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Issue of Sexual Consent Between Elderly Adults With Dementia Proves Problematic

July 23, 2013 at 12:00 AM EDT
As increasing numbers of older Americans have had to deal with dementia and Alzheimer’s disease, Bryan Gruley of Bloomberg News reports that nursing homes find themselves ill-equipped to handle issues of sexual relations. Ray Suarez talks to Gruley about the ethical, legal and practical questions for health care professionals.

JEFFREY BROWN: And finally tonight: It’s not a subject much discussed, certainly not in public, but it’s growing increasingly consequential as baby boomers age and the incidence of Alzheimer’s grows.

The issue is sexual relations, dementia, and what constitutes consent, and it has nursing homes struggling with ethical, legal and practical questions.

Bryan Gruley of Bloomberg News has written two in-depth reports on the subject, and joins us now.

And welcome to you, Bryan.

You tell the story of a case that occurred at a nursing home in Iowa called Windmill Manor that shows how unprepared institutions are for dealing with this.

A man and a woman, not married to one another, are discovered in bed once and then again. Tell us a little — tell us briefly what happened from there.

BRYAN GRULEY, Bloomberg News: Well, it was the second incident, Jeff, that really triggered things, because they were actually having intercourse. The woman was married to somebody on the outside. The man was divorced. Both of them had dementia to some degree.

And the results of this was catastrophic for a number of people. The man was eventually removed from the home. His family then had to drive almost two hours to visit him. The administrator was fired. He’s no longer in elderly health care. The nursing director was fired and eventually lost her license.

And it just didn’t end well for anybody, even though these two people appeared to like each other.

JEFFREY BROWN: The issue, of course, was, what is consensual and then what needs to report — to be reported to whom? And you show how these questions simply are not clear.

BRYAN GRULEY: Well, that’s right.

I mean, the laws — and they vary from state to state — the laws obviously deal with issues of rape. And they deal with issues of — to some degree, of how much privacy that people who want to be together in nursing homes have.

But there aren’t very clear guidelines. Many nursing homes and other long-term care facilities who are financially strapped anyway, you know, they haven’t really had to deal with this. But the coming bubble of baby boomers over the age of 65 may well force them to come to grips with these issues. And they’re very complex.

And, you know, even people who are experts in geriatrics will say it’s difficult to tell whether somebody with dementia would have the right — or — excuse me — the capacity to consent to sex. They might have that capacity even though they don’t know how to, say, balance their checkbook.

JEFFREY BROWN: In this particular case that you write about — and we should say you withheld the names of the people out of respect for their privacy — but you say that the woman called the man by her husband’s name and was calmed by his presence.

There was an intimacy there, clearly. It wasn’t clear what she knew at the time. And so that led to some of the questions.

BRYAN GRULEY: That’s right.

And, you know, maybe I missed it in the hundreds of pages of documents I read, Jeff, but I couldn’t find a reference to the various authorities at the nursing home and in the state regulatory agencies ever asking the man or the woman what they thought. And maybe they just didn’t trust them because they had dementia.

But the question remains, you know, were they — were they exercising their own right to intimacy? And the truth is they have a right to this.

And obviously they also have a right to safety if they’re uncomfortable in a situation like that. But what evidence there is — and we don’t know because we weren’t in that room — the evidence is that, you know, they kind of liked each other.

JEFFREY BROWN: Now, your second report, you write about some nursing homes that are taking a rather different approach. And one in particular you wrote about is Hebrew Home in New York, where you say — which you say presumes that residents with dementia have the capacity to decide whether to have sex. More encouraging of intimacy, including sex?


The Hebrew Home back in 1995 recognized the fact that people were being intimate, whether it’s hand-holding or kissing or fondling or all the way to intercourse. It was happening, whether they wanted to admit it or not.

And the folks there decided, let’s confront this head on.

And so they wrote a policy that helped staff know what to do, what to look for to make sure that residents, including those with dementia, including those without, were comfortable in those relationships, the underlying belief being that not only did they have a right to these relationships, just as they would on the outside, but it’s good for these people, particularly those who have dementia and may have lost touch to some degree with family or friends.

And that feeling of closeness with somebody else, the feeling of touch, is a gift later in their life.

JEFFREY BROWN: Bryan, very briefly, if you would, to the extent that this is becoming a bigger issue, is there more talk about it? Is there more being done with guidelines and standards?

BRYAN GRULEY: I think there’s more talk about it now, Jeff, than there was even five years ago.

And, hopefully, these stories and some of the conversations it generated will make nursing homes think about it more and will get researchers to do more research into this, because the numbers are what the numbers are.

And they’re big. And they’re going to have to deal with this as this generation, my generation moves into their late 60s and 70s and 80s.

JEFFREY BROWN: Bryan Gruley of Bloomberg, thanks so much.

BRYAN GRULEY: Thank you.