Alisa Grigorovich is a health services researcher and a critical gerontologist. her research focuses on evaluating health services and policies to identify structural barriers to equity and access in the context of rehabilitation and long-term care for adults with multiple and complex health conditions. Her postdoctoral research is focused on aggression and sexuality in long-term residential dementia care.
Exploring sexual rights and unwanted sexual attention in long-term residential care
There is increasing recognition that sexual expression has beneficial effects for older people. However, supporting the sexual rights of older persons living with dementia in residential long-term care settings is complex and involves an array of ethical, legal, personal, and professional considerations. Not only is there the need to balance residents’ rights to sexual expression with protection from undue risk, particularly with regard to sexual harm, but we must also consider the rights of formal care providers, for whom facilitation of residents’ sexual expression may constitute a moral compromise and/or a compromise of their own sexual rights. In particular, more research is needed to explore care providers’ perceptions and experiences with sexuality and dementia. This presentation will focus on findings from an ethnographic study that explored how care providers in one home in Ontario, Canada understood and responded to unwanted sexual attention from residents, and to explore how their individual experiences were shaped by organizational and structural factors. Data collected included participant observation and in-depth interviews with providers (n=26) across multiple professions and roles, as well as a discursive analysis of relevant documents. While participants reported multiple types of sexual attention and that these were uncomfortable or unwanted, they rarely reported these formally as they perceived these as unavoidable aspects of care work. Participants normalized sexual attention as a dementia-related symptoms, or mental pathology, and generally considered persons with dementia as having compromised capacity for sexual expression. As a result, they typically ignored sexual advances, distracted or redirected residents, and focused on completing their tasks. They also reported a lack of formal education and training regarding sexuality and expressed the desire for more assistance with managing sexual dynamics in practice. Our analysis suggests that participants’ normalization of unwanted sexual attention is driven by reductive legal mechanisms for prevention of sexual harassment, as well biomedically focused dementia care education and training. Implications of these findings for policy and practice will be discussed.