Adopting a Multilevel Approach to Protecting Residents’ Rights to Sexuality in the Long-Term Care Environment: Policies, Staff Training, and Response Strategies

Abstract

It is estimated that long-term care (LTC) facilities in the US will experience a 40 % increase in occupancy between the years 2000 to 2020 (American Health Care Association 2012). Whole-person wellness embodies multiple elements of well-being, among which sexuality and the choice to remain sexually expressive, a basic human right for older adults, should be included. However, this right is largely overlooked in the context of LTC, and oftentimes, normative sexual expression among LTC residents is mislabeled as problematic behavior. Systems and bioecological theories provide a conceptual multilevel framework for understanding interactions among relevant institutions and government entities and their influence on residents’ sexual expression. The current article addresses the issue of preserving residents’ choices to be sexually expressive and places current US laws regarding sexual expression in LTC in the context of international perspectives on sexual health rights and laws. Input from LTC Ombudsmen from the US was utilized to inform recommendations to enhance current policies and contribute feedback for effective training guidelines for LTC staff in addressing residents’ sexual expression. Both universal acknowledgement of sexuality as a human right and legal guidelines are necessary to broaden understanding of the meaning of sexuality in older adulthood and aid in ethical and person-centered response strategies which promote autonomy and preserve each individual resident’s rights to sexual expression while maintaining safety.