Sexual Expression, Policy, and Practices in Skilled Nursing Facilities: An Updated Assessment in the State of Kansas

Background and Purpose: Prior studies have reported barriers to meeting the sexual needs of older adults within skilled-nursing facilities, such as a lack of privacy, lack of supportive practices and policies, and judgement or discomfort on the part of the staff (Doll, 2013; Hajjar & Kamel, 2003). In 2008, Doll and colleagues assessed the scope of sexual behaviors, staff perceptions of and responses to such behaviors, and whether facilities had a sexual policy in place in SNFs in the state of Kansas (Doll, 2013). Methods: In the present study, an online survey was distributed to the same population to provide an updated assessment of sexual behaviors, policies, and practices. Results: Of 60 survey respondents, 62.7% reported knowledge of individual sexual acts (e.g., masturbation) within the past year and 34.5% reported interactional (between two or more residents) sexual acts. When encountering a sexual event, staff were most likely to report the incident to an administrator (76.7%) and treat residents with respect (70.0%), while 35.0% and 41.7% were expected to respond with embarrassment and discomfort, respectively. Only 40% of administrators reported having a policy related to sexual expression. Over 1/3 indicated that staff would respond differently to an LGBTQ-identified resident engaging in sexual behaviors than a non-LGBTQ-identified resident. When asked to state why, administrators cited unfamiliarity and discomfort with such identities, particularly within small, rural communities. Over 70% indicated that staff would respond differently to residents with cognitive impairment, citing concerns regarding consent and the need to “protect” residents. Conclusions and Implications: The proportion of facilities in Kansas with policies related to sexual expression has increased from 26% to 40% in the past 12 years, but there remains a need for greater specificity of sexuality-related policies and trainings. Findings indicate that staff are likely to respond differently to LGBTQ residents due to discomfort, indicating a need for further efforts to promote awareness and education around this population. The sensitivity around issues of consent and “protection” regarding resident with dementia suggest that trainings around sexuality and sexual policies must be sensitive to and relevant to such concerns.