Nursing homes don’t seem very sexy – my mental image involves sleepy old people drinking soup and playing bingo, which is potentially the least sexy thing in the world. Many people believe that sexuality and the need for sexual relationships declines with age. Surely, if you feel pressure to get married and settle down by the time you’re thirty, then you won’t be pursuing casual relationships in your eighties! This is downright wrong. For the fact is that old people have the same sexual desires and needs as everyone else. There are a number of complex issues surrounding intimacy and the elderly: can people with dementia consent? Are the needs of LGBTQI people being met? What about the growing prevalence of chlamydia, gonorrhoea and other sexually transmitted diseases among elderly people? These are problems that need to be dealt with sensitively and progressively in aged care facilities.

It’s not as if all the horny old men and predatory cougars are sitting in their communal lounge rooms screaming, “I want sex, I want sex.” For some elderly people there is simply a need for intimacy and physical relationships, whether that involves intercourse or not. This may be a reaction to the sterile and clinical environment of a nursing home, where often residents don’t have much privacy or opportunity to sustain any kind of relationship away from the watch of staff. Others’ needs may be much more sexual. In these cases, residents may not be able to tell the difference between their spouse, care worker, or another resident, but still be driven to act on their urges. These two different scenarios require very different solutions.

Some nursing homes are unsure where to set boundaries for their residents in terms of the relationships they are able to pursue. Family members are sometimes uncomfortable with the idea of their elderly loved ones entering into relationships with other residents in aged care facilities, and put pressure on nursing homes to prevent this from occurring. But policies that prohibit these kinds of relationships cause more harm than good. Depression, anxiety and feelings of isolation are serious mental health concerns for elderly people in care, so to deny healthy romantic relationships that could alleviate those feelings seems grossly unfair. And what right do the managers of the nursing homes have to restrict the freedoms of their charges anyway?

The even more taboo topic is whether or not residents should be permitted to engage in purely sexual relationships, with their spouses, other residents, or even sex workers. As far as I know, on the whole, nursing homes are comfortable with their residents being intimate with their spouses, and allow this to happen in private, safe spaces. When it comes to other residents, however, it’s a different story. In many nursing homes, staff try to prevent sexual relationships from occurring, in the interest of both elderly people and their families. They do this by limiting the kinds of places residents can go together, and trying to separate them as often as possible.

To my mind, as long as both parties are consenting, I don’t think this kind of sexual relationship is problematic. Issues arise, however, when one party is unable to consent, particularly if they suffer from Alzheimer’s or dementia. In these cases, it is really important that staff monitor the residents in their care. It seems like a contradiction, then, to say that staff in nursing homes should both give elderly people more privacy and be watchful of all their relationships with other residents. This points to the diversity of both the needs and limitations of all kinds of different people living in aged care.

One solution to this problem could be to facilitate access to sex workers for the elderly. There appears to be many nursing homes that already allow this, if a resident directly requests to hire a sex worker, or their family does this on their behalf. But what about aged care facilities that are run by religious groups? I understand that hiring sex workers may go against the doctrine of these institutions, and it would be impossible to force religious nursing homes to allow prostitutes into their facilities. Nevertheless, it’s also important to note that many elderly people haven’t made the decision to go into a religious home themselves – they may have been put there by their family, or decided to go there for financial reasons. Nonetheless, they might have no other way of satisfying their physical needs. Similarly, what about elderly people who are LGBTQI? There are some nursing homes that cater specifically to LGBTQI people, but certainly not enough, and none that advertise themselves as such in Canberra.

This article raises more questions than it answers, sure – but at the very least, awareness about intimacy in aged care facilities is important, particularly when the physical and mental health of the elderly is at stake.