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.