Saturday, July 12, 2003
Unmarried seniors having sex in nursing homes
A story published today in the Kentucky Post reports that when a 72-year-old grandmother and a 68-year-old man started holding hands at a Westwood nursing home, staff members thought it was cute. But when the unmarried couple announced they wanted to have sex, staffers were stunned.
"We thought, 'No way,' " said Sara Gramann, director of nursing at the home at the time. "Then we realized we would be violating their rights."
After checking with adult protective services, state officials, social workers and ombudsmen, nursing home officials briefed the couple on safe sex practices, gave them condoms and the use of a private room.
"The woman's children were irate and threatened to sue us because they didn't picture their mom having sex while she had grandkids running around the nursing home," said Gramann.
"It was quite an issue. Sexuality in any health care setting is just not talked about."
While nursing homes give elderly and sick people help ranging from medical care to personal hygiene to genial companionship -- sex is generally ignored.
"The whole subject is taboo," said Dr. Duncan MacLean, the medical director of Delaware's state-operated system of nursing homes who's studied the complicated issue. "Most nursing homes sweep it under the rug.
"However, sex is a fact of life in nursing homes that should not be ignored."
Nick Folchi, 85, of Erlanger, is wary of bringing up sex in a nursing home, even though it's on his mind.
Folchi, who lives in his own home, says he would like to have sex with his wife, Mary, 83, who resides in an Erlanger nursing home, but is afraid to ask staffers for the assistance it would require.
"My wife is paralyzed on one side and I have a bad back, so I would need somebody to put her in bed for me," he said. "But I wouldn't dare discuss it with the nursing home.
"Mary is there on Medicaid and they're cutting out a lot of Medicaid. If I came up with a proposition like that, Medicaid might say if you're well enough to have sex, you're well enough to live at home."
Sex, it turns out, is not a welcome topic at many nursing homes.
People having sex in nursing homes will be impossible to ignore in a few years, predicted Dr. John Morley of St. Louis University, a geriatrics expert.
"We're going to see an explosion in the issue," he said. "You've got a lot of Baby Boomers like me coming along who are not going to be happy in nursing homes if we can't continue doing what we've been doing. Plus, we've got Viagra."
Baby Boomers, 78 million Americans born in the post-World War II population explosion from 1946 through 1966, now range in age from 37 to 57 years old and are expected to begin swelling nursing home populations in a few years.
Today, about 2 million Americans live in nursing homes. In 2030, when Baby Boomers will range in age from 64 to 84, U.S. nursing home population is expected to skyrocket to 5 million, according to estimates by the Mayo Clinic in Rochester, Minn.
Many Baby Boomers came of age during an era of sexual liberation in the 1960s and 1970s and the advent five years ago of Viagra, the popular drug already used by 16 million men to remedy erectile dysfunction (impotence), will help Baby Boomers continue to have sex as they grow older.
Viagra's effectiveness is not affected by age, said Daniel Watts, a spokesman for Viagra-manufacturer Pfizer. "It works well in elderly patients," he said. "In clinical trials of men aged 65 and over, 92 percent showed improvement in achieving erection with Viagra."
Right now, though, nursing home staffers are reluctant to get involved in the sexuality of residents, said Morley.
"I'm sure I would get killed by everybody working in a nursing home if I prescribed Viagra for a resident," he said. "I don't think any nursing home employee wants to deal with sex among patients."
MacLean noted that one study of nursing homes found that two-thirds of staff members considered resident sexuality as unimportant to address.
Local nursing home administrators also downplay sex.
"There are no torrid sex scenes going on," said Barry Bortz, chief executive officer of Care Spring, which operates several nursing homes in Northern Kentucky and Cincinnati.
"I wouldn't be surprised if sex occurred, but I can't remember a specific incident where it happened among residents.
"Sex is still there, but sex becomes a different thing with them -- holding hands, caressing each other, combing each other's hair. It's a much more innocent process than you might think."
John Hutcherson, administrator of Baptist Convalescent Center in Newport, said he assumes sex has occurred among residents, but said it has never posed a problem.
"There really isn't much sex talk here," he said. "The focus of residents is really elsewhere. Their focus is more on food."
At Hillebrand Nursing Center in Bridgetown, "sex has never been an issue," said the administrator, Richard Kidd.
"I don't think it (sex among residents) happens," he said. "The staff would know if individuals were going into a room together and closing the door."
Sex at some nursing homes is so private that not even other residents realize it's going on.
Beverly Clay of Fort Mitchell, a resident of Highlands of Fort Thomas Health Care Center and Rehabilitation, said she was "somewhat surprised" to learn from a staffer that sexual relations there had occasionally been privately accommodated.
"I just assumed it didn't happen here," she said. "Sex is a topic that has not come up here and that does surprise me some. I'm sure some residents think about sex, but they don't talk about it."
Clay noted that while she hasn't discussed sex with anyone, "I still have a desire. If I get a need, I'll read or play music. I have a belief that you do not have sex unless you're married.
"But, I'm not going to say I wouldn't like to see some nice-looking gentleman come in here."
Some nursing homes are operated by religious groups that might have opposition.
"Even in non-sectarian nursing homes, many staff members see their work as religiously motivated," noted MacLean. "These staff and facilities may approach sexual issues from the standpoint of moral teachings of their faith or from a general ethical perspective."
Pam Pangburn, the Northern Kentucky long-term care ombudsman and advocate for nursing home patients, said she has received no comments from residents about sexual matters.
"It's not an issue around here," she said. "If it is an issue, it's not been brought to my attention."
It is a big issue in some European nursing homes, where administrators have liberal sexual policies.
In the Netherlands, many nursing homes allow residents to bring in prostitutes, according to Dr. Peter Gott, who writes a syndicated newspaper column about health.
Gott lamented that "sex is a no-no in American nursing homes," but he advocated getting rid of the "misperception that sex after middle age is 'dirty' and somehow unnatural."
"If we did," he said, "American nursing homes might become far more responsive to the wishes of their residents, who should be entitled to the same privileges enjoyed by younger, non-institutionalized adults."
Although sex drives may diminish with age or illness, they don't disappear, as studies cited by MacLean show.
A study of healthy people aged from 80 to 102 found that 88 percent of men fantasized about sex, 66 percent had sexual intercourse and 72 percent used self-stimulation, while 72 percent of women fantasized about sex, 38 percent had intercourse and 40 percent used self-stimulation.
Another study of nursing home residents found that sexual interest continued despite considerable barriers, including no available partner, lack of privacy and poor health.
While there are no laws against consensual sex among mentally competent nursing home residents, most nursing homes have no policies on how to assess its appropriateness or accommodate it.
"It's the age thing," said Morley. "As a society, we think that as people get older, they should give up sex. Unless you're Hugh Hefner.
"Another problem is the children of nursing home patients. Children often find it unacceptable for a parent to be having sex in a nursing home."
That's the wrong attitude, says Dr. Margo Tallmer, a New York City expert on geriatrics.
She said sexual activity among mentally competent nursing home residents should be encouraged because it "enhances life, gives pleasure and alleviates depression."
That view is shared by John Sammons, Kentucky's chief long-term care ombudsman.
"Sex is very natural, it is healthy, it is good for our lifestyle and residents of nursing homes have sexual needs and desires just like other individuals," he said.
In one instance, Sammons said, two residents had fallen in love and gotten married.
"The nursing home operator tried at first to accommodate the married couple, but perceived there were problems, when in fact there wasn't any more difficulty than ordinarily occurs with married couples," said Sammons.
"The local ombudsman talked with the residents and helped them move to another facility where they were able to stay in the same room. It turned out very well."
Federal law doesn't address sex in nursing homes, other than to require facilities to allow spouses to share a room if they wish, contingent on room availability and financial affordability.
However, MacLean points out that numerous Supreme Court decisions recognize a Constitutional right to privacy, including sexual rights.
Kentucky and Ohio government agencies that oversee nursing homes don't regulate sex among patients.
"Basically, the view is that nursing homes are the homes of these people and if they are consenting adults, then that is the way they are treated," said Gil Lawson of the Kentucky Cabinet for Health Services.
"They have just as much right to do what they want to do as anyone else does."
Michelle LoParo of the Ohio Department of Health said sex is a "residential right. Nursing home residents are allowed free choice, just like any other resident of the state."
"A lot of issues could play into sex among nursing home patients," LoParo added. "Many are Alzheimer's patients. You have to look at their cognitive ability. You have to check into their health and other issues that might come into play.
"The aging population might have aggressive behavior. Safety must be taken into consideration."
MacLean has circulated a proposal for discussion among 8,000 members of the American Medical Directors Association, but MacLean said very few nursing homes follow his policy or, for that matter, any policy.
At the Baptist Convalescent Center in Newport, for instance, there is no written policy on sex, Hutcherson said.
"It would be handled on a case by case basis," he said. "If residents said they wanted to have sex, I would need to bring together the appropriate people to discuss it and work out the best course of action."
MacLean said he hopes his proposed policy will "open a few doors" on the issue.