Sexuality and intimacy in aged care is moving up the regulatory agenda.
The Aged Care Quality and Safety Commission has named sexual safety and sexual rights as one of four sector risk priorities for 2026–27.
For Kate Lamont, Managing Director of Thrive Aged Care Consultants, the announcement was a welcome one.
“I was pleasantly surprised that the Commission named sexuality and intimacy as a focus area for 2026-27,” she shares.
“This is something the sector has quietly known needs attention for years, but it’s rarely had the mandate or the resourcing to move up the priority list.”
Lamont said the focus gives services greater reason to put structure around an issue that has often been left to the comfort level of individual staff.
“This isn’t being positioned as a niche or awkward issue anymore; it’s being treated as a legitimate rights and safety matter, sitting alongside things like restrictive practices or clinical governance,” she said.
“That shift matters, because it changes who takes ownership of the problem, from the clinical floor right up to the board.”
Providers are still responding reactively
While sexuality has previously been recognised as a human right in aged care, Lamont said many providers are still managing sexuality and intimacy reactively.
“There’s often no policy at all until an incident forces one into existence overnight, usually written under pressure and skewed heavily toward risk minimisation rather than resident rights,” she said.
Training is another gap.
Lamont said sexuality and intimacy are rarely covered meaningfully in induction or ongoing professional development. That can leave staff making difficult decisions about capacity, family objections and relationships based on personal judgement.
The physical environment can create problems, too.
“Many facilities simply aren’t designed with privacy for intimacy in mind, shared rooms, thin walls, staff walking in without knocking,” she said.
“Even where the will to support someone exists, the environment, routines and habits don’t make this easy.”
Lamont also pointed to documentation, particularly where conversations about capacity and consent aren’t recorded well.
That becomes especially important when capacity can change.
Consent and capacity isn’t a one-off assessment
“Capacity is rarely as black-and-white as services want it to be,” Lamont said.
“It can fluctuate day to day, and it’s decision specific.”
A resident might have capacity to consent to a relationship, but not to manage their finances, or vice versa.
Lamont said relying on a single cognitive screening score rather than assessing capacity for the specific decision being made is one of the “most common and riskiest shortcuts” providers can take.
For someone living with dementia, capacity may also change with the time of day, environment, fatigue or progression of their condition.
“A resident might have clear, considered capacity to engage in and enjoy a relationship in the morning, and present very differently by evening,” she said.
“Services need a way of accounting for that fluctuation, rather than treating capacity as something assessed once and fixed permanently.”
The issue extends to how staff interpret behaviour.
Lamont said expressions of comfort, affection or unmet need among people living with dementia can be labelled as “disinhibited” or “a behaviour to manage”.
Without a dementia-specific approach, staff may suppress a legitimate expression of connection or miss a genuine risk because it is dismissed as “just the dementia”.
When residents and families disagree
Family objections can add another layer to decisions around sexuality and intimacy.
Lamont said this can be particularly difficult in dementia care, where families may struggle with a new relationship or with a resident continuing to express their sexuality.
“Providers can end up managing family comfort rather than resident wellbeing, without necessarily realising that’s what’s happening,” she said.
Relationships between two residents living with dementia can raise further questions, particularly when their cognitive abilities differ.
Providers then need to consider the rights and protection of both people and determine whether the relationship reflects mutual affection or behaviour driven by confusion or disinhibition.
The challenge isn’t necessarily a lack of policy.
“Even with good policy, staff can be hesitant to act on it because they’re worried about getting it wrong, being blamed, or facing a complaint, so risk aversion quietly overrides the policy’s intent,” Lamont said.
What does going beyond compliance look like?
For Lamont, having a sexuality and intimacy policy isn’t enough.
“Compliance gets you a policy document sitting in a folder somewhere. Beyond compliance gets you a policy that staff have read, understand, and feel confident applying under pressure, plus the training and culture that sit around it.”
She said sexuality should be embedded into routine assessment and care planning in the same way providers ask about mobility, nutrition or social connection, rather than only being addressed after an issue arises.
Tools such as the Sexuality Assessment Tool (SexAT) can also help providers assess the broader service, including the environment, policy and training.
For people living with dementia, Lamont said providers should apply the same person-centred frameworks used for other changed behaviours and look at what may be behind an expression of intimacy or affection before moving towards restriction.
Staff also need a process for situations where there isn’t a straightforward answer.
“A genuinely mature approach doesn’t produce a single ‘yes’ or ‘no’ policy on intimacy; it produces a decision-making process that can flex to the person and situation in front of you, with clear escalation points when capacity or safety questions arise,” she said.
Lamont said this is one of the more complex areas of dementia care, which is why Thrive Aged Care Consultants includes sexuality and intimacy in its workforce education.
“Ultimately, compliance asks ‘have we met the standard?’ Beyond compliance asks, ‘would this resident feel respected and supported if they knew how we were making this decision?’ That’s a much higher, and much more useful, bar.”
What should leaders review now?
Lamont recommends starting with the organisation’s sexuality and intimacy policy and asking these questions as a start:
- Does it default to restriction?
- Does it give staff a clear process when capacity is in question?
- Does it account for fluctuating capacity in people living with dementia?
Assessment and care planning are another area to examine, including whether sexuality is discussed at all and whether capacity assessments relating to intimacy are decision specific.
Training should cover consent and capacity, responding without shaming residents, family concerns and how dementia can affect behaviour.
Everyday practices matter as well, such as:
- Do staff knock and wait before entering rooms?
- Can couples access privacy?
- Do room configurations support relationships?
- Does rostering allow uninterrupted private time?
Previous Hello Leaders reporting has highlighted how barriers within aged care environments can compromise intimacy and resident relationships. The Commission’s latest focus puts greater attention on how those rights are supported in practice.
But Lamont said leaders can get a useful indication of where their organisation stands without starting yet another policy document.
“Ask your frontline staff what they’d actually do if a family member raised a concern about a resident’s new relationship tomorrow, and specifically, how they’d handle it if that resident was living with dementia,” she said.
“If the answer is hesitant, inconsistent, or ‘I’d probably just call my manager and hope they know,’ that’s your starting point, not the policy folder” the people applying it.”
Then, review recent incidents or near misses.
Were they managed using a documented, dementia-informed process, or did staff rely on individual judgement in the moment?
“That tells you whether your policy is actually operational or just exists on paper.”
