Barriers to Sexual Expression in Residential Care Facilities for the Elderly

BACKGROUND: The right to be sexual (in a way which does not harm others) is a universal human right—across age, class, race, and physical/cognitive capacity. As a more sexually liberal population with access to medical advances in sexual functioning move into Residential Care Facilities for the Elderly (RCFEs), there is a greater need for policies regarding sexuality to protect this right. METHODS: We conducted in-depth interviews with a convenience sample of 14 upper level administrators of licensed RCFEs and 2 residents in the San Francisco Bay Area. Administrators filled out demographic surveys about the facility, and 3 focus groups with mid-level managers and front-line care staff of RCFEs were also conducted. FINDINGS: Perceived barriers to healthy sexuality of residents included: the loss of social ties related to aging; a diminished sense of self-determination and agency; the common assumption on the part of peers, family members, and facility staff that seniors and/or widowers are (or should be) asexual; privacy issues in double rooms; and legal concerns about liability regarding residents with cognitive impairment who cannot give consent. RECOMMENDATIONS: Recommendations for supporting residents' healthy sexuality included: educating their adult children about seniors' sexuality; educating facility care providers about best practices in addressing resident sexuality; and establishing state level regulations and intra-facility policies requiring explicit protection for residents' rights to pursue personal pleasure.