Dementia and Sex in Nursing Homes

This affair was between an older couple. He was single, a bit of a ladies’ man in his younger time. She was still married but now separated. They met by chance. But they gravitated towards each other whenever they came across each other. They were often seen holding hands, and were relaxed and mellow when they were together. This older couple enjoyed moments of intimacy and friendship. If this was anywhere else it would elicit a smile. But this affair occurred in a nursing home and the couple suffered from dementia. 

In this case, the nursing home was the 120-bed Windmill Manor in Itoralville, Iowa. The man was 78, while the woman was much older at 87. Three and a half years of private litigation ended with the elderly couple becoming separated to different nursing homes and each died within a few years. While the administrator and the director of nursing home were both fired.

The issue is whether they had consensual sex and how you determine that.  The woman referred to her lover as her (living) husband. Was she confused and therefore agreed to have sex under a delusion.

The sad story here is that the law attempts to define edges. To enumerate a black and white picture in an otherwise blurred context. Sometimes we have to look at how unique individuals deal with such cases to find a moral or ethical compass. The law is too clumsy a tool for us.

Supreme Court Justice Sandra Day O'Connor’s husband was suffering from dementia and was placed in a nursing home. While there he become romantically attached to another resident. Justice O'Connor decided that this made him happy and sanctioned their behavior. It takes courage to understand the disease for what it is., a disease. And sometimes how we react to people suffering dementia is more a reflection of our fears, prejudices and moral expectations, as much as it is about the degenerative disease itself.

It is not that these moral and ethnical dilemmas exist. It is that they are still dilemmas. In an age when the tsunami of dementia will push us more frequently against the reality of older adults with dementia we should have better tools than the law to deal with such radical changes in human intimacy. For some couples coping with dementia, physical intimacy continues to be a source of happiness. In others the dementia brings about behavioral changes that might increase or decrease the need for physical expression and relief. There might also be changes in sexual etiquette and expressions of sexual urges (or not). It is difficult to separate the person from the disease. But the disease can change the behavior of the person to such an extent that you cannot rely on past experience in responding to them.

By the time the person is in a nursing home, there are already noticeable changes in behavior. What this teaches us is not to rely on the law but to examine what the home will allow and what we are comfortable accepting.

© USA Copyrighted 2013 Mario D. Garrett