Senior Living Providers Seek Boundaries of Dementia and Sex

Senior living providers will likely face a growing conundrum regarding their role in the sex lives of residents with memory impairments, especially as boomers head into old age, writes Bloomberg in a recent article.

The number of older Americans with memory impairments is expected to surpass 7 million in about a decade from now. About 5 million people aged 65 and older in the U.S. have already been diagnosed with Alzheimer’s, according to the Alzheimer’s Association.

“One of the most complex and unexamined issues facing elderly care facilities as the Baby Boom generation enters old age: How to determine if residents with dementia have the mental capacity to consent to sex,” says Bloomberg.


The director of nursing and the administrator of Windmill Manor, a nursing home in Coralville, Iowa, were both fired in relation to two 2009 incidents when nurses encountered two dementia residents engaging in intercourse, reports Bloomberg.

The administrator ultimately decided not to report the incident to the state Department of Inspections and Appeals as he believed it was mutual, and Iowa law only requires reports in cases where physical or sexual abuse is suspected. But in 2010, the department was looking into another matter at the nursing home and heard about the two incidents, resulting in a two-week investigation.

An official at the department decided Windmill Manor had failed to protect the woman, whose dementia was more advanced than the man’s, and the facility paid a $14,500 fine without admitting to wrongdoing, reports Bloomberg. The administrator and director of nursing were fired for “reasons [not] made public” and the woman’s family filed a lawsuit holding Windmill Manor and its corporate affiliate responsible for her alleged rape.


“Sex among the elderly, especially those with Alzheimer’s or other types of dementia, is a subject that many of the nation’s 16,000 elderly care facilities have largely been able to ignore,” says the article. “The aging of the Baby Boomers, many of whom grew up in the 1960s sexual revolution, will force more facilities and families to confront the sorts of legal, ethical and moral questions that arose at Windmill Manor.”

Studies show that many people remain sexually active as they age. Bloomberg cited a 2007 study published in the New England Journal of Medicine, which revealed that 53% of people between the ages of 65 and 74, and 26% of those aged 75 to 85, reported being sexually active.

“Nursing homes have long struggled with episodes of rape in which victims clearly didn’t consent,” says the article. “Sex between the demented raises more-nuanced questions that make it difficult for facility staff to know whether they should report cases of potential abuse to authorities.”

Recommended SHN+ Exclusives

The American Health Care Association, a trade group for the nursing home industry, has no formal training or guidelines for dealing with senior sexuality, according to spokesperson Greg Crist.

“The whole area of geriatric sexuality is an area we need to learn a lot more about,” Robert Bender, a geriatrician, is quoted as saying in an interview relating to the Windmill Manor investigation. “I don’t think we should be pointing blame when people are expressing themselves in natural ways.”

Read the full piece at Bloomberg.

Written by Alyssa Gerace