Sexuality in Residential Care

In some places this is handled very badly while in others it is handled extremely well.

Lack of understanding of what sexuality and intimacy is, is the reason for this not being handled well especially for and older or disabled people.  All too frequently they are seen as asexual beings, yet it is impossible to be asexual as sexuality affects a person from birth to death.

So why do people think this way?

Sexuality and intimacy is seem as pertaining to the sexual act i.e. sexual intercourse.  Yet everyday, everyone is expressing their sexuality through their maleness and femaleness.  It is expressed by the way a person dresses and takes care of themselves, the makeup they wear, the perfumes, lotions and potions they use and by the way the act around people.  It is the way they present themselves to the world and it is the way a caregiver assists others, in their care, to do the same; this includes children, adults and the elderly. 

Caregivers, and that is anyone who is in the role of being responsible for the care of another person, are being intimate with others on a daily basis.  The person receiving care is allowing others to do the things for them that they cannot do for themselves.  They are forced into a situation where they have to trust the person doing the care.

So why are people seen as asexual being who have don’t have the need for intimacy when they come into residential care?

It is because people get sexuality and intimacy so intermingled with sex, the sexual act, sexual intercourse or sexual intimacy. 

Every caregiver brings their on connotations of what sexuality and intimacy is to their workplace.  This is derived from their cultural, family and religious beliefs which are handled down to them from those they trust.  It is something that is learned. 

Many caregivers don’t understand that they are attending to the sexuality needs of the people in their care, and being intimate with them, on a daily basis.  Those in care have to trust the people giving them care.  Many residents/clients are unable to do all the activities of daily living for themselves.  The things that each and everyone one of us does for ourselves every day without giving much thought to and forget that the client/resident used to be able to be able to tend to their own needs also.

Those in care often have little choice as to who is taking care of them, so it is essential that a trust relationship is developed between the client/resident and caregiver from the outset.  It is impossible to be intimate with someone you do not trust. 

So how do we change this?

Firstly, caregivers need to understand that everyone is a sexual being.  That sexuality is part of person throughout their whole life span.  It is expressed through the clothes that are worn, the way they wear their hair, the lotions and potions applied to the body, the way a person acts or reacts around others and the rituals played out in relationships with people. This is expressing our sexuality.

Secondly, intimacy is performed all the time in trust relationships.  Each person determines how intimate they are going to be with a person.  Some people it is easy to feel safe around, while others it is not.  The degree of intimacy displayed is shown through the way a person speaks to another, the body language and eye contact of the person and is based on what that person believes to be true about the other person i.e. have they met them before, do they remind them of someone in their past life, has their been a personal introduction etc. In essence a whole range of that leads to the person receiving care to believe the person giving care is trustworthy and therefore will allow that person into their person space.  This happens in all relationships either caregiver/resident or friendships..

Caregivers invade a person’s personal space everyday.  Often this is not taken into consideration when they perform care.  Care is seen as a job and that job is to get the person in or out of bed, washed, dressed, to meals on time etc – everything to fit into the caregivers or the facilities timetable. 

All too frequently the individuality of the person is over looked.  Do their clothes match, are the clothes clean and free of stains, are their shoes clean and have laces in them, has a male been shaved, a female got lipstick on (if this was important to them), are their clothes in good repair (zips do up, all buttons present, seams intact etc), are they clean and dry and assisted with continence needs if they are unable to do this themselves.  These are all things that make a person feel a worthwhile male or female.  This is what it  is to attend to the

sexuality needs of another person, and in many cases, to do this a caregiver has to be extremely intimate with the person in their care.

Intimacy is about being close to another person, and for some people this is really important.  They need for touch and to be close to another person is really important and for some the sexual act is important.  However, in my experience, the sexual act is of lesser importance; it is the intimacy they are looking for. 

These aspects are not always taken into consideration when a person comes into care and will be based on the degree of comfort an individual feels around their own sexuality.  For example, if a person has been married or in a long term relationship for many years, slept in a double bed, had that closeness of another person or even used to sitting on the couch holding hands or just sitting close, then these factors need to be considered.  If not, then the person coming into care is going to search for something or someone to replace what is missing. 

Problems may start to arise if that person starts to set up a relationship with another person of the opposite sex.  The staff, and families get really upset about this.  They think the person is being disrespectful to their partner and want to stop it from happening.  Their belief that the person is an asexual being will influence this.  While it can be very distressing for families, especially if the spouse is still alive, all the person is doing is searching for the closeness they had with their partner.  They aresuffering a huge sense of loss and they are trying to fill the big gaping hole that is now consuming them and they are desperately trying to fill in what is missing.  This is the sense of joy, happiness and wholeness that has gone from their life.  This is especially difficult for people with dementia. 

On top of this, they come into a facility and are placed in a room on their own with a single bed, the door is closed at night and the light turned off with the door being opened frequently by a caregiver to check on them.  There is a lot of noise and some caregivers talk to each other in loud voices not understanding that these people are used to peace and quite at night.

Now I am not saying the doors should be left open, but if a survey was taken of the number of people who close their bedroom door at night and those who didn’t, I would suspect that most people would have their door open.  Nor am I saying that a person should not be checked on especially if they are at risk in some way or they shouldn’t have a room of their own.  What I am saying is that perhaps caregivers need to understand how difficult it can be for a person coming into residential care and that all of these factors need to be taken into

account when taking care of a person.  After all the facility is actually the residents’ home.  While the company may own the building and the Manager is responsible for the care that is given, it is only the residents who live their 24 hours a day.  The owner doesn’t live therr, nor does the Manager or caregiver, they all go to their own home.  If we don’t get this concept across then the those in care, will be disempowered. 

In residential care now, we have many different cultures taking for of the older or disabled person.  It is rare, particularly in Auckland, for people to be looked after by their own culture.  This creates another problem for the person receiving care.  A caregiver needs to adapt to the culture of the person in their care, not the other way round.  They resident, after all, is paying their wages.  It is disrespectful for a caregiver to expect those in their care to conform what their way of thinking.  A caregiver is the servant, they are there to serve those that cannot do for themselves irrespective of their culture.

If caregivers do not understand that sexuality and intimacy is a part of everyday life and it is how everyone expresses themselves as their maleness and femaleness, they will not consider this as factor when giving care.  It cannot be ignored and if a person chooses to have a sexual relationship while in residential care, then that is their choice, after all if they were living in their own home, and they set up a relationship with a member of the opposite sex, or the same sex for that matter, would it be any of our business? 

What a person does in their own bedroom is their business.  It is not up to any other person to judge them or form an opinion.  The person, (or people), in residential care have the right to privacy, as if they were in their own home.  Caregivers, managers, nurses etc need to butt out and accept it even if it challenges their own cultural or religious beliefs.  It has nothing to do with them. 

Leigh Kelly RN ADN
Managing Director
Clinical Update (NZ) Ltd
leigh@clinicalupdate.co.nz


 

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