Sexuality

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.

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.

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.

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.

Reviewed 22 February 2016