In many aged care settings, sex, intimacy and relationships remain taboo. Older adults are often seen as beyond desire, yet the need for connection, closeness and companionship does not disappear with age. Denying this part of life ignores human rights and the responsibility of providers to support dignity and personal expression.
Dr Nathalie Huitema, sexologist and gerontologist, says sexuality in later life has long been misunderstood.
“Sexuality exists on a continuum and extends beyond intercourse. A wide variety of behaviours can fall under the umbrella of sexuality, and some might make us feel uncomfortable. Restricting these behaviours should not be driven by personal discomfort.”
Barriers to intimacy
Most aged care environments are not designed with intimacy in mind. Shared rooms, small beds and a lack of private spaces all get in the way. Staff often feel uncomfortable when residents move beyond hand-holding, particularly when dementia is involved. Out of fear, staff may overprotect rather than support.
“When care staff are scared something might go wrong, they often have a sense of responsibility. Staff have almost an impossible task navigating these scenarios without any training or organisational policy,” Dr Huitema says.
Rethinking consent in dementia care
Traditional views often see a dementia diagnosis as removing capacity for consent. Dr Huitema argues this is too simplistic. She promotes a salutogenic approach, focusing on potential rather than deficits.
“If a resident takes the initiative to hold hands and clearly enjoys it, they are demonstrating the ability to consent. Even individuals in the later stages of dementia can still express their desires and boundaries – we just have to want to see it.”
Consent can be determined by communication skills, voluntariness and enjoyment, and the ability to initiate or stop interactions. A patient, case-by-case approach can help avoid unnecessary restrictions.
Policies, training and guidance
The lack of training and policy is a major barrier. Dr Huitema says organisations should introduce clear sexual health guidelines that explain consent, harm and autonomy. Decision trees and sexual health committees can guide staff in ambiguous situations.
One provider in the US faced a dilemma when a resident with dementia began a relationship while his wife still lived in the community. After consulting staff, the wife and a sexual health committee, the provider agreed the resident could consent. Arrangements were made to respect both relationships, creating a solution that honoured everyone’s emotional well-being.
A matter of rights
Intimacy and sexuality in aged care are not fringe issues. They are human rights that must be recognised in practice, not buried under discomfort. As Dr Huitema notes, policies and staff training make these conversations easier, protecting both residents and workers.
Supporting intimacy is not about lowering safety standards, but about balancing dignity, autonomy and protection so older people can continue to experience connection in all its forms.
Originally published in Hello Leaders winter print edition. Read the full article here or contact us on [email protected] to order your print copy.
