2009-07-30 / Local & State

Senior Sexuality A Gray Area, Pennsylvania Official Says

By Bruce R. Posten

READING, Pa. (AP) - With America's growing population of senior citizens - many of them coming from the more permissive Baby Boomer generation - the issues of love, intimacy and sexual expression are out of the bedroom and into senior living communities, personal care homes and even long-term care facilities.

But tiptoeing around the need for public education on issues involving seniors and sex in community long-term living situations appears the rule rather than the exception.

"Usually it's considered a public relations nightmare for anyone in facilities to talk about this,'' said Manetta R. Maniaci, a Berks County Office of Aging ombudsman.

Her job is to educate staff of senior living facilities, investigate complaints and help to ensure elderly residents' rights.

"Federal and state regulations are clear that people are allowed to have choices in these situations,'' she said. "But when it comes to nursing staff training ... well, we do have programs, but we are seldom asked to give assistance.''

Gerontology experts say there is a national need for education of residents, institutional staff and families on issues involving everything from acknowledgment and providing accommodation to addressing serious concerns about inappropriate touching, the capacity to consent, possible abuse and the spread of sexually transmitted diseases.

"Yes, older people are alive, well and pretty active,'' Maniaci said. "Elderly sexuality is there and should be dealt with openly.''

Several personal care or nursing home officials declined to comment on the issue of acknowledging and accommodating senior sexual needs in community living situations.

To some degree, that appeared to indicate the subject of sex and seniors, if not taboo, still may be draped in some stereotypical thinking and societal prejudice involving the realities of sexuality and seniors.

For Maniaci, there are two different aspects regarding sex among residents in nursing homes or personal care facilities.

First, she said, staff should try to increase the comfort level where sexual expression is appropriate, and provide privacy - a task not always easy with semi-private rooms and doors that are kept unlocked to allow staff access.

Secondly, however, she said there has to be quick judgment and immediate intervention when sexual expression is deemed inappropriate.

"This is not a black-and-white issue - there's a lot of gray,'' she said. "Sometimes you are talking about residents with a loss of capacity to consent or make a decision.

Complicating the issue still further are attitudes or moral views of family members who may disapprove of their elderly parents' actions, even among those elderly deemed physically and mentally capable.

"Truly, it's like Dad with the teenage daughter,'' Maniaci said.

Over the past 10 years as an ombudsman, Maniaci said she has seen issues involving romance and intimacy among seniors on the rise in personal care facilities, as opposed to nursing homes where residents are more frail and may be compromised physically or mentally.

"Where we get involved are the complaints, but not to the level of gross abuse or neglect, which would be covered by Protective Services,'' she said.

With about 5,000 people in long-term living situations in Berks County - 15 nursing homes and 32 personal care facilities (assisted living) - Maniaci has 13 volunteer ombudsmen who are given training. They help her meet residents' needs on a variety of issues, not just sexual.

"I'd love to have 40 people,'' she said, adding that a volunteer can spend anywhere from two hours to 15 hours a month visiting nursing homes, with a goal of stopping by a facility at least once every two weeks.

"We do a lot of listening,'' she said. "The thing to remember is when people have a loss (of capacity) and become dependent, they may be fearful to speak up about certain things. Our job is to reassure them, empower them so we can protect their rights.''

Maniaci believes most facilities are fairly flexible when it comes to accommodating the sexual needs of the elderly, but felt some need to update their policies.

"Generally, the bigger the institution, the less flexible when it comes to sexual expression,'' she said.

"The other point to be made is that attitudes of the residents themselves need to be taken into account,'' Maniaci said about senior care facilities. "These are communities after all. People do have choices, but there are limitations on privacy, so there is still a need to be discreet.''

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