via Marina Kamenev The Atlantic
Desire for physical intimacy doesn’t disappear when Alzheimer’s sets in. Supporting that aspect of a patient’s wellbeing raises a host of ethical questions.
Earlier this year, a sex worker in Sydney, Australia — I’ll call her Emma — got a call from a woman whose 93-year-old father was confined to a nursing home with dementia.
“You could tell in her voice that she was really nervous. But you could also tell that she knew what she wanted for her dad,” Emma said. He missed the intimacy of sex.
Emma works a day job in elderly care, but she has also been a sex worker specializing in working with people with disabilities, including dementia, for 30 years.
This nursing home resident had been an “openly sexual” person in his later life and had now asked his daughter to find him a woman. The nursing home staff was supportive, welcoming Emma into the facility and assisting her to move the elderly man into a comfortable position.
Many of Emma’s clients don’t have long to live. The man died within a month and a half of her visit, but his daughter said he was more relaxed, less agitated, after seeing Emma. She remained grateful to her for her services.
“I’ve got something to give,” said Emma. “I’ve got the most intimate gift of all.”
How residents in care facilities should receive this gift is an ethical minefield. A study by Australian researchers found that nursing home residents “including those with dementia, saw themselves as sexual beings and with a continuing need and desire to express their sexuality.” But a further study in the Australian Journal of Dementia Care by some of the same authors found that only 20 percent of Australian nursing homes had policies about sexuality or sexual health. Most of them framed intimacy among residents as disruptive or problematic behavior.
According to the World Health Organization, 35.6 million people have dementia worldwide and that number is projected to double every twenty years. A large proportion of those people with dementia will die in a residential aged care facility. While the elderly are free to do what they like in their own homes, once in facilities, their sex life is regulated by staff. Far from all of them are as sympathetic as the nursing home that Emma described.
The study in the Australian Journal of Dementia Care found that staff were anxious about addressing sex among their residents. They were chiefly concerned about the reactions of a resident’s family, as well as the legalities of the arrangements.