Operators: Addressing Sex in Senior Living is a Balancing Act

Senior living communities have long focused on resident safety — just not as it relates to their sex lives.

But failing to address issues related to sex among residents, experts say, can have widespread implications for senior living communities, particularly when it comes to handling memory care residents and nonconsensual behaviors.

Without education, training or policies in place, operators are “leaving themselves very vulnerable to regulatory problems and a high-risk situation that could potentially result in litigation,” says Sandi Flores, director of clinical services and founder and CEO of Sandi Flores Consulting Group, which provides clinical management for a number of senior living providers.


Until recently, sex has remained largely ignored by the industry as many say it’s a “gray area” that can’t be addressed by black and white policies, but operators are now beginning to shift their attention to address the issue, hoping others will follow suit.

Sonata Senior Living, a Florida developer and operator of independent, assisted living and memory care communities, has been implementing new policies within the past year to address these concerns.

With input from its risk management consultant, Sonata developed policies and an educational tool that gives staff members certain scenarios and then provides them insight into which scenarios involve inappropriate behavior and would require staff to notify a supervisor.


“When it comes to residents’ rights and also balancing that with our responsibility to protect our residents, we have to be very careful,” says Shelley Esden, senior vice president of operations at Sonata Senior Living. “We thought it would be important to give our caregivers a tool to help them understand how we are balancing that.”

But defining who can and cannot give consent is an issue many memory care operators struggle with, often leaving the decision to untrained staff and caregivers.

Because of this, Sonata has created a sexual relations consent policy to determine whether interventions are necessary for a resident’s well being, especially those with memory impairments.

The consent policy details five levels of sexual behavior — from kissing and hugging to unwanted, overt sexual behaviors — each of which have specific procedures that staff must follow.

“Just because an individual is in secured memory care, that doesn’t take away all their rights to make decisions on their own behalf and certainly when they have not been deemed incompetent,” Esden says.

Sonata’s staff are trained to assess residents’ competency by using dementia assessment tools, sexual intimacy assessment questions and a decision tree for determining if a resident is able to consent and participate in an intimate relationship.

Additionally, staff are instructed to make “objective observations” of developing sexual or intimate relationships between residents, noting frequency of contact, intensity, duration of relationship and the level of risk involved in the observed sexual behaviors.

Risk, Esden says, is assessed by looking at the resident’s competency and his or her mental awareness of the relationship, including the ability to avoid exploitation and the awareness of potential risks involved in having a sexual relationship.

And when dealing with residents with cognitive impairments, Sonata uses a multidisciplinary approach in which communication is essential. The operator involves families, physicians and, if necessary, a social worker, to discuss the relationship.

“In the end what has worked best is bringing everybody to the table,” Esden says.

Other senior living providers are also making headway on addressing sex among residents.

One Texas-based operator has the benefit of discussing the topic before it even opens its doors.

Though still in its development stages, Avanti Senior Living, a fledgling owner, operator and development company that will specialize in assisted living and memory care services, has already begun having conversations about sex prompted by a New York Times article, which published June 10.

The article brought to light important issues senior living providers should be addressing at their communities, including privacy among residents and consent between partners when a relationship involves a person with memory impairments.

Avanti says communication will be key to addressing issues that may arise when residents form sexual relationships.

“For us, what will be important is not necessarily having or not having policy, but also training and ongoing training of our team members so that they can be aware of what is normal and what is not normal [behavior],” says Lori Alford, chief operating officer at Avanti. “At the end of the day it’s more about communicating with everyone responsible for that senior’s wellbeing and making sure your staff is trained on how to handle those situations.”

Alford says Avanti plans to incorporate this training into the organization’s staff orientation and annual training sessions.

More established operators, including Thrive Senior Living, an assisted living and memory care developer with communities in Texas, Louisiana, Florida and Georgia, have also taken note of the NYT article.

“The New York Times article has sparked a lively internal conversation about how we handle this issue, both in the past and going forward,” Thrive Principal Jeramy Ragsdale says.

Although some communities have addressed or will address issues relating to sex in senior living, most still shy away from the subject. But operators can’t afford to put it off any longer, as waves of boomers are expected to usher in much more open views about sexuality. 

Written by Emily Study

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