The Ultimate Guide to Sex after Fifty

The nurse was frantic. She’d just seen two elderly people having sex in a room at the Hebrew Home at Riverdale, New York. She asked Daniel A. Reingold, then the home’s executive vice president, what she should do.

“Tiptoe out and close the door so you don’t disturb them,” he told her.¹¹⁰

So begins “Sex in Geriatrics Sets Hebrew Home Apart in Elderly Care,” an excellent article written by Bryan Gruley for Bloomberg.com. I am elated that we’re starting to talk out loud about the issues of sex in long-term care facilities, despite the deafening clanging of the ick factor bell among people of all ages who—whether they themselves are sexual or not—do not want to think about old people still expressing themselves sexually.

But we need to think about it. If we’re lucky enough to be active and independent now, we’re smart enough to realize that we, too, will face these issues personally. What will you want for yourself? For your loved ones? How can you make sure that your wishes are respected? Take some time to think about these ideas and questions:

• When do we lose the right to sexual expression?

• Does our right to sexual expression end if/when we can no longer live independently? If so, why?

• Who determines whether we can still express ourselves sexually, and by what guidelines do they make that decision?

• If a staff member has a different personal belief about what’s appropriate sexual behavior (or nonbehavior), do her/his values override our own?

• Do elders with dementia have the right to sexual expression? Who decides that, and on what basis?

• If family members are uncomfortable with us having a sexual relationship, should their wishes supersede ours?

As uncomfortable as this might seem, I suggest you write down your personal policy about your right to sexual expression in your later years, and share it with your loved ones. Just because you might be unable to voice your wishes when the time comes doesn’t mean you no longer have those wishes.

“Many staff and family feel that the elderly should not be sexually active. My feeling is, whatever you were doing at thirty is okay to be doing at eighty, as long as it doesn’t harm you or anyone else,” says Jeannine Clark, MSN, who was a geriatric nurse practitioner for thirty years and now works as a geriatric consultant on topics including sexual attitudes, practices, and policy in long-term care facilities. Does this include older adults with dementia? “Absolutely,” says Clark, “as long as they’re not exploiting anyone, it is consensual, they have the capacity or competence to make that decision, and they’re not causing any harm.”¹¹¹

Personally, I want the right to decide when and how I want to be touched sexually—whether by my own hand, a partner I’ve chosen, or a sex toy that they’d better not pry out of my arthritic hands—for the rest of my life. You?

If I end up living in a facility, I imagine I won’t submit to rules easily, unless they are as progressive as the Hebrew Home. I’ll want only those rules that make sense to me, and they will include these sex-positive directives:

• Make sure I have an outlet and batteries to keep my sex toys in working order.

• Do not interfere with any warm connection I may be enjoying with any companion I choose, in any way I choose to express that connection.

• If I’m involved with a sexual partner, make sure I have easy access to safer sex protection.

• When I close the door—whether I’m alone or with another person—give me privacy.

• If I’m still capable of sharing information about senior sexuality with residents and or staff, provide me with opportunities to do that.

The Hebrew Home at Riverdale…recognizes and respects the importance of emotional and physical intimacy in the lives of older adults. Such close human interactions are viewed as a normal and natural aspect of life…. This policy recognizes and supports the older adult’s right to engage in sexual activity, so long as there is consent among those involved…. In assessing sexual activity in the context of this policy, professionals and caregiver staff…should set aside personal biases and judgment to maintain objectivity in upholding the sexual rights and choices of all older adults in the Home’s care.¹¹²

—“Policies and Procedures Concerning Sexual Expression
at the Hebrew Home at Riverdale”

The Hebrew Home at Riverdale (www.hebrewhome.org) stands for the sex-positive attitude we want in senior residential care. Hebrew Home has a progressive policy about sex among the residents, including that residents “have the right to seek out and engage in sexual expression,” including “words, gestures, movements or activities that appear motivated by the desire for sexual gratification.”¹¹³ They have a policy for determining sexual consent, even when a resident has dementia.¹¹⁴

“For all living under our roof, the Hebrew Home at Riverdale believes that there is still life to be lived, pleasures to be had, and sexuality to be celebrated, not curtailed,” explains Robin Dessel, LMSW, the director of memory care and a sexual rights educator at the Hebrew Home. “Sexual expression should be sanctioned and rightly belongs in residential healthcare settings. Sexual rights should not be subject to change based upon age, place of residence, sexual preference, or the decision making of others…. After all, life in a healthcare setting is more than bedpans and call bells.”¹¹⁵

The Hebrew Home’s sexual rights policy is progressive and unusual now—and it was even more progressive and startling when they first adopted it in 1995! (They revised it in 2001 and again in 2013.)

CHOOSING A SEX-POSITIVE ELDER HOME

By Gayle Appel Doll, PhD

Until recently, I would bet my bottom dollar that nursing and retirement home developers have never considered building or planning for resident sexuality at all. In fact, a colleague and I are surveying contractors who build senior housing to see if it has ever been mentioned. The answer we are finding is still no.

So is it possible to find housing that can be considered a sex-positive environment? Probably, and it will continue to get easier in the future.

For now, the savvy senior housing shopper will look for a home that publicly announces its sexuality policy. If you see it posted on its website or displayed prominently in resident application materials, you know that this home takes the sexual needs of residents seriously. True sexuality policies will use phrases like “sexual expression” and “sexuality as a basic human need.”

A policy that explicitly addresses sexual expression is important. Some homes may state that they have a policy, but they may be citing just the residents’ right to privacy—which doesn’t suggest that the home has given sexuality any serious thought.

If a home does not have a sexuality policy, and very few of them do, look for a home that espouses a person-centered philosophy. Staff and administrators are trained to see the residents as whole persons with varying needs, rather than the medical diagnoses that brought them to the home. While these homes may not have a stated sexuality policy, if they are truly person-centered, they are more likely to understand how to meet sexuality needs because of this philosophy.

Most important: Do not rely on what is said in writing. Go see for yourself.

Probably the most important aspect of sexual openness and opportunity is privacy. Semiprivate rooms are everything but private. If residents live in these spaces, are there opportunities for privacy like conjugal visitation rooms, private living areas, or planned nights in a hotel?

In our work we’ve found that it takes very little to get staff members to begin thinking more openly about sexuality. It only takes one resident asking for privacy for sex, or one family member asking about a resident sexuality policy, to begin the process of making a home more sex-positive.

—Gayle Appel Doll, PhD, is Director of the Center
on Aging at Kansas State University and author of
Sexuality & Long-Term Care: Understanding and
Supporting the Needs of Older Adults.

Gen Silent is a powerful documentary film about the prejudice, hostility, and fears that lesbian, gay, bisexual, and transgender people face toward the end of their lives or the lives of their loved ones. A transgender woman had lost her entire family when she transitioned. Now she feared medical providers and caregivers who “don’t want to touch my body.” The film shows the dismay and stress of gay and lesbian couples who cannot find a long-term care facility that will treat them with acceptance and respect—and permit them to room together as a couple. Learn more about Gen Silent on the filmmaker Stu Maddux’s website at www.stumaddux.com/.

We need to see the personal stories, and we also need to know the scope of the problem. These statistics are from Gen Silent’s website:¹¹⁶

• There are almost thirty-eight million LGBT Americans over sixty-five, or 12.6 percent of the population. This will nearly double by 2030.

• Four out of five LGBT elders say that they don’t trust the healthcare system.

• Fifty percent of nursing home workers said their fellow workers would be intolerant of LGBT people.

• The Joint Commission, which regulates assisted living and nursing care facilities, issued regulations against anti-LGBT bias in 2006. However, these regulations have never been enforced, and LGBT culturally competent care is almost nonexistent in mainstream assisted living and nursing care.

• LGBT advocates have developed cultural competency programs that improve service to LGBT elders, but there is no funding or mandate by state and federal aging agencies to train caregivers.

• In 2000, the federal government noted in its Healthy People 2010 campaign that LGBT people face specific and magnified health vulnerabilities. Despite identifying these risks, Healthy People 2010 failed to research or track LGBT elders in this landmark health program.

• According to the National Transgender Discrimination Survey: Report on Health and Healthcare,¹¹⁷ 19 percent of the respondents of all ages were refused care because of their transgender or gender nonconforming status, 28 percent were subject to harassment in medical settings, and 2 percent were victims of violence in doctors’ offices. Fifty percent of the sample reported that their providers lacked the knowledge to treat them.

Whatever your age, medical situation, or relationship status now, I hope you can look forward with a commitment to being the best you can be—and keeping a gleam in your eye.

• Stay in the best shape possible physically, through good nutrition and exercise. Whatever your limitations, find what can move, and move it regularly. Exercise affects not only sexuality, but also quality of life.

• Stay in the best shape possible intellectually, learning something new every day. Read, listen to audiobooks and discussions, learn a new subject, and listen to different points of view.

• Stay in the best shape possible emotionally, reducing stress and nurturing yourself with activities and people that make you smile and fill you with the joy of being alive.

• Stay in the best shape possible sexually, welcoming touch, exploring tools, toys, attitudes, and experiences. Talk out loud about sex as an elder.

• Give your best to relationships: love your loved ones, appreciate people who help you (even if it’s their job), get to know people of different generations, and reach out to strangers.

• Celebrate aging. There are plenty of challenges, granted, but there are also some wonderful surprises if we are open to them.

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