Sexuality and Long-Term Care Facilities: A Comprehensive Analysis

Introduction and Overview

Sexuality is a component of human personality, and it also occurs in the post-reproductive period, as well as in the later years of life. However, in the case of sexuality among residents in long-term care facilities (LTCFs), the sexual needs and sexual activity of residents are ignored or denied, which results in major limitations to their well-being. This research paper aims to establish ways in which LTCFs meet or do not meet residents’ sexual needs and rights. It will assess the existing social and organizational policies, human resource awareness and attitudes, gendered cultural norms, and constraints to sexuality in LTCFs: Sexuality and Long-Term Care Facilities: A Comprehensive Analysis.

This paper seeks to focus on the following objectives: explaining why sexuality should form part of elder care, and using current peer-reviewed literature, the paper recommends how the quality of Life in LTCFs can be improved by highlighting this nevertheless facet. This research highlights the gaps in policies and practices in LTCFs regarding sexuality and proposes strategies to foster a more inclusive and respectful environment for older adults to express their sexual identities.

Methodologies

Mixed-method approaches were followed to better understand issues related to sexuality in LTCFs. This section details the methodologies adopted in collecting and analyzing data to ensure a proper balance between qualitative insights and quantitative rigor.

Literature Review

The identified qualitative and quantitative research articles regarding sexuality in LTCFs were reviewed. One of the ways was searching through the articles included using PUBMED, JSTOR, as well as Google Scholar and the tag words which were ‘sexuality in aging’, ‘long-term care facilities’, and ‘elderly sexual health’. Thus, according to the specified inclusion criteria, only articles published within the last ten years, those that had access to full text and published in peer-reviewed journals, were used. Special emphasis was paid to articles that contain findings and numbers depicted as case studies, policies, or staff/ residents’ feedback.

Qualitative Interviews

Semi-structured interviews were conducted with LTCF residents, staff, and family members to capture personal experiences and perceptions. The interview sample included 20 participants: 10 residents, five staff members, and five family caregivers. These interviews were designed to discuss impediments to sexual conduct, norms, and possible resolutions from individuals from various cultures. Interactions were audio and/or videoed and later transcribed, and the themes that emerged from the data were coded and analyzed into themes that defined the study.

Surveys

The questionnaire included questions on current policies, the scope of staff education, and attitudes toward resident sexuality. Attitudes were measured on a Likert scale: Strongly Agree through Strongly Disagree on matters like inclusiveness, consent, and privacy. Responses to the questionnaire were received from 150 individuals; this response rate permits statistical treatment of the data.

Policy Analysis

A review of existing policies on sexuality in LTCFs was conducted to identify gaps and strengths. Policy documents were obtained from publicly available sources and LTCFs that agreed to provide internal policies. The analysis focused on the degree to which these policies addressed resident rights, consent, and cultural competency.

Case Studies

Included also are case studies of successful programs dealing with sexuality in LTCFs. The selected case studies are those that were cited in the recommendations from experts in gerontology and/or had literature-documented evidence of measurable outcomes in either resident satisfaction or policy improvement.

Research Findings and Discussion

Importance of Sexuality in Older Adulthood

Sexuality is related to older adults’ mental health, emotional well-being, and quality of life. Numerous studies report that sexual activities and intimacy have positive effects on self-esteem and satisfaction in life among older adults (Boyacıoğlu et al., 2023). It is surprising that many LTCFs are conducted based on misconceptions that sexuality is absent among older adults (Miguel et al., 2024), resulting in LTCF policies that disregard their sexual needs. This neglect not only undermines the well-being of residents but also violates their autonomy and human rights.

Older adults also face societal stigma about their sexual expression, which is then compounded by feelings of isolation and inadequacy. These are compounded by LTCFs with restrictive institutional policies and lack of privacy. Sexuality during later life is an important element that necessarily creates an enabling environment for general well-being. The role of sexuality as a critical component of well-being, therefore, calls for proactive measures aimed at dismantling ageist stereotypes and misconceptions in LTCFs.

Research suggests that a healthy sex life in old age results in enhanced emotional health, increased physical health, and enhanced marital relationships (Portellos et al., 2023). A concentration on sexual needs in the care of elderly patients emphasizes the need for seniors to be loved in numerous ways. Notably, Zhang et al.’s (2023) longitudinal research confirms that older people with regular sexual partners demonstrate lower signs of depression, which, in turn, makes the connection between sexual health and psychological state even stronger.

Policies and Organizational Barriers

The political imperatives of policies set within LTCFs do not consider or respond to the sexual rights of inhabitants. According to Jen et al. (2022), only a third of LTCFs in their sample had policies in place that addressed the residents’ sexual rights. This absence of organizational support is a major determinant of unequal and somewhat inadequate care, with residents’ sexuality being practically erased in many facilities. Incidences by members of staff and the subsequent claim risks also contribute to hesitance in forming and/or enforcing such policies.

The lack of extensive measures can be attributed to a systemic problem, which comprises LTCFs as a system. Unfortunately, most centers pay more attention to physical issues of health and security than subjects of mental and psychological health. This docketing strategy excludes the profession of elder care as a multifaceted type of work that also involves meeting residents’ social and emotional needs. Proper formulation of resident-friendly sexual rights policy is fundamental to enhancing equality of service provision.

In addition, the consideration of sexuality within care paradigms will open the way for a more comprehensive, accepting recognition of residents’ personalities. For example, policies that ensure privacy during intimate moments and address consent for those with limited capacity significantly enhance the quality of care. Furthermore, ongoing staff education on implementing person-centered approaches can empower residents to express themselves freely without being constrained by stereotypical assumptions.

Staff Training and Attitudes

The organizational environment that shapes the sexuality of LTCF residents is provided and modified by the staff members. However, Skeldon and Jenkins (2022) revealed that most staff members have no training in this area, and they develop discomfort and negative attitudes towards it. These attitudes still reflect cultural and generational beliefs, reducing the likelihood of change as far as sexuality in LTCFs is concerned. It is recommended that staff is trained well on the aspects of sexuality in older adults to appreciate the aspect and know how to handle residents with such needs.

Consent, communication, and cultural competency should be part of teaching and awareness of the staff. By focusing on these areas, opportunities are created for LTCFs to equip staff to handle controversy-filled scenarios in an understanding manner.

Further, temperate discussion of sex at the place of work can help to reduce prejudice and stereotyping. Including principles of experiential learning, such as role-play, into training can also improve the staffing ability to meet residents’ needs. Furthermore, approaches such as the use of health care workers, social workers, and psychologists can offer an integrated view of the topic.

Mitchell et al. (2022) observed that after an effective training program was conducted in one of the Canadian LTCFs, the staff’s attitude toward tackling sexuality improved by 35%. This proves that education can significantly change the current care practices and enhance the satisfaction of the residents.

Cultural and Religious Influences

Ethnocultural beliefs imply a strong influence regarding sexual orientation in LTCFs. Custodial-like AACIF settings are less likely to endorse sexuality and sexual expression by the residents (Khumalo et al., 2020). On the other hand, the institutions that practice cultural sensitivity in treating the clients end up being more effective in managing the sexual needs of the entities’ residents. For instance, LTCFs that adopt diverse sexual orientations and gender identities have higher satisfaction among residents than those with an opposite attitude.

It is, therefore, important to be culturally sensitive as regards the needs of the residents on LTCFs. This entails understanding the needs that exist because some residents may face discrimination or be forced to conceal their sexual orientations. Leadership should come up with policies that can make all the people residing in LTCFs accept each other in equal regard. Finally, embracing culturally appropriate practices of residents can help enhance the working relationship between caregivers and residents, the care hence being enhanced.

Culturally competent staff is, therefore, essential in promoting diversity and multiculturalism. These training sessions should be directed toward the construction of respect for the diversified traditions, orientation, and religion. Having boards of advisors and employing other people from different cultural and belief system backgrounds will also go a long way in the formulation of good, culturally appropriate solutions.

Ethical and Legal Considerations

Integrating residents’ sexual rights with ethical and legal responsibilities presents significant challenges for long-term care facilities. Key considerations include establishing protocols for obtaining consent and determining the extent of legal privacy rights for individuals with varying levels of cognitive impairment. These aspects are critical to ensuring ethical and respectful care practices within such facilities. According to Esmail and Concannon (2022), with the development of the protocol, including a paradigm for daily resident relations, staff and families can overcome these challenges.

In the context of LTCFs, consent proves to be the most challenging, especially regarding residents with dementia or some cognitive impairments. Policies for determining capacity at a minimum and for decision-making, capacity, and procedures in confirming the residents’ ability to consent to the intended services and actions are critical milestones to residents’ rights and welfare. Further, persons’ rights to privacy, for instance, the privacy of space as well as privacy from any physical or symbolic invasion, can help residents to have and express their sexuality. Efficient legal measures that would enhance residents’ decision-making while preventing risk to themselves or others can be useful in dealing with such issues.

Ethical considerations also include the rights of an individual and the duties of the LTCF to the residents. Implementing this idea means that staff members will also encounter situations where personal autonomy directly opposes the family members’ expectations as well as organizational standards. LTCFs should administer ethical training sessions for their employees while engaging ethics committees when encountering such questions (Haddad & Geiger, 2023).

Addressing Barriers to Sexuality in LTCFs

A comprehensive and multifaceted approach to addressing barriers to sexuality in LTCFs should encompass organizational, cultural, and individual factors. Implementing inclusive policy development, educational initiatives, and advocacy efforts can effectively promote and ensure the sexual well-being of residents.

Policy Development

The first and most important step is to establish policies that protect and recognize the sexual rights of residents. These should be polarity on different dimensions such as consent, privacy, inclusiveness, and positions of the staff members. Precautions for care in existing facilities for older persons with dementia or other mental illnesses should be well spelled out to safeguard the rights of residents as well as guarantee their safety.

Staff Education

Providing caregivers with the skills necessary to address sensitive situations with empathy requires comprehensive training programs. These programs should focus on the physical, emotional, and social aspects of changes in adult sexuality, as well as effective communication strategies and cultural competence. Additionally, staff within organizations can benefit from refresher courses to reinforce and update their knowledge of best practices.

Infrastructure Enhancements

Privacy-enabling activities such as the provision of an exclusive door to a room or a particular area where intimate communion can be achieved will go a long way in improving social relations in LTCFs among residents. These assist in making the residents feel their worth in the community through expressions of that affection.

Resident Advocacy

The creation of leadership boards, such as resident councils or support groups, enables the person to express needs and decisions freely. Such groups can share care plans on sexual health and well-being with LTCF staff and cooperate with them.

Community and Research Integration

Contact with external partners and stakeholders, as well as extensive advocacy and academic organizations, add a layer to the quality of the care delivery system. The focus on sexuality in aging will contribute to the establishment of broad guidelines for the best practice in LTCFs and encourage the further active construction of LTCFs’ enhancements.

Technology Integration

With the help of technology, the lack of knowledge between the residents and the staff can be solved via virtual workshops and e-learning. Other support may be expected from apps specialized in sexual health and education for older adults. Through these strategies, LTCFs may effectively counter the systemic invisibility of sexuality, such that LTCFs become accepting places for residents. Also, they improve residents’ living standards and foster residents’ independence, besides promoting the relevance of a quality daily life in elderly care institutions.

Family Engagement

Profiling families and engaging them in talks on issues regarding sexuality in aging erases resistance and ensures care coordination. As such, giving workshops or seminars can help inform families on how they should ensure that the dignity and independence of their relatives are preserved. Thus, it is possible to eliminate the systemic obstacles and establish conditions that contribute to the comprehensive residents’ care at LTCFs. It is important to improve the quality of the recipients’ lives and for their elderly clients to be valued as unique, self-governing individuals.

Conclusion

Sexuality in LTCFs is an under-researched area in elder care, hampered by a dearth of relevant policies, staff training, and cultural impressions. The findings in this study point to the need to embrace the sexual rights of LTCF residents to improve their experiences. Systems deficiencies pointed out in the literature include inadequate, possibly non-existent, policies, training, and awareness of the diverse population. Directions for future research include advancing the understanding of creating best practices and establishing a paradigm shift in sexual rights and the sexuality of residents in LTCFs.

Achieving this raises a challenge that will demand efforts from a broad array of stakeholders such as policymakers, caregivers, the residents, and their families so that the LTCFs are transformed into environments whose policies uphold and support all aspects of the resident’s welfare. By focusing on integrated sexuality in eldercare, LTCFs are well-placed to lead in a positive, sensitive change in aging.

References

Boyacıoğlu, N. E., Oflaz, F., Karaahmet, A. Y., Hodaeı, B. K., Afşin, Y., & Taşabat, S. E. (2023). Sexuality, quality of life and psychological well-being in older adults: A correlational study. European Journal of Obstetrics & Gynecology and Reproductive Biology: X, 17(78), 100177. https://doi.org/10.1016/j.eurox.2023.100177

Esmail, S., & Concannon, B. (2022). Approaches to determine and manage sexual consent abilities for people with cognitive disabilities: Systematic review. Interactive Journal of Medical Research, 11(1), e28137. https://doi.org/10.2196/28137

Haddad, L. M., & Geiger, R. A. (2023, August 14). Nursing ethical considerations. National Library of Medicine; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK526054/

Jen, S., Jeong, M., Lafountain, O., Doll, G., & Cornelison, L. (2022). Sexual expression, policies, and practices in skilled nursing settings serving older adults: An updated assessment in the state of Kansas. Gerontology and Geriatric Medicine, 8(78), 233372142211131. https://doi.org/10.1177/23337214221113137

Khumalo, S., Taylor, M., Makusha, T., & Mabaso, M. (2020). Intersectionality of cultural norms and sexual behaviors: A qualitative study of young Black male students at a university in KwaZulu-Natal, South Africa. Reproductive Health, 17(1). https://doi.org/10.1186/s12978-020-01041-3

Miguel, I., Von Humboldt, S., & Leal, I. (2024). Sexual well-being across the lifespan: Is sexual satisfaction related to adjustment to aging? Sexuality Research and Social Policy. https://doi.org/10.1007/s13178-024-00939-y

Mitchell, S., Jaccard, E., Schmitz, F. M., von Känel, E., Collombet, P., Cornuz, J., Waeber, G., Guessous, I., & Guttormsen, S. (2022). Investigating acceptability of a training program in precision medicine for frontline healthcare professionals: A mixed methods study. BMC Medical Education, 22(1). https://doi.org/10.1186/s12909-022-03613-2

Portellos, A., Lynch, C., & Joosten, A. (2023). Sexuality and aging: A mixed methods explorative study of older adult’s experiences, attitudes, and support needs. British Journal of Occupational Therapy, 86(7), 030802262311642-030802262311642. https://doi.org/10.1177/03080226231164277

Skeldon, L., & Jenkins, S. (2022). Experiences and attitudes of the LGBTQ+ community on care/nursing homes. Journal of Homosexuality, 78(98), 1–33. https://doi.org/10.1080/00918369.2022.2086751

Zhang, F., Yang, Z., Li, X., & Wang, A. (2023). Factors influencing the quality of sexual life in the older adults: A scoping review. International Journal of Nursing Sciences, 10(2). https://doi.org/10.1016/j.ijnss.2023.03.006

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