What is sexual abuse in a nursing home?

By Steve Moran

I live in a suburb of Sacramento, California, which is California’s capital. Our local newspaper provides more content fodder than I would have ever thought possible, largely because they have taken a real interest in the problem (mostly real but sometimes imagined) of nursing home resident abuse. This was the front page headline on September 17 (click the headline to read the article): 

What is Sexual Abuse In a Nursing Home

How Bad?

In February, Eagle Crest Nursing Home in Carmichael (another Sacramento suburb) self reported to the department of health a possible case of sexual assault. It turned out to be the last straw for this facility. It has been on the special focus list (the worst of the worst) for 37 months. What happened was cited as an “immediate jeopardy” and they were on the verge of losing their ability to receive Medicare funding. The corporate owners beat the state to the punch by announcing the closure of the facility.

The Story

A 70-year-old male resident with a history of sexual behavior was found in the room of a 79-year-old woman with Alzheimer’s pulling his pants up. The woman’s briefs and gown were off her and at the head of her bed. She later reported that she had been “intimate” with her dead husband.  

More to the Story . . . Maybe

According to the story, the male resident who was “cognitively intact” reported that he had been flattered when she took off her clothes and called him darling. The facility administrator at the time also said that this woman from time to time sought out the male resident. Her sister said she could be touchy and flirty.  

Dementia and Consent

This is not in any way a defense of this facility or this incident. It seems pretty clear that this man had enough history that he needed to be watched all the time or more likely should have been in a different facility that could more closely monitor his behavior. It was likely a case of needing to or wanting to keep him for economic reasons because of low occupancy, and hoping for the best.

That being said the question really is this: Can residents with altered mental status consent to sex and under what circumstances. According to one San Francisco-based elder abuse attorney if a person has moderate or severe dementia they cannot consent to sexual relations at all. I find this position to be too black and white.

It All Depends

The reality is that senior living providers need to be very diligent about this issue. I am not an attorney and this is not legal advice, but it seems that it might look like this:

  1. It is generally better to err on the side of caution.

  2. On the flipside, residents still have the right to be sexually active if that is their mutual desire.

  3. While hard to talk to families about their parents or grandparents sexual activities, families need to be part of the discussion (when families have the legal right to be involved).

  4. Frank conversations need to happen with the appropriate people.

  5. Document like crazy whatever you do and why you are doing it.

  6. Depending on the level of care, state regulations, and your relationship with the your licensing folks, a proactive conversation could save some pain down the road.  

The ultimate problem is that these things are often not very black and white. What advice do you have? How do you address the issue in your organization?