More liberal sexual expression policies are needed for person-centered care in nursing homes, researchers find

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Current approaches to sexual expression do not fit into the culture change movement toward more person-centered care in nursing facilities and similar settings, according to a recently published report.

Researchers from the Center on Aging at Kansas State University interviewed 23 long-term care ombudsman about their experiences in cases involving sexual expression. Of 123 cases considered, 85% occurred in a skilled nursing facility and the remainder occurred in assisted living or care homes.

The sources of the complaints could be categorized in five broad areas identified by the researchers: risk, risk associated with dementing illness, limited knowledge, lack of privacy and values.

The report includes descriptions of particular cases related to each of these categories. For example, risk involved cases involving criminal sex offenders and the possibility of sexually transmitted infection transmission. With regard to privacy, lack of physical privacy is the most pressing concern, but resident and staff gossip about sexually involved couples also compromises privacy, the authors noted.

Across all these categories, the researchers found that sexual expression was inhibited due to the institutional nature of nursing facilities, which restrict residents' autonomy and self-expression.

However, nursing homes are moving away from an institutional model, the researchers noted, which has implications for sexual expression among residents. The researchers said that more workforce training is needed to help staff appropriately respond to residents' sexual expression. Privacy issues could be eased through “cost-effective enhancement of residents' physical privacy,” they wrote.

Standards of practice need to be developed for cases involving sexual offenders and residents with consent issues, which the researchers found were “consistently difficult” for ombudsmen.

The report appears in the current issue of The Gerontologist.

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