A Primer on Sex and Sexuality in Assisted Living

Misconceptions abound in regard to life in an assisted living community. People who have no exposure to assisted living oftentimes completely muddle the term and use it synonymously with a nursing home. (They are not one in the same, by the way.) A major area in which there are broad misconceptions is the arena of sex and sexuality in assisted living. In this article, we provide a primer for you on sex, sexuality, and assisted living. We cover these topics:

  • Assumptions about sexual activity in an assisted living community
  • Definitions associated with sexual activity in assisted living
  • Basic principles of ethics regarding sexual activity in long-term care (including assisted living)

Assumptions About Sexual Activity in an Assisted Living Community

Human beings generally are naturally social creatures. This applies to people of all ages. Of course, some individuals are more socially open and active than others. But, within all people – including men and women in their Golden Years – there is a universal characteristic for connectedness with others, according to scientists, physicians, and other professionals. 

One of the benefits of living in an assisted living community is the opportunity to socialize. Research makes clear that socializing has a variety of benefits for older individuals that include improving physical and mental health, staving off the onset of dementia, and even prolonging life. 

Human connectedness can include sex and sexuality. Researchers from the Cleveland Clinic make note that:

  • Long-term care residents are sexual. Sexuality is a universal human characteristic that extends throughout one’s lifespan. 
  • Existing intimate relationships can involve individuals who move into an assisted living community. For example, a married couple might move into assisted living. In the alternative, one spouse of a married couple might move into a community. In either scenario, the couple might remain sexual activity in their Golden Years. 
  • Intimate relationships can also develop between residents of an assisted living community. In other words, mentally competent adults may form connections with fellow assisted living residents that evolves into something intimate and sexual. 

As a result of the potential for residents of assisted living being in intimate sexual relationships, a community needs to keep a number of issues in mind when it comes to the articulation of appropriate policies relating to sex and sexuality of residents:

  • Fully articulated policies on the subject should be in writing
  • Provided that facilities have fully articulated written policies that support the intimate relationships of residents, surveyors respect the right of residents to accept the risks of an intimate relationship 
  • Facilities educate, train, and inform residents, families, and staff regarding their processes for accommodating intimate relationships of residents

Definitions Associated With Sexual Activity in Assisted Living

As part of an exploration of sex and sexuality in assisted living, a common understanding of key terms is imperative. We provide you with the widely accepted definitions of commonly utilized terms used in discussions of sex and sexuality in an assisted living community. 

Intimacy: An expression of the natural desire of human beings for a connection with others. Intimacy is a state of reciprocated physical closeness to, and emotional honesty with, another person. Physical closeness to another includes physical touch as demonstrated by non-genital, nonsexual touching, hugging, and caressing. Intimacy is not a synonym for sex or sexual activity. With that said, sexual activity frequently occurs within the confines of an intimate relationship. 

Protective Oversight: An awareness twenty-four hours a day of the location of a resident. Protective oversight is a key safety and wellness protocol associated with long-term care facilities. Protective oversight provides staff the ability to intervene on behalf of the resident when necessary. It also allows for supervision of nutrition, medication, or actual provision of care. Protective oversite involves a responsibility for the welfare of the resident, except when that individual is on voluntary leave from an assisted living community. 

Sexual Abuse: Subjecting another person to sexual contact by use of forcible compulsion. Sexual abuse includes, but is not limited to:

  • Sexual harassment
  • Sexual coercion
  • Sexual assault

Sexual Contact: Sexual contact includes a variety of acts and activities that include:

  • Sexual intercourse
  • Oral sex
  • Masturbation
  • Sexual touch

Sexual Activity: Includes sexual contact and other activities intended to cause sexual arousal. This includes such activities as:

  • Viewing sexually explicit photographs and videos
  • Reading sexually explicit text
  • Phone sex
  • Zoom and Facetime sex and sex involving similar audio and visual communication applications 

Volition: A resident’s clear, unequivocal, and unforced willing participation in an intimate relationship or sexual activity. Freedom from coercion is a trait of volition. In this document “consenting resident” means a resident whose participation in an intimate relationship or sexual activity is volitional.

Basic Principles of Ethics Regarding Sexual Activity in Long-Term Care

There are a pair of fundamental, basic principles of ethics associated with resident sexual activity in a long-term care facility, including an assisted living community:

Principle of respecting residents as persons: An assisted living community staff should support efforts to improve a resident’s quality of life. This includes supporting a resident’s right to make choices that include establishing and maintaining intimate relationships. Intimate relationships can include sexual relations with other people. These types of relationships can enrich the life of an assisted living resident. 

Principle of doing good and avoiding harm: The staff of an assisted living community should act for the benefit of residents and refrain from acting in ways that harm them. Some things can both benefit and harm a resident or benefit one resident but harm another. The staff of an assisted living community needs to ask this question: What are the consequences of actions to avoid unintended harm to all residents?

A sexually active older individual, and his or her family, should understand an assisted living community’s policies and protocols regarding intimate relationships, sex, and sexuality before making a decision about moving into a particular facility. As noted previously in this article, ideally an assisted living community has a written set of policies that should be made available to you upon request.