Editor’s Take: Sex, Violence, and Assisted Living

Sometimes it seems that when it comes to media coverage, assisted living just can’t win. Any doubters should check out this week’s headlines.

In one newsflash, assisted living providers were scolded for being too restrictive of residents’ sex lives. “Older people have sex. But it seems that some assisted-living facilities may be the last ones to get the word on this,” reads the lead of a Huffington Post write-up about a recently published study on sex in AL.

Is that true? Or perhaps assisted living providers are all too aware that older people have sex, it’s just that often, these sexual encounters are violent. That’s suggested by a separate study, which also made headlines this week, which found that assisted living facilities should do more to protect seniors and staff from the physical, verbal, and sexual violence often perpetrated by residents.

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The Huffington Post article was about a small study coming out of the Gerontology Institute at Georgia State University. Researchers investigated six assisted living communities in Atlanta, and found that administrators and other workers agreed about residents’ having the right to be sexually intimate, but that concerns around safety and consent meant that privacy often was compromised, making it difficult for residents to canoodle.

“While assisted-living facilities have many rules, they typically lack systematic policies about how to manage sexual behavior among residents ― which falls under residents’ rights,” study author Elisabeth Burgess stated in a press release.

The Huffington Post singled out RiverSpring Health’s Hebrew Home as a model for progressive sexual rights policies. I’ve reported on this community several times as have other news sources—it’s the go-to example of a progressive sexual rights policy. I agree that the Hebrew Home is a great example of what communities can do to with regard to residents’ rights to be intimate. But there must be a reason why the policy model has not caught on more widely; in fact, it seems obvious there are several reasons, including a general squeamishness that adult children and others have around seniors’ sexuality. But it seems that the threat of sexual violence or nonconsensual encounters also is playing a big part, the Georgia State researchers and the Huffington Post pointed out.

Still, some of the media coverage around the Georgia State sexuality study took on a chiding tone around these privacy and safety concerns, the subtext being that providers are going too far in this regard and are encroaching on residents’ rights.

Yet, the coverage of the other study findings, regarding violence, go in the opposite direction and say assisted living providers need to go further to ensure everyone’s safety and security.

Here’s the lead from Kaiser Health News:

“Assisted living residents who abuse other residents or staff are likely to have dementia or severe mental illness, afflictions that pose unappreciated risks in facilities occupied by vulnerable elderly adults, a new study reported. That abuse can include physical, verbal and sexual incidents, according to a study published online last month in the Journal of Applied Gerontology.”

This study, led by a researcher from the Department of Health Administration and Policy at George Mason University, examined data from a 2010 survey of facility administrators, which included questions related to recent instances of violent or threatening behavior of residents. It captured data related to more than 6,800 residents at least 65 years old.

About 7.6% of residents had either physically or verbally abused other residents or staff members in the month before the survey, and 2% were involved in sexual abuse. Dementia and mental illness, not surprisingly, both were associated with significantly higher likelihood of violence.

A takeaway for family members looking into senior housing for a loved one? Look for assisted living communities that have separate memory care wings, and that train staff on the early warning signs of dangerous behavior, lead author Gilbert Gimm told KHN.

Certainly nothing wrong with Gimm’s advice. Same goes for Burgess’ saying that assisted living providers should pay more attention to sexual behavior policies. But assisted living doesn’t come off all that great in either of these studies, nor in the media coverage of them. Readers are likely to come away with their worst perceptions of assisted living reinforced, that these communities are scary, restrictive places that just can’t get it right when it comes to providing housing and care that seniors deserve.

I can’t offer any easy solutions for how assisted living can get it exactly right, but I can at least put these two studies side-by-side and try to give providers a fair shake. The findings seem legitimate and important but there’s no doubt they send somewhat mixed messages, and providers continually face a tough task in balancing freedom and security of residents—and in not getting too aggravated by media reports stating they are the “last to get the word” about their residents’ wants and needs, or that they “underappreciate” the risks encountered daily in their communities.

Written by Tim Mullaney

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