Let’s talk about sex!

That got your attention! This week’s blog is written by April Dobson from Hallmark Care Homes, who is a member of the HDRC Steering Group. Over to you April…

I have discovered that announcing that you’d like to talk about sex and intimacy is a fool-proof way of encouraging attendance at workshops. That being said, it’s a topic that people find quite difficult to discuss, particularly in relation to older people living with dementia in care homes, and in the main, it’s because there are so many aspects that cause anxiety and worry. Where on earth do you start?

Imagine this scenario; you open the door to a resident’s room and find her cuddled up in bed with the man from across the landing – both are well into their 80’s and both are living with dementia. You can see that they’re undressed and appear to be very happy with the situation despite the fact that both are married to other people. Imagine no more, for this is a real-life example, and one which may well be familiar to care and support professionals.

What would your reaction be? How would you feel? What would you do? Who should you tell? What we decide to do next will be based to a certain extent on our own personal values and norms, also on our inclination to protect others and keep them safe from harm. There are of course a number of regulatory and legal factors to take into consideration, and despite the fact that the Care Quality Commission (CQC) and the Royal College of Nursing (RCN) have released guidance on the subject, it still remains a challenging and concerning area as there is no ‘one size fits all’ approach.

With this in mind, Hallmark Care Homes made the decision to explore ways to help our team members open up the discussion and gain some confidence that they are ‘doing the right thing’. In 2019 Esther Wiskerke, a specialist in the field of intimacy and dementia ran workshops for our homes which led on to some fascinating discussions and helped give us some clarity around some really important points. For example:

• Older people with dementia can have intimate relationships with others
• Remember that mental capacity is specific to every decision, so just because you’re not able to manage your own financial affairs, doesn’t mean you can’t consent to sexual relations
• The CQC guidance is clear. Care homes will be judged on how they enable, and where appropriate, support people to develop intimate relationships
• Not all of us would want someone from a care home discussing our sexual relationships with our children!

In addition to Esther’s workshops, all of our homes have been equipped with the Alzheimer’s Society’s big pink box; a fantastic resource called ‘Lift the Lid on Sex, Intimacy and Relationships’, and team members from each home have been shown how to use the resource in a group setting. The resource takes the form of a game and gets everyone talking and voicing opinions.

Included in the box is a set of ‘True or False’ cards; using the cards, members of the group are asked to indicate if they think the answer to a question is true or false – for example, If a family member objects to the resident forming new relationships then the care home staff must take action to prevent or end such relationships. This provoked quite a heated debate – fortunately there is an answer on the back of each card and in this case it says FALSE. Care homes should always put the needs and rights of their residents first as well as respect the confidentiality of relationships between residents and do not have to disclose information to relatives and other parties. It goes on to quote the RCN:

“Individual rights and choices in sexuality expression and intimate relationships are established in law and underpinned by the Human Rights Act 1998. Assumptions and stereotypes should be challenged”

Another true or false card states Any physical closeness between residents with dementia needs to be reported as a safeguarding issue. Many of our team members believed this to be true and were surprised to discover that this is not the case, again prompting a really in-depth discussion.

The resource also includes a very practical framework to help us all decide on the actions we need to take in any situation involving dementia and sexuality, and working through it step-by-step is straightforward. It helped us to consider the bigger picture and what we needed to think about. There is also guidance about how to start a conversation – tricky at the best of times – which was welcomed by everyone, and how to look for signs that perhaps some people may not be comfortable with approaches made by another.

I can happily say that since we’ve started talking more about the topic, we have been able to resolve some situations which previously were a cause of a huge amount of anxiety for everyone. One example is that of two residents living with dementia who started a relationship in a Hallmark care home. It began with hand holding and quickly progressed to a far more intimate level which everyone was aware of, but no one talked about. Unbeknown to us and completely independent of each other, their families had been worrying themselves sick about whether their mother/father would be moved to another home because of their behaviour. They happened to hear the team talking about a workshop they had attended and asked to know a bit more, so the team shared what they had learnt from Esther. The relief on their faces was almost tangible and they were so pleased that their loved ones could continue to enjoy a relationship that brought them comfort and happiness.

Our next step in supporting our teams will be to develop a policy to underpin our approach, but more importantly we will keep talking!

Sources of information that helped:

• alzheimers.org.uk – The Alzheimer’s Society, free information and various services available
• facebook.com/cuppa69/ Join the discussion
• https://www.cqc.org.uk/sites/default/files/20190221-Relationships-and-sexuality-in-social-care-PUBLICATION.pdf
• https://www.rcn.org.uk/professional-development/publications/pub-007126 – Older people in care homes; sex, sexuality and intimate relationships – An RCN discussion and guidance document for the nursing workforce
• https://shop.alzheimers.org.uk/activities-and-sensory-stimulation/Lift-the-Lid

April Dobson, Head of Relationship Centred Care, Hallmark Care Homes

Thanks April!

Connect with ADS on twitter @DementiaStudies and on Facebook @adsuow