Care homes address touchy subject
Imagine this scenario: a woman with Alzheimer's disease moves into a residential care facility while her husband continues to live at home. He visits her regularly and as the disease takes its toll, she becomes fearful and loses the ability to make decisions about her finances and health care. Her husband wants to continue his private visits with her, but she can't articulate whether she is comfortable with this.
BY VANCOUVER SUN MARCH 21, 2014
Imagine this scenario: a woman with Alzheimer's disease moves into a residential care facility while her husband continues to live at home. He visits her regularly and as the disease takes its toll, she becomes fearful and loses the ability to make decisions about her finances and health care. Her husband wants to continue his private visits with her, but she can't articulate whether she is comfortable with this.
It's a dilemma faced by care home staff on a regular basis and there are no easy solutions, said Heather Campbell, director of policy and research at the BC Care Providers Association.
Intimacy in care homes - and among seniors generally - has historically been such a taboo topic that there are few best practices or guidelines for those in the industry on how to handle such situations, Campbell said.
"I think society has the misconception that seniors are asexual, don't have an interest in sex or if they are living with dementia, perhaps it's inappropriate for them to be having intimate relations," Campbell said, adding the reality is seniors need to feel love and a sense of belonging as much as anyone else.
The challenge for care homes is to strike a balance between respecting individual privacy and ensuring that relationships happen in a safe and consensual way, she said.
Many people experiencing cognitive decline have power of attorney or representation agreements in place that allow someone else to make decisions on their behalf with respect to finances or health care.
"When it comes to sex, the law is unclear in terms of what can a substitute decision maker consent to on behalf of somebody," Campbell said.
The Supreme Court has ruled that consent cannot be given in advance and must be given in the moment, she said. "If we have a husband who's living in the community and his wife is now in a care home and he comes in and wants to engage in an intimate relationship with her, the argument that 'we've been married for 40 years' doesn't have much weight because it's: 'Can the wife provide consent in the moment?'" Campbell said.
"It's not really something you can consent to through someone else."
Catherine Kohm, executive director of Haro Park Centre in the West End, has encountered such situations and says the solution is often to involve family or close friends in deciding what to do. There have been times when staff have consulted the couple's children, although it is usually the last thing they want to get involved in, Kohm said with a chuckle.
The forum discusses what can be done to respect and respond to the needs of LGBT residents, some of whom are afraid to move into a care home because they come from a generation where being gay was highly stigmatized, Campbell said. This fear sometimes results in "re-closeting" when a person enters residential care.
Staff at Haro Park have gone through training to make sure they are inclusive and don't assume heterosexuality in their language, policies and choices of activities - using the word "partner," for example.
It's important to acknowledge that there are LGBT individuals in the residential care population and that they feel welcome and included, Kohm said, adding that a group from Haro Park march in the Pride parade each year.
Outside the West End, however, things can be different. Certain activities - having to choose an oppositesex dance partner, for example - and assumptions made by staff or other residents can make LGBT seniors feel unwelcome.
There are times when bullying and discrimination are problems, Campbell said, noting that aggression is a symptom of dementia.
There are also times, Kohm said, when relationships develop between residents, "and how wonderful is that?" Philippa Ward is one such resident. She met John Hewis Smith in 2012 when he was seated at a table near hers in the dining room. He liked the way she greeted everyone and came over to introduce himself, Ward recalled. He tried to impress her with his large television and after that, they were "constant companions."
Smith had a near-death experience and was determined to get everything he could out of life, Ward recalled. He was diabetic and bored with his limited meal options at the centre, so they used to troll the West End together in search of interesting food. They also went to lectures, concerts and movies - "everything that was happening," Ward said.
Smith died in November at age 89. His large flatscreen TV found a home in Ward's room.
"I try to continue some of it still," she said of the excursions on the town "but it's a lot lonelier now."
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