A kind of care: sexual intimacy for older adults in long term care

By Vanessa Schouten.

How sexual intimacy is conceptualized matters, and this is particularly true for people whose decisions are shaped by the fact that they live in a communal facility under the care of others, such as older adult residents of long-term care facilities. As one of the participants in our study pointed out, intimate touch is after all a ‘kind of care’ – as essential to the wellbeing of residents as being able to socialize or experience simple tactile pleasures such as a hair cut or massage.

It is common for sexual intimacy to be conceptualized as a right (for example the right to engage in any kind of sexual intimacy of your choosing with other consenting adults), a need, or sometimes even as a privilege for those with the status (or the means) to achieve it.

In the context of long term care, these distinctions matter. If intimacy and sexuality are conceptualized as needs, care providers have an obligation to ensure these needs are met (in the same way they have an obligation to ensure other needs like nutrition and medical care are met). If intimacy and sexuality are conceptualized as rights, then care providers must ensure that they are not impinging on residents’ abilities to exercise that right. If intimacy and sexuality are treated as a privilege, care providers have no obligations to ensure residents can act on their desires in this domain.

We argue that none of these three approaches is the right approach for long term care. In 2018, we embarked on a national two-arm mixed methods cross-sectional study in Aotearoa New Zealand: What Counts as Consent? Sexuality and Ethical Deliberation in Residential Aged Care.  The first arm of the study was an anonymous, self-administered survey completed by 433 staff (response rate estimated at 62.5%). The second arm was semi-structured interviews with staff, residents and family members conducted between October 2018 and October 2019. Project staff conducted 61 interviews with 75 participants.

In both arms of the study, we gathered data about participant’s attitudes towards sexual intimacy – in particular, how they conceptualized sexual intimacy for older adults in the context of long term care.

We found that staff, residents and family frequently used the familiar language of needs and rights to discuss sexual intimacy. It is not surprising that rights in particular were frequently appealed to, given that when long term care facilities have policies around sexual intimacy, those policies are often heavily focused on liberal values such as autonomy, self-determination and rights.

But we also found that our participants often used the language of wellbeing, as well as the language of care, frequently in the context of justifying why they considered intimacy and sexuality to be a right or a need. Reframing the conversation in this way to include well-being serves a useful purpose: it shifts the focus from simply meeting minimum obligations to a focusing on caring for the whole person, and considering their overall well-being and quality of life.

Therefore we propose that rather than relying on the language of rights or needs, discussions about intimacy and sexuality for older adults in long-term care should take a salutogenic, person-centred approach – and that applying this approach in practice means reconceptualizing intimate touch as a ‘kind of care’, essential to overall wellbeing.

Paper title: Intimacy for Older Adults in Long-term Care: A need, a right, a privilege – or a kind of care?

Author: Vanessa Schouten (1) , Mark Henrickson (2), Catherine Cook (3), Sandra McDonald (4), Nilo Atefi (2)

Affiliations:  (1) School of Humanities, Media and Communication, Massey University (2) School of Social Work, Massey University, (3) School of Clinical Sciences, AUT, (4) Ngāti Whātua and Ngāti Wa

Competing interests: None declared


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