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Barriers to sexual freedom in assisted living

The baby boom generation came of age at a time that pushed boundaries of sexual freedom. Changes in attitudes and behaviors about sexuality were framed by the sexual revolution, women’s rights, gay rights, and the birth control pill. Decades later, the first wave of this generation is now turning 65. While most boomers still have a decade or more before they consider moving into assisted living facilities, a study suggests that sexual freedom is difficult to come by for those who currently reside in a structured environment such as assisted living. Today about one million Americans reside in assisted living facilities and this number is expected to increase. As boomers age and need additional support, how will they maintain the sexual freedom they have enjoyed in the past?

In order to understand current attitudes about sexuality in assisted living, we conducted a qualitative study including interviews and participant observation in six assisted living facilities in and around a large southeast city.

Focusing on findings from staff and administrator interviews and focus groups, we found that they routinely emphasized the assisted living facility was the residents’ home, which is in line with the philosophy of assisted living, and they could do what they pleased. However, we also found a tension between affirming the autonomy and sexual rights of residents and explanations of when those freedoms should be limited. The justifiable concerns about older adults’ sexual behaviors in this setting include a responsibility to keep residents safe, address family concerns about residents’ well-being, and make sure that older adults engaging in sex are willing and able to consent to these activities.

Yet at the same time, AL staff, sometimes directed by administrators, acted in subtle and nuanced ways to create an environment that discouraged sexual behavior. Unlike living in a private residence, older residents live in space managed by others with schedules to keep and multiple residents to help. As a result, staff and administrators work to minimize conflict and maximize efficiency, which can limit the opportunities for residents to engage in sexual behaviors. For example, staff frequently gave a cursory knock before entering a closed room to provide necessary care and support, such as light housekeeping. This unlimited access to resident space meant true privacy was hard to achieve.

There are clear state-level policies that hold facilities responsible for the safety and well-being of residents, but the details of how these policies are implemented and enforced is handled by individual facilities and vary widely. In this sample, we found an absence of facility-level policy about sexual behavior. The lack of discrete policy creates a challenge for staff, residents, and families as they negotiate the boundaries of sexual freedoms.

This study is a start to the conversation. However, policies vary across facilities and regulations vary from state to state. Future research needs to explore how these issues vary across the country. Furthermore, most older adults don’t live in assisted living. What does privacy and opportunity mean for the majority living at home? What roles do family and healthcare providers play in shaping, monitoring, and managing sexual freedoms of all older adults?

In the coming decades, baby boomers will seek assistance in environments such as assisted living, and the current climate does not guarantee that they will be able to maintain the same sexual freedoms that they fought for as young adults. Unless there are policy changes and attitude shifts regarding sexual freedom of older adults, it is possible the boomers of today will also experience barriers in the future.

Featured image credit:Couple happy old by miltonhuallpa95. Public domain via Pixabay.

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