Aged care barriers compromise intimacy, resident relationships

Australia’s aged care homes often lack the appropriate guidance and privacy necessary for older people to enjoy fulfilling intimate relationships, according to research from La Trobe University, however, appropriate staff training could change that.

Having surveyed staff at almost 3,000 residential aged care homes, La Trobe’s Australian Centre for Evidence Based Aged Care (ACEBAC) found that a combination of physical and societal barriers meant a resident’s ability to enjoy intimacy, including sex, was compromised.

Staff access to education and training courses on sexual behaviour in older people was also identified as an important factor as some aged care workers were not aware of how to respond to certain resident relationships and interactions. 

Research Fellow and co-author of Intimate relationships in residential aged care: what factors influence staff decisions to intervene?, Dr Linda McAuliffe, said that older people living in aged care deserve to have their right to intimacy respected.

“Our sexuality is a part of our identity and being able to express who we are is important to our wellbeing,” said Dr McAuliffe.

“This doesn’t change just because we get older or move into residential aged care. 

“Intimacy can take many forms and can offer much comfort during challenging times, such as when dealing with illness or impairment.”

According to Dr McAuliffe aged care providers have an important role to play in ensuring residents have opportunities to form and maintain relationships that have a level of intimacy and sexual expression.

The core component of the research was a case study of a fake relationship between two elderly residents, Norm and Carol. 

Every aged care staff member who completed a survey was required to react to various relationship scenarios which ranged from a traditional relationship with no issues to Norm showing signs of distress while Carol was around.

Staff were even asked how they would react if they knew Norm was married and his wife still lived in the community.

Ultimately, just 10% of staff said they would intervene in some way if it was a traditional relationship with no noticeable concerns. But if Norm was distressed, 89% would have stepped in, while 40% said they would do something if it was an affair.

Dr McAuliffe said the responses were promising, although staff became indecisive when additional factors such as cognitive impairment were introduced.

“We were encouraged that staff attitudes towards resident sexuality were largely positive, with only a minority indicating that they would intervene in the relationship,” said Dr McAuliffe.

“As the scenario became more complex, however, whether this was in terms of level of cognitive impairment, family involvement, or physical contact, we observed more hesitancy in staff responses. 

“This reflects that when faced with complicated situations, and in the absence of good policy to guide practice, staff err on the side of caution and act more conservatively.”

While staff intervention was one contributing factor to the longevity of relationships, physical barriers are another.

Residents are often unable to enjoy any privacy due to a lack of unlockable doors and spaces where they can spend alone time together.

Many couples, whether they enter aged care together or a relationship that develops while in a home, cannot physically share a bed as there are rarely double beds.

Dr McAuliffe said aged care providers can take simple steps in providing residents with the opportunities and privacy to form and maintain intimate or sexual relationships.

These could include knocking on doors before entering a room, providing ‘do not disturb’ signs and being sensitive to the needs of residents.

In the longer term, Dr McAuliffe said it is essential to think about the design of facilities to ensure there are private spaces where couples can retreat, and bedrooms that are big enough to accommodate a double bed.

Calls for staff education on sexual behaviours

In addition to staff responses, the study identified that many aged care homes were without important policies and guidelines relevant to sexual behaviour and intimacy.

It revealed that half had written policies on sexuality, one-third had policies on sexual behaviour, and just one in six had policies on sexual health.

Dr McAuliffe identified the lack of guidance, including legal guidance, as a major reason why staff were often uncertain about when to intervene or not.

“Sexuality between residents can be a difficult matter for residential aged care staff, especially if cognitive impairment is involved,” said Dr McAuliffe.

“There needs to be a comprehensive policy to guide staff in their practice and to support healthy resident relationships.”

The aged care system is faced with additional challenges surrounding relationships and sexual behaviours as a loss of cognitive function put a significant population of residents in a vulnerable position.

“Unwanted sexual behaviour is a serious issue and residents should absolutely be protected from this,” said Dr McAuliffe. 

“Staff can work with particularly vulnerable residents, such as those with cognitive impairment, to ensure they understand who they are entering a relationship with and the risks involved, and by revisiting this conversation.”

While they are protected by the Charter of Sexual Rights, which was launched in December, the number of reports to the Aged Care Quality and Safety Commission of alleged or suspected unlawful sexual contact is rising.

ACEBAC will tackle the issue on February 24 in its workshop for aged care professionals and workers, Addressing unwanted sexual behaviour in Residential Aged Care Services.

The workshop will explore the ways to prevent and manage unwanted sexual behaviours, the negative stereotypes of older people and the challenges that staff face when detecting and reporting incidents.

Dr McAuliffe, who is set to speak at the workshop, said education opportunities for staff will help them support a range of intimacy and sexual health needs for aged care residents.

More information on the ACEBAC sexual behaviour workshop is available here.