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JDC Asks...

Mon 07 Jan 2019

In the many years I have been involved in this area of life professionally, our attitudes, behaviour and approach to listening to and supporting older adults around sexuality and intimacy have indeed changed for the better. I have joyfully witnessed excellence and state-of-the-art support, attitudes of compassion and integrity, enhanced independence and freedom from fear of exploitation.  We have cause for celebration and hope. But there is still a lot to do to ensure that equality and human rights are upheld.  Our own experience of sexuality - and of older adults and sexuality – as well as our value system and cultural lives, all influence how we view residents’ sexuality - positively or negatively. When we work on our own issues first, we can then openly and honestly support staff and residents and their needs. Our fears and concerns over sexuality and intimacy are often fuelled by the possibility that we might “get it wrong” and be held accountable. Conversations with residents and their families before they come to live in the care home will do a great deal to address these vital areas of healthy living.  In 2017, the Care Quality Commission (CQC) re-prioritised exploring how the sexual and intimacy needs of LGBT+ residents are being supported in care homes.  We are all ageing and not everyone is interested in sex and intimacy. But many adults are, into later life. We can be intimate without sex. How can we live a safely sensual life with or without sex as we age? Ask yourself and your staff at what age and under what circumstances would it be alright for someone else to decide you can’t have a sex life any more. It’s a good place to begin.

Danuta Lipinska is a counsellor, trainer and author of the book Dementia, Sex and Wellbeing.

 

Intimacy with another can be one of the most joyful and fulfilling human experiences and in everyday life most independent adults can choose the circumstances of their intimacy in private. When we lose independence, however, we lose privacy and in communal environments such as care homes, hospitals or hospices our behaviours come under a more public gaze. If our mental capacity becomes fragile, our choices and behaviours are questioned and others, who might have very different mores and values from ours, make decisions for us. Most care homes in my experience are supportive of residents’ needs for intimacy.  The “taboo” is in society and health care generally with the prevailing stereotype that, for people who are older, have disabilities or are at the end of their lives, intimacy is not a priority. Do we as health professionals always include sexual choices in our assessments? Do we consider the consequences of treatments or medications on sex and intimacy? And do we create environments that facilitate private time for couples (including same gender) lying together on a bed? Promoting residents’ rights to sex and intimacy is not always straightforward, particularly when mental capacity is in question. Newly-published guidance from the Royal College of Nursing offers frameworks, pathways and tools for practice along with a range of examples detailing how care homes have worked through complex situations.

Hazel Heath is co-author of Older People in Care Homes: Sex, Sexuality and Intimate Relationships: An RCN discussion and guidance document for the nursing workforce.  www.rcn.org.uk.

 

The subject of sex and intimacy has always, in my opinion, been a very difficult one to mention, even when there is not the added complication of the person living in a care home and living with dementia. There are so many reasons for this, not least because of the naturally reserved British culture but also the usual generational divide between the average age of the care worker and the person being cared for.  It adds another layer to the difficulties caused by illness, whether it is dementia, heart disease or arthritis, and the issue sinks into the background as the focus so easily becomes the physical and other more obvious emotional needs of the person. Simply stating that “attitudes need to change” suggests that it is because of care home staff failings that the subject is not raised. But I do not believe that the lack of conscious discussion and assessment regarding a person’s desire for intimacy is a failing of care homes. I believe it is because culturally the subject is not freely discussed. Just as understanding and acceptance has grown in the last 10 -15 years regarding the rights and needs of the LGBT community, I think that understanding of the sex and intimacy needs of residents will improve with more open discussion and support for staff. Then the subject will be broached with more confidence and less embarrassment. No, I don’t think attitudes needs to change, I think staff need to be supported to feel more confident in themselves about how to discuss such personal matters.

Lynne Phair is an independent consultant nurse

 

Starting with more than 70 creative ideas, our sex and intimacy in care homes innovation project decided to develop one of them, a “workshop in a box” called Lift the Lid on Sex, Intimacy and Dementia.  It was approved by a Dragons Den-style panel following a prototype check with care staff. We started a conversation with care home staff about something “we just don’t talk about” and gained insight through honest response, ranging from “sex and older people shouldn’t be allowed” to “this is a person’s life, this is their home, they must not be expected to leave their human rights on the doorstep”.  It became clear that many staff felt uncertain and fearful about the consequences of in-the-moment situations, what they might see and what they might do. Their response had a tendency to be informed by individual views rather than reference to aligned home values and principles. We identified a journey that care homes need to embark on to support their residents’ needs and rights in respect of sex and intimacy. Being Aware, Being Equipped and Being Supporting are the three activities around which the Lift the Lid workshop is designed.  Lift the Lid was tested in 10 care homes and their feedback informed its content and design. The workshop is facilitated by the care home, it runs for two to three hours or can be divided into three shorter activities. It contains all the tools needed to challenge perceptions, to support respectful behaviours around sex, intimacy and dementia, and it helps staff agree on shared values and actions they want to take forward in the care home. We believe care home staff are best placed to make a real and lasting difference to the lives, loves and wishes of people living with dementia in this setting. ​

Beverley Page-Banks is programme development manager, Alzheimer’s Society Innovation team. Lift the Lid is available at shop.alzheimers.org.uk or by calling 0300 124 0900.

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