Addressing intimacy in long-term care facilities
Policy guidance developed by Center for Practical Bioethics
Contact: Lorell R. LaBoube, (816)221-1100 Ext 239
llaboube@practicalbioethics.org
October 16, 2006
Residents of long-term care facilities need and desire privacy for intimate relationships and sexual expression. Supporting such relationships is easier said than done, considering the tension often evident in the judgments and social values held by long long-term care staff and residents’ families, to say nothing of the concerns about the facility’s role in providing protective oversight.
Into such a complex venue stepped the Center for Practical Bioethics nearly a year ago, at the request of leaders of long-term care facilities seeking practical, ethically informed policy guidance to address these issues. The result is a guidance document, Considerations Regarding the Needs of Long-Term Care Residents for Intimate Relationships and Sexual Activity.
“This document provides guidance on the intersection between institutional protective oversight and the ordinary privacy rights of individual residents for self expression and intimacy,” says John Carney, vice president for aging and end of life at the Center for Practical Bioethics. “It’s not about investigating aberrant or abusive behavior. The guidelines do not prescribe a one-size-fits-all resolution, but a conceptual framework and methodology that will help long-term care facilities address these sensitive matters.”
Approximately 50 volunteers worked with Center staff for more than a year formulating the scope of the document. Representatives from Missouri long-term care facility surveyors, medical directors, administrators, social workers, and nurses reviewed and commented on the document. A national expert on aging and intimacy also provided input.
Patricia Wyatt, CEO of Swope Ridge Geriatric in Kansas City, asked the Center to consider intimacy issues after having to address such situations at Swope. “This document provides guidance where none had existed before,” Wyatt says. “We will use this guideline when similar situations develop in the future.”
Core recommendations of these guidelines include the following:
- Employees of licensed long-term care facilities should support residents’ efforts to maintain and improve quality of life. Intimate and sometimes sexual relationships can enrich the lives of residents.
- It is good for facility employees to support the residents who want to participate in decisions that affect the residents’ lives. Residents participate more effectively when they understand their situation and make choices involving themselves and their relationships with others.
- Employees of licensed long-term care facilities should refrain from unwarranted interference in the intimate personal relationships and sexual activities of residents.
- Facilities are legally obligated to respect the privacy of certain types of information. With respect to intimate relationships and sexual activity, the principle of confidentiality is not absolute. In some situations legal or policy considerations require disclosures that would otherwise violate confidentiality.
The Center for Practical Bioethics has a history of working with and providing guidance to long-term care facilities facing ethical issues related to the dignity and autonomy of residents. Previous documents address the process of determining decisional capacity, making life-prolonging treatment decisions, and improving the care of seriously ill and dying patients in long-term care, home health, and hospice.
“This document will allow staff in long-term care facilities to begin the conversation regarding intimacy of residents,” said Carol Scott, Missouri State Long-Term Care Ombudsman. “This subject is typically not discussed until an issue arises. By taking a proactive stance of developing guidelines, the rights of residents will be further promoted, and the facility will not be thrown into a ‘crisis’ mode of trying to figure out the correct course of action on the spot.”
Considerations Regarding the Needs of Long-Term Care Residents for Intimate Relationships and Sexual Activity is available on the Center’s website by clicking here.
Founded in 1984, the Center for Practical Bioethics is an independent organization nationally recognized for its work in practical bioethics. More than a think tank, the Center puts theory into action to help people and organizations find real-world solutions to complex issues in health and healthcare.
