When Audrey Davison, age 85, met a special guy at the Hebrew Home at Riverdale in the Bronx, New York, they did more than sit next to each other in the dining room. He invited her to his room. They hung a "Do Not Disturb" sign on the door. And at breakfast the next morning, they both sported broad smiles.

Of the home’s 870 residents, administrators estimate that 40 are involved in sexual relationships. The staff wishes there were more. Relationships make people happier, and happiness reduces stress and irritability, and improves mood, appetite, sleep, sociability, and immune function. Sex also provides exercise, and at a time of life when many elderly feel cold, sleeping as a pair provides warmth.

The Hebrew Home does more than merely tolerate resident nookie. The facility holds regular happy hours, dances, and has even organized a dating service for residents, G-Date—“G” for grandparents.

From Institutional to Individual Care

Sex in nursing homes is about more than just lovemaking. Until the 1990s, nursing facilities were run on a military model. Staff woke everyone at the same time, marched them to meals, shepherded them to activities, and put them all to bed. No longer. Today, nursing homes have evolved toward a more individualized model of care. Residents are encouraged to arrange their own schedules as much as logistically possible, and this increased self-determination has led many to sexual relationships.

Daniel Reingold, CEO of the company that runs the Hebrew Home, was a pioneer in sex-positive elder care. In 1995, a nurse walked in on two residents making love and ran to Reingold asking him what to do. “Tiptoe out,” he replied, “and close the door behind you.”

The incident led to a survey of hundreds of nursing homes around the country. Most denied that any sex was happening under their roofs. But slowly, industry conventions began sponsoring workshops on sex among nursing home residents, and attitudes changed. Today, most nursing homes have sexual expression policies that instruct staff to respect residents’ privacy and decision-making and inform incoming residents and their families that sex among residents is fine—just not in public spaces.

The new sexual freedom has also encountered pushback. Families have objected to nursing-home relationships in cases where one of the lovers is still married to a non-resident spouse, and some religions view sex as appropriate only for procreation and struggle with amorous elders. But the trend is clear—sex is part of life at any age, even in nursing homes.

Touch Me

Aging involves losses, including impairment of four of the five senses—vision, hearing, smell, and taste. But the ability to appreciate gentle, loving touch remains largely intact.

There are two kinds of nerve fibers in the skin. One type detects pain, but the other, the C-fibers, respond to gentle touch, triggering a neurological cascade that reduces blood levels of the stress hormone, cortisol, and improves mood, appetite, sleep, sociability, and immune function.

Touch is the one sense we cannot live without. Babies born blind or deaf can live full lives despite their handicaps. But babies deprived of touch may develop a condition known as failure to thrive, and if they continue to be touch-neglected, they may shrivel and die. Touch remains vital throughout the lifespan. Some researchers call it “skin hunger,” and view touch as a nutrient absorbed through the skin. Nursing home residents deprived of touch often withdraw. But when massaged, they perk up. Some nursing homes contract with massage therapists to provide neck, shoulder, and back rubs. Lovemaking extends massage to the whole body.

Shortage of Men

Institutional objections to sex may be diminishing, but demographics remain cruel. On average, women live longer than men. The typical nursing home population is largely female, meaning that the many women compete for the attention of the few men. That’s sad. At some nursing homes, staff have had to deal with jealousy, hurt feelings, and the awkwardness of break-ups. But that’s life, and people should be free to live life in all of its glory and rancor at any age.

Sex in the Dementia Unit

Mutually pleasurable sex involves two people consenting to make love. But what if one has Alzheimer’s disease and may not be capable of consent?

In 2014, Henry Rayhons, a 78-year-old farmer, and former Iowa state legislator, was charged with sexual assault when the nursing home staff told police that he was having sex with his wife, Donna, who was a resident of the Alzheimer’s unit. Staff were alerted by Donna’s roommate, who reported “strange noises” coming from the other side of the curtain. The prosecutor said that due to her dementia, Donna was not capable of legal consent, therefore, Rayhons’ actions constituted sexual abuse. The defense countered that the couple had always reveled in their relationship and that despite her dementia, Mrs. Rayhons welcomed the sex and even initiated it. It was the first such case in the nation. The jury acquitted Rayhons.

The verdict is unlikely to settle the issue, but touch hunger is primal and even people with dementia crave physical affection and possibly lovemaking. Sex in the dementia unit has become a hot topic at nursing home industry conferences and the trend is clear. Facilities are slowly moving from a policy of “don’t” to “do not disturb.”

References

Hu, W. “Too Old for Sex? A Nursing Home in the Bronx Says No Such Thing,” New York Times, July 13, 2016.

Kaplan, S. “Former Iowa Legislator Henry Rayhons, 78, Found Not Guilty of Sexually Abusing Wife with Alzheimer's,” Washington Post, April 23, 2015

Sehlstedt, I. et al. “Gentle Touch Perception Across the Lifespan,” Psychology and Aging (2016) 31:176

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