Policies Around Sex in Nursing Homes

Have One? You Need One!

It starts with holding hands. But in the end it's about being accountable for residents' rights, preferences and safety. Getty Images

The Hebrew Home for the Aged in Riverdale, New York created a sexuality workgroup composed of facility staff, researchers, residents’ family members, and religious representatives to establish policies and procedures related to sexual expression and residents’ rights. The resulting policy states clearly that residents have the right to seek sexual expression in an appropriate manner, provided that all activity is consensual and does not negatively affect the resident community.

In their publication Exploring the Sexual Rights of Older Adults, they explore myths about sexual activity among elders and the role of staff in honoring resident choice.

One of many myths associated with aging is that elderly people are asexual. Research shows that the majority of older adults are sexually active, and many of those who aren’t would be if they could find a willing and able partner. The National Social Life, Health and Aging Project interviewed a representative sample of approximately 3,000 adults ranging in age from 57 to 85 about their sexual practices.

Among the oldest individuals surveyed, who were aged 75-85, more than half (54%) reported having sex 2-3 times a month, and nearly a quarter (23%) reported having sex at least once a week. In addition, roughly a third reported engaging in oral sex. And across ages, about half of the men surveyed and a quarter of women reported masturbating – rates that are consistent for individuals with and without an intimate partner.

The likelihood of being sexually active was highly correlated with physical health: individuals with significant health problems were less likely to be sexually active. Equally important, the lack of an available, willing and able partner was one of the most common reasons older adults, particularly the women surveyed, were not sexually active.

Another myth explored was the notion that an older adult with diminished mental capacity is incapable of actually choosing to form an intimate relationship and engage in sex. They argue that cognitive impairments don’t necessarily preclude a person from recognizing their desire for intimacy and pursuing a meaningful relationship.

Riverdale’s advice in their publication can form the basis for an effective policy when it comes to resident sex.

Seek training.

All professionals who work with older adults need to understand healthy sexuality and aging and also know the warning signs of sexual abuse and be prepared to respond.

Support healthy sexuality.

Within the parameters of your professional role, find appropriate ways to support healthy sexuality among your clients. This requires asking older adults about their sexual history and current practices as a part of intake and assessment procedures and during other routine interactions, especially if you are concerned that an individual may be involved in an unfulfilling or potentially abusive intimate relationship.

Respond immediately and appropriately to signs of sexual abuse.

In a previous article, we explored the abuse topic and some steps you can take to minimize the chances of it.

Hire Right

Preventing abuse starts at the hiring process. Minimize the chance of hiring an abusive worker by following these steps.

  • Have written applications.
  • Conduct personal interviews.
  • Check references.
  • Conduct background checks of criminal records.
  • Check dependent adult abuse registries with your state Department of Health and Human Services.
  • Check motor vehicle records, sex offender registries and professional disciplinary board records.
  • Conduct alcohol and drug testing.

There are intangible parts of hiring that can help you understand how a prospect would fit from a cultural perspective - their compassion, values. You can start to understand these attributes by asking the right questions.

Care Plans and Environment

  • Fix features of the physical environment that may make abuse and/or neglect more likely to occur, such as secluded areas of the facility.
  • Assess and develop care plans for residents with behaviors, which might lead to conflict or neglect, such as residents with a history of aggressive behaviors; residents who enter other residents' rooms.

Identifying Abusive Behavior

Here are some things that could signal elder abuse in a facility.


  • Unexplained signs of injury such as bruises, welts, scars, bedsores, abrasions, burns.
  • Unexplained weight change.
  • Poor personal grooming.


  • Threatening, belittling, or controlling caregiver behavior.
  • Withdrawal from activities.
  • Unusual behavioral changes.
  • Staff preventing family from being alone with loved one.

Nursing homes need to nurture residents. Provide quiet, private spaces, adapt privacy policies, knock before you enter, help them find things to do together. Have a written policy, train staff, and protect vulnerable residents.

Many nursing-home workers simply don't look at the elderly as mature adults, but as children who must be policed out of fear of legal or medical repercussion. It’s time to change that.

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