Paul Simpson (Edge Hill University)
Sex and intimacy are, apparently, for the young. Birthday cards mock ageing and associate it with loss of mental, physical and sexual capacity. Indeed, older people are stereotyped as prudish or ‘past it.’ When not excluded from the sexual imaginary, their sexuality can be considered taboo. In care homes accommodating older people, residents’ needs for sex or intimacy can be considered a threat because they are understood as counter-intuitive or a problem of disinhibition associated with a dementia. It seems that residents’ needs concerning sexuality and intimacy are designed out of care systems – being absent from policy and practice.(1) The situation might be additionally complicated for residents identifying as lesbian, gay, bisexual or trans (LGB&T) who can feel obliged to go back into the closet when accommodated in care.
More than 500,000 individuals aged over 65 reside in a care home, which means that many could be (unwittingly) denied basic needs and rights concerning touch and sexual activity. Concerned to challenge the above stereotypes and by the lack of scholarship in the UK and Europe, the Older People’s Understanding of Sexuality (OPUS) research initiative was established. The OPUS team straddles sociology, psychology and nursing studies and includes representatives from older people’s organizations. Between May and August 2014, the team conducted a study in Northwest England, which consulted three residents (two male and one female) and three female spouses of residents with dementia via individual interviews for their thoughts on addressing the issue of intimacy and sexuality in care homes. The study also took soundings from care staff via focus groups – which included qualified nurses (N=16).
We have defined sexuality and intimacy (as they particularly apply to older people/care home residents) in another document.(2) Whilst older citizens’ experiences of sexuality and intimacy are affected by gender, class, ethnicity and biography, our empirical data indicate that lived experience is more complicated than any of the above-mentioned stereotypes. Our findings mirror an Australian study, which showed that residents variously invoke denial, nostalgia and continuity when talking about sexuality and intimacy.(3)
Residents’ and spouses’ stories
The most common story among study participants – residents, spouses and staff – was one that reinforced the idea that residents (and older people) exist outside of what Ken Plummer calls ‘sexual citizenship.’(4) Residents might be considered post-sexual, even post-intimate. For instance, one male resident, ‘William,’ aged 78, spoke of how, ‘Nobody talks about’ sexuality or intimacy and residents just ‘live as we are… We’ve had our sex life way back.’ This indicates a tacit silence among those involved in the home but, deeper still, such assumptions indicate the workings of an ageist erotophobia. This concept refers to anxiety over older people as sexual beings, which can include a failure to recognize them as such and tends to weigh more heavily on female residents.
However, one female resident, ‘Emily,’ aged 80, considered that whilst some women might prefer to busy themselves with children and grandchildren, other women might wish to continue with sexual activity. As a widow, she acknowledged the possibility that ‘things might change’ should she become close to another resident. In short, one should never say ‘never.’ More assertively still, ‘John,’ a resident, aged 61, affected by Parkinson’s disease, acknowledged that whilst no longer physically capable of sexual activity, he continued to experience desires. Such statements indicate a form of sexual citizenship operating at a psychological level.
Most common in spousal interviews was a story of how later in life intimacy (e.g. cuddling and affection) rather than sexual activity figured as a basic human need. Being worthy of human touch is important when we consider that older, frailer or sicker bodies receive touch largely for the purposes of care and through the protective barrier of plastic gloves. Besides, spousal accounts of intimacy served, on the one hand, as markers of the length and depth of a relationship and, on the other hand, to normalize a relationship with a radically changed partner (e.g. because of a dementia or life-limiting condition). These understandable claims to continuity were expressed by John’s significant other, ‘Olivia,’ who declared: ‘I’ll always be his wife and he’ll always be my husband.’ Their shared humour and emotional support throughout the interview challenged the stereotype of older, disabled people as pitiful objects of care and shows how such individuals are actually involved in mutual relations of care.
For residents and spouses, needs relating to sexuality and intimacy sat alongside or were even eclipsed by other needs. For example, two residents spoke of the importance of maintaining relationships with family and maintaining independence (using public transport for day trips). One spouse, ‘Joan’ was particularly concerned about the hairdresser cutting her husband’s hair too short and not the way he liked it. For Joan, this signified a loss of control over the care being provided and failure to meet needs that are vital to maintaining her husband’s identity.
Challenges and responses: care workers’ stories
‘It’s not really talked about on our unit… any sexual needs…’ This stark statement from a female care worker, given despite the fact that the home’s admissions procedure covers needs relating to sexuality, intimates the kind of ideological obstacles that prevent the meeting of such needs. No wonder then that staff were crying out for training to help them enable residents to meet their own erotic and intimacy needs. Indeed, care workers are required to meet myriad legal, institutional demands and negotiate diverse relationships. Staff raised various instances of grey areas of consent within long-term relationships where one or even both partners showed declining capacity to consent to sex or intimacy. Whilst residents tended to de-emphasize sexuality, care workers were acutely aware of how sexualized expression could pose ethical and legal dilemmas. Examples given included residents who might want to hire the services of a sex worker or where residents with a dementia project sexual feelings towards another or receive such forms of attention inappropriately.
Sex and intimacy can be difficult subjects to approach anyway but this situation is complicated by generational differences. As one female careworker said: ‘It’s just something you don’t approach with an older person.’ Several staff spoke of the discomfort of discussing such matters with individuals of their parents’ or grandparents’ age. Further, a female manager expressed concern about reducing personal issues to a bureaucratic procedure when she declared: ‘I’d hate the thought that somebody would write a care plan for me and my husband on how we can be intimate.’
Staff also acknowledged that, despite a climate of tolerance, a valid sexual/intimate citizenship could be harder to establish for residents identifying as LGB&T given that fellow residents will have experienced for most of their lives an institutionally sanctioned homophobia. One care worker spoke in a way that recognized the heteronormative character of home’s ‘sexuality care plans’, which routinely failed to record LGB&T identification or anything about the sex and intimacy needs of such individuals.
The ideological barriers to meeting sex and intimacy needs were also manifest structurally in environmental arrangements and care practices that constrain possibilities for intimacy. Echoing the thoughts of two residents and two of the spouses, one female manager recognised that the predominance of single rooms and single seating effectively preclude opportunities intimacy and sexual activity. One example of an over-protective, possibly infantilizing approach to safeguarding welfare concerned the operation in one care home of a ‘no locked door’ policy, which compromised the privacy necessary for intimacy. One spouse, Olivia, likened this kind of surveillance to ‘living in a goldfish bowl.’
But, not all accounts of sexuality or intimacy were problematic. In fact, care staff were more concerned to enable than contain or make a problem of residents’ sexual/intimate needs. For example, a manager in one care home described how her staff had improvised by placing curtains behind the frosted glass in one room for the benefit of one couple and how she had confronted several staff members to ask them to reflect on their attitudes towards residents whose sexuality had been mocked. The incidents just described indicate possibilities for a measured approach to safeguarding and enabling intimacy that is determined more by the expressed and observed needs and reactions of residents than anxiety about ageing sexuality.
Our study was small, local and exploratory. There is a need for a larger study that would address the combined influences of ageism, classism, ethnocentrism, sexism, heteronormativity etc on expression of sexuality and intimacy in care homes accommodating older people. Nevertheless, we hope to have expanded knowledge where so little exists. Study participants’ stories have intimated that anxiety over residents’ sexuality is commonplace. But, encouragingly, our data suggest that generations that have grown up with Jagger and Joplin and witnessed women’s and gay liberation movements may be more equipped to claim sexual/intimate citizenship on their own terms. Such issues need to be part of a general debate about the meanings of ageing (and ageism) beyond obsession with the ‘demographic time-bomb,’ which regards older people as a burden.
(1) Hafford-Letchfield P (2008) ‘What’s Love Got to Do with It?’ Developing Supportive Practices for the Expression of Sexuality, Sexual Identity and the Intimacy Needs of Older People, Journal of Care Services Management 2(4): 389-405.
(2) Simpson P, Horne M, Brown L.J.E., Brown Wilson C and Dickinson T (Forthcoming, 2015) ‘Older Care Home Residents and Sexual/Intimate Citizenship’, Ageing and Society.
(3) Bauer, M, Fetherstonhaugh D, Tarzia L, Nay R, Wellman D and Beattie E (2012).’I always Look under the Bed for a Man.’ Needs and Barriers to the Expression of Sexuality in Residential Aged Care: The Views of Residents with and without Dementia.’ Psychology and Sexuality, 4(3): 296-309.(4) Plummer K (1995) Telling Sexual Stories: Power Intimacy and Social Worlds, London: Routledge
Paul Simpson is a sociologist and Lecturer in Applied Health and Care at Edge Hill University. He is principal investigator and a founder member of OPUS. He is interested in gender, sexuality and ageing. His publications include Middle-aged Gay Men Ageing: over the Rainbow (Palgrave Macmillan, 2015) and on gay male ageing in British Journal of Sociology, Sexualities, Sociological Research Online, Families, Relationships and Societies and Critical Studies of Fashion & Beauty.