing," Cain said. 'My thought is that they are at the end of their lives, let them have anything they want to make them happy. Look at all they've lost. If they find companionship and it's consensual, let them have their happiness."

If it isn't consensual sex, the law is clear, according to Dr. Marge Coalman, vice president of wellness and programs for Touchmark, the parent company of Inland Point. Coalman trains and educates care givers throughout Oregon, and also designs and instructs person-centered dementia care classes for the Oregon Health Care Association.

'First you have to establish if anything criminal has occurred," Coalman said. 'The Oregon statutes on abuse are very clear."

Dementia is such a broad category -- it's not just Alzheimer's, and each diagnosis has different associated behaviors. What has to be determined is whether the resident understand the risks, rewards and possible consequences of a relationship, Coalman explained.

There are batteries of tests and assessments that can be done by psychiatrists, social workers and other health care professionals. A person may not respond to those assessments in a verbal or traditional way, but they can usually clearly demonstrate if they feel fear or intimidation.

Even guardianship or power of attorney does not necessarily give the family the right to make sexual decisions for an individual, according to Coalman. And each incident must be looked at on a case-by-case basis.

'It's pretty complicated and gets more so when sexuality is involved," she said. 'It's just such a hot-button issue for family and staff. But we can't promise people -- nor should we -- that a person isn't going to develop a relationship in our (care center) communities."

Still, Coalman feels issues involving dementia need to be discussed and understood.

'We pretty much have an epidemic with Alzheimer's and age-related dementia as people are living longer," she said. 'We need to make this a public health priority. The more we can bring these issues to people in terms of the need to have them understand it as a disease, the better. We also need to press forward with developing medications and vaccines."

Public education about dementia is key, Coalman added.

'The more we know about people, the better we can meet their needs," she said. 'This is a hard topic to bring to light or raise funds for, but it's something people need to talk about."

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