Sex and intimacy
In the run-up to publication of my new book Carers and Caring; the One Stop Guide; how to care for older relatives and friends I am sharing some of the practical solutions learned from research and experience. If you think any problems have been missed, you can email me and tell me, and I’ll make sure they are covered in the next edition and online on my website at www.juneandrews.net.
Sex is intensely private and should be between consenting adults
Sex is intensely private and should be between consenting adults, and in respect of older people it’s a bit of a taboo. If it’s with reference to our parents, we probably prefer not to know anything about it. When you are a carer, you might also be the spouse or partner of the person you care for. Particularly when carers from outside the family are involved, it can become a difficult issue. An example would be a care home that doesn’t provide you with privacy, or even a suitable bed for spouses or partners to make love. That’s very sad for both the carer and the person cared for. A care home might even feel they are acting in the best interest of your wife when they judge her incapable of consenting to sex, and effectively prohibit you from intimacy.
Even a confused person can consent if they are able to understand information about sex
Even a confused person can consent if they are able to understand information about sex, can remember this long enough to help them decide about it on this occasion, use the information to make a choice and remember it. No one should doubt that this matter can be difficult and creates strong emotions in carers as well as care workers. One example of a condition that causes difficulty in relation to sex is frontal-lobe dementia. In these cases the person becomes disinhibited and less constrained by social norms. They might say and do things that are embarrassing or offensive and become sexually indiscriminate.
My brother and I disagreed about what to do when our mother started up a relationship with another resident in the care home. It seemed to David that she mistook him for our late father. I didn’t mind but David was horrified. (Claire, sister of David, children of Rosie)
If Rosie has capacity, she is perfectly at liberty to make a relationship with whoever she wants. It doesn’t matter how disconcerted David is. If the person you care for seems attracted sexually to another person in the care home, you may feel you have a right to put an end to it. Older people can be lonely and seek the comfort of human intimacy. All behaviour is communication. And Rosie is communicating that she wants a special friend. No one has an automatic right to stop that.
CQC states that people with dementia CAN consent to sexual relations
The guidance of the CQC (Care Quality Commission) is clear that even people with dementia can consent to sexual relations and care home staff must support that, unless there are signs of distress that might indicate there is a problem. It becomes more complicated when care staff from a wide range of social, ethnic, religious and educational backgrounds have varying views about whether older people should be interested in sex and allowed to express that interest. In the case of older homosexual men, the memory of legal and social discrimination may come rushing back because of negative attitudes of staff. Homes are trying to make sure that care workers understand that sex is not a problem to be managed but part of a resident’s normal life. What the family carers think can be another issue.
The commonest sexual symptom of dementia is apathy and lack of interest. A relatively unusual symptom of dementia is hypersexuality, where the partner or spouse becomes aroused by very slight stimuli and makes sexual demands with a frequency and intensity which becomes intolerable or even abusive to the spouse/carer. If you are caring for someone with this symptom, you must seek help from your doctor.
There is much more about sex and intimacy in Carers and Caring: The One-Stop Guide: How to care for older relatives and friends - with tips for managing finances and accessing the right support available from all good bookshops from May 2022
Three hints:
1. Sex is not a problem – it is part of normal life
2. You as a carer have a right to continue or discontinue an intimate relationship
3. The person you care for also has rights, but they are not limitless
