Members of the Charles E. Smith Life Communities noticed one elderly resident making sexual advances toward another several years ago. Both were cognitively impaired.
While the man may have been acting on a basic, and natural, human need, a difficult question arose for these two residents and the staff. Was the woman capable of consenting to sexual activity? Did the man realize his overtures weren’t appreciated?
The staff stepped in, said Barbara Hirsch, an administrator at the Rockville facility. They tackled the issue as a team, speaking with everyone involved in caring for the two residents, discussing the issue with family members and approaching the residents themselves.
In this instance, the staff decided to keep the two residents apart. He was prevented from propositioning her further, “because the woman looked like she was shuddering” in response, and some staff members noticed she had begun to withdraw into herself, Hirsch said.
Dementia – not basic memory loss, but a progressive memory loss that is often accompanied by depression and agitation – can leave sufferers confused. They can find it difficult to understand and appreciate what is happening.
Yet, residents of assisted living facilities are adults, free to make decisions about when and if they want to be intimate, and with whom, said numerous health and social work professionals. A person may live in an assisted living facility, but that facility is still their home, and they are entitled to privacy, said Eileen Bennett, director of Montgomery County’s long-term care ombudsman program.
“This is definitely a nationwide discussion within the four walls of a nursing home,” said Bennett.
Last month, Henry Rayhons, a former member of the Iowa House of Representatives, was found not guilty of sexually abusing his wife in her nursing home. The case centered on the definition of consent to sex by a person with dementia, and it raised the question of whether nursing homes are ready to deal with this issue.
Local prosecutors say they would have to look very closely at the facts in such cases, given the many layers involved—psychological, medical and legal.
“I think it would be highly unusual for a case like that to come to court in Montgomery County,” said Debbie Feinstein, chief of the family violence division at the Montgomery County State’s Attorney’s Office. “We are always looking at whether criminal prosecution is the correct path.”
The Charles E. Smith Life Communities has no written policy on what constitutes unwanted sexual advances involving residents or how to handle the issue of residents engaging in sexual relationships. “We approach it on an individual [basis], holistically,” Hirsch said.
The Hebrew Home at Riverdale in New York recently issued a two-page policy on how to determine if a resident is enjoying intimacy or being abused. The policy explains the differences between rape or sexual assault, which are crimes, and inappropriate sexual activity due to poor impulse control or hypersexuality.
Barbara Halperin of Leisure World knows what it’s like to watch a loved one lose his mind. The man she married was a brilliant, successful pharmacist who spent most of his career in public service. They traveled the world together and had two daughters.
Jerry Halperin, the “most outgoing person,” seemed to have trouble finishing sentences. Then the man who held four honorary doctorate degrees stopped talking. He also experienced mood swings.
“I think there were times he definitely went to the dark side,” his wife said.
It became too much for her, as she confronted back, knee and balancing problems of her own.
Together with her daughters, they moved Jerry Halperin into Kensington Park’s assisted living housing.
“We knew this had one road. We knew this was going to end up one way,” she said. She visited her husband daily, watching as he plunged into a world where his family members who had been a focus of his life, seemed only somewhat familiar to him. He just couldn’t place her, Barbara Halperin said. Then, he mistook her for one of the staff.
At that point, he would only whistle, then only hum, and then only curse – something he never did, she said. “Then he started crying without tears. Then he cried with tears.”
She began thinking of her husband as Mount Rushmore – a stone figure that could not move, could not react.
“Good” was her immediate reaction to the Iowa verdict. At that point, if her husband could have found something positive in his life, something he wanted to share with anyone at all, Halperin would have been pleased. “These people have nothing to look forward to.”
Her husband, however, showed no desire for intimacy while in Kensington Park, Halperin said.
Several of the area senior homes reached for this article said that although they lack written policies on consent for sexual intimacy, they are aware that people suffering from dementia are entitled to privacy, may be able to consent and may have sexual urges.
B’nai Brith Homecrest House in Silver Spring operates three buildings, one of which houses people who need assistance. At its Edwards Personal Care Facility, there is no blanket policy regarding the sexual lives of residents; residents’ ability to consent to sexual activity is evaluated on an individual basis.
Questionable incidents are examined by the executive director’s staff, and findings are reported to family members, and if need be, adult protective services, said Joe Podson, executive director.
“We respect them as adults. We respect their privacy,” Podson said, “These are adults. I am not their caregiver, but we do care.”
When two residents enter into a relationship, that’s a personal decision, not a healthcare one, said Bennett, of Montgomery County’s long-term care ombudsman program. People have rights “until someone takes them away” through power of attorney or court-appointed guardianship.
She called sexual attraction “a very natural urge that really doesn’t go away” with age. Sometimes the onset of dementia brings decreased inhibition, she said.
That’s why social workers routinely talk about sex to nursing home staff, Bennett said. Facilities are advised to provide condoms to avoid the possible spread of disease.
According to AARP, as a result of the national trend among seniors, Medicare is considering providing coverage for STD screenings for seniors.
This topic is not going away, said Bennett. “Exponentially, dementia is our overriding complication in everything we deal with.”