A discussion and guidance document for the nursing workforce from the Royal College of Nursing (RCN).
This guidance was created to assist nurses and care staff in working effectively with people in care homes who are dealing with issues of sexuality, intimate relationships, sexual expression, and sex.
Its goal is to help nurses and care professionals manage the needs of older service users in a professional, sensitive, legal, and practical manner by facilitating learning, supporting best practise, and serving as a resource.
Sexuality, in all of its forms, is an integral part of who we are as people throughout our lives.
Fundamentally, people who move to a care home should be able to maintain the same rights, choices, and duties that they had at home, as long as they do not interfere with the rights of those in the home.
Providers of care should seek to:
- design policies that support the rights of all persons who live, visit, or work in care facilities; and provide environments that encourage individual rights and choices in sexuality expression and intimate relationships.
- provide workers with assistance and proper education in dealing with sexuality, intimate relationships, and sex concerns.
Person-centred care systems and care delivery should:
- focus on individuals’ perspectives within the context of their unique lives and experiences
- be open to learning about people’s significant experiences and relationships
- promote and support human rights, dignity, privacy, choice, and control
- promote clear boundaries that protect and support residents and staff
All decisions will be based on the individuals involved and their unique circumstances, and a thorough examination of each individual’s unique circumstances, including risk, will be required. When appropriate, all essential people’s perspectives should be acknowledged; choices should not be taken in isolation, but with the help of teams caring for individuals.
Key choices and actions should be made ‘outside the box’ and documented in care plans, but confidentiality must always be preserved.
Staff at care homes should aim to strike a balance between an individual’s right to privacy and control and the need for care and surveillance, such as residents remaining in their rooms undisturbed or with shut doors and staff entering only when invited.
Employees should attempt to address relationships and sex alongside other parts of care, such as sexual health counselling, help with hygiene around sexual activity, and infection control to protect residents and staff from illnesses, such as HIV.
Staff must follow legal and professional guidance in situations where an individual is unable to make decisions, such as mental capacity legislation and UK Nursing and Midwifery Council (NMC) guidance, to ensure they operate in the person’s best interests. Specialist assistance should be obtained when necessary, such as for legal clarification, psychosexual or relationship problems, mental or sexual health issues, and safeguarding concerns.
Staff must be able to justify any decisions they make, demonstrating that they are using best evidence and best practise to enhance the health and well-being of persons in their care, their partners, families, and the general public and carers
Throughout one’s life, sexuality is a vital component of being human. Gender identities and roles, sexual orientation, intimacy, sexual expression, and sexual activities are all included. Identity, self-image, self-concept, and self-worth are all influenced by sexuality. It also has an impact on mental and physical health, as well as social interactions and overall quality of life.
Relationships with people help to sustain one’s sense of self and identity, which can become increasingly crucial as one gets older.
Relationships, especially long-term and close ones, can bring comfort and support to people as they navigate through life’s ups and downs. Individuals can feel appreciated, needed, desired, and enjoyed through relationships. In established couples, sexual connections and enjoyment from sex do not necessarily deteriorate with age. Many people love sexual relationships till the end of their lives, as data from around the world shows.
It becomes more difficult for elderly people to exercise their rights to sexual expression and intimacy when they become ill or incapacitated and are unable to meet their own needs independently and privately. When they transfer to a care home, the situation becomes more complicated because not only are residents increasingly reliant on staff to satisfy their requirements, but also because care homes are communal situations where the rights of other residents must be addressed. For residents, partners, families, and staff, dealing with sexual self-expression, intimacy, and sexual relationships can be tough.
Individuals’ fundamental rights to autonomy, choice, and consent, on the other hand, are enshrined in law and supported by human rights legislation. Furthermore, people have the right to be free of prejudice.
In terms of age, experiences, expectations, priorities, preferences, and wants, it is critical to recognise the diversity of older people.
Older folks, like those in younger age groups, have a wide range of sexual intimacy desires.
We recognise that changes in sexual functioning occur as people age, both as a result of normal ageing and as a result of pathological changes. A key message is that, in addition to sexual intercourse, older adults can find other activities fulfilling and life affirming. Examples of such activities are:
- being close – both physically and mentally
- cuddling
- kissing
- music and dancing
- being naked
- sharing a bed
- sexual intercourse
- using sexual adjuncts
Sharing time, smiles, and nice words, being completely available for each other, and having control and choice over these activities, whether in existing or new relationships, are all examples of being close. The concept of being together, of spending quality time together, can help to promote mental health, reduce stress, and reduce feelings of loneliness.
For some people, as they get older, fresh and fundamentally different foundations for intimate relationships become available. Some people love improving their sexual activity, while others want to explore new things with other persons. With less time constraints than at previous periods of their lives, some older people report that sexual activity can be more leisurely, lasting over an entire afternoon or an entire day.
There can be a conflict between promoting personal liberty and adhering to legal guidelines. Although decisions are rarely simple, nurses must always act in accordance with the law and the NMC Code (2015).
Nurses must work to promote and protect human rights, dignity, privacy, and choice, as well as to eliminate discrimination of any type. All judgments will be based on the people involved and their unique circumstances. Instead of relying on assumptions and stereotypes, approaches must be person-centred, and care must be offered in a customised manner.
When necessary, comprehensive assessments of individuals and their circumstances, including risk assessments and mental capacity assessments, must be carried out. At the proper times, care plans must be evaluated.
Wherever possible, the perspectives of a variety of key persons should be incorporated into the care, and if necessary, specialised guidance should be obtained.