"Sexuality and Long-Term Care confronts ageism by helping to set
the stage for abetter understanding that older people still
experience love, seek intimacy, and are sexual.Administrators,
staff, and family members who read this book will gain the
recognition thatresidents in long-term care settings are clearly
full human beings. If facilities embrace Doll'sbook, then older
adults will gain recognition as individuals who can enjoy a sexual
life waypast the time that society currently believes they should
be doing so."-- (07/18/2012)
For all the innuendos and images surrounding sex in our society,
it's a topic that many long-term caregivers are reluctant to bring
up with residents and their family members.Sexuality is far more
than being about sex, or as Freud might have put it, sometimes a
cigar isn't just a cigar. As Gayle Doll explains in her new book,
"Sexuality & Long-Term Care: Understanding and Supporting the Needs
of Older Adults," sexuality encompasses many aspects of a
resident's life. This includes the desire for companionship and
intimacy, the need for privacy, and holding onto one's
identity."Unfortunately, the only time many long-term care
facilities address sexuality is when there is a 'problem, '" writes
Peggy Brick, the president of the Sexuality and Aging Consortium at
Widener University, in her introduction to Doll's book.That can
mean anything from public inappropriate behaviors to an adult child
flipping out upon finding a parent has a new girlfriend or
boyfriend.So what can long-term care staff do to mitigate problems
yet help residents still enjoy all parts of their lives? That's
what is great about Doll's book: Rather than an academic treatise,
"Sexuality & Long-Term Care" is a workbook, with activities and
questions designed to help managers lead staff in creating a
positive environment. Those questions can be basic, such as, "Does
your organization have policies, which include consequences, to
deal with employee or client complaints of discrimination or
harassment, and is there a follow-up process?"Other activities and
self-assessments will open up sticky psychological wickets for
staff based on one's personal values and background. How does a
staff member handle a resident viewing pornography, same-sex
residents holding hands, or a dementia patient falling in love?
Doll doesn't provide the answers, but she does provide a framework
for respecting resident's sexual needs while protecting him or her
from harm.If you've been down this road and have thoughts to share,
please leave them in the comments below. To sweeten the deal, a
commenter will be chosen at random to receive a copy of Doll's
book.-- (01/24/2012)
There is a myth that sexuality vanishes with age. Gayle Appel
Doll's book Sexuality andLong-Term Care: Understanding and
Supporting the Needs of Older Adults does well attrying to change
that attitude. Research has demonstrated that sexuality is a vital
componentof well-being throughout the life span. Lindau et al.
(2007) found that most of their samplein a study of 3,005 adults
ages 57-85 thought that sexuality was an important part of life.The
idea that the aging have significant desires and needs for intimate
relationshipschallenges many people's belief systems. Furthermore,
many find it even more implausibleto consider sexuality for older
people in long-term care. In fact, if sexuality is acknowledgedor
addressed, it is often seen as a problem in nursing homes rather
than as a natural part ofthe developmental life cycle. Residents in
long-term care are under constant surveillance andoften have their
sexuality discounted or even forbidden.Redefining SexualityDoll,
the director of the Center on Aging at Kansas State University,
begins her book byredefining sexuality. According to Doll,
sexuality is far more than sex; it is one's feelingabout oneself as
a male or female, one's body image, and the desire for intimacy,
connection, and touch. She defines intimacy and sexuality as acts
that include complimentsand emotional acts of warmth, as well as
sexual intercourse.The need to balance residents' desires for
companionship and intimacy with otherswhile maintaining their
integrity and privacy is critical in long-term care. Doll is
convincedthat it is possible to create environments where
individuals can still experience love, in all itsdiverse forms, in
a residential health facility. Sexuality and Long-Term Care takes a
personcenteredapproach to residents' sexuality in long-term care.
Doll provides guidelines thataddress the rights and
responsibilities of older adults and help long-term care facilities
todetermine their own best practices in order to establish an
environment that supportsresidents' sexual health and
well-being.Long-term care staff, administrators, and family members
have historically had muchdifficulty responding positively to older
adults' sexuality in a residential setting. Dollengages the reader
in a discussion of how residential facilities can balance the
rights of theindividual resident with the concerns of the community
as a whole. She provides strategiesfor teaching staff and
administrators how to acknowledge the sexual and intimacy needs
ofthe residents effectively, respectfully, and compassionately.In
addition, Doll offers tools to teach staff, such as handouts and
learning activitiesthat encourage staff and administrators to
explore attitudes and biases about residents'sexuality. Staff
members are encouraged to look at how they deal with the residents
on thebasis of their own personal values and backgrounds. Doll
provides a clear framework forrespecting a resident's sexual needs
while protecting him or her from harm.Issues of Sexuality in
Long-Term CareDoll's book provides ample scenarios to illustrate
potential issues surrounding how to dealwith resident sexuality in
long-term care settings. Readers will find that each case
examplecreates opportunities for discussion about how the staff
handled the situation, what worked, what failed to work, and what
would have been a more effective way to deal with thesituation.
Doll offers effective ways to resolve common dilemmas surrounding
sexuality inlong-term care settings. Issues can include how the
staff members handle residents viewingpornography, same-sex
residents hugging, or a dementia resident falling in love.What
makes Sexuality and Long-Term Care even more intriguing is that
researchvalidates Doll's best-care practices for supporting
resident sexuality. Simple ideas such asmaking "Do Not Disturb"
signs available on doors and pushing beds together are
potentialpossibilities. More important than any specific suggestion
is the effort to help staff becomeaware that the residents are
whole people and do not just need the staff to watch them and
dotasks for them.The book grapples with the definition of normal
sexual expression in old age. Dollacknowledges that the
administrative team must intervene to prevent unsafe and
abusiverelationships. She discusses how facility caregivers can
recognize inappropriate sexualbehaviors and then suggests how to
address them. Another complex issue that needs seriousconsideration
involves a resident in a long-term care home developing a sexual
relationshipwith another resident when he or she still has a living
spouse. Doll also addresses howdementia affects sexuality. It is
not difficult to let the residents who are cognitively intacthave
meaningful intimate relationships; it is far more challenging to
give the same freedomto individuals with dementia.Doll discusses
how the losses associated with moving to a long-term care facility
aremagnified for the LGBT community. Sexuality and Long-Term Care
addresses the concernsthat lesbian, gay, bisexual, and
transgendered residents have about moving into a long-termcare
community (Stein, Beckerman, & Sherman, 2010). Often, after living
openly, they haveto return to the closet to avoid discriminatory
actions. Doll helps long-term care homesbecome more accepting to
the LGBT community by creating antidiscrimination policies
anddiscouraging heteronormative language.Doll addresses another
hurdle regarding resident sexuality: residents' families. Inmany
situations, long-term care facilities will choose to follow the
directives of familymembers over the residents' expressed desires
for intimacy. Doll suggests that long-termcare facilities can
support families through education and counseling. Helping families
toacknowledge the need for sexual expression may honor the person
that the older individualhas become.Addressing Sexuality in
Long-Term Care SettingsMany nursing homes and long-term health care
facilities have not discussed residentsexuality or developed
policies to address it other than possibly forbidding it. The
researchand training tools included in Doll's book will help them
start this discussion and developpolicies to create a positive
environment related to residents' fundamental desires forintimacy
and sexuality.Clearly, long-term health facilities need to protect
themselves from unexpectedlawsuits. Spending time creating
sexuality policies will go a long way toward reducing theese
threats. Figuring out how to make policies regarding sexual
expression that show acommitment to residents' quality of life is
essential. Doll addresses the issue of whatconstitutes consent
and/or competence in residents of a long-term health facility.There
have always been needs and desires for intimacy and sexuality in
residents oflong-term care, and there have always been and will
always be residents who act on thoseneeds and desires. As a result
of personal and societal discomfort with sexuality in the aging,
support and compassion from administrators and staff of these
facilities are sorely lacking.Sexuality is an area that most
long-term caregivers are historically reluctant or unwilling
tobring up or embrace.Although there are ample resources in Doll's
book, the willingness of residentialfacilities to implement these
approaches remains to be seen. Unfortunately, it will be a
verydifficult task to get caregivers to deal with and resolve their
discomforts with sexuality andto begin to see residents as sexual
and intimate beings so that facilities can make use ofDoll's
remarkable tools.Sexuality and Long-Term Care confronts ageism by
helping to set the stage for abetter understanding that older
people still experience love, seek intimacy, and are
sexual.Administrators, staff, and family members who read this book
will gain the recognition thatresidents in long-term care settings
are clearly full human beings. If facilities embrace Doll'sbook,
then older adults will gain recognition as individuals who can
enjoy a sexual life waypast the time that society currently
believes they should be doing so.ReferencesLindau, S. T., Schumm,
L. P., Laumann, E. O., Levinson, W. L., O'Muircheartaigh, C.,
&Waite, L. J. (2007). A study of sexuality and health among
older adults in the UnitedStates. The New England Journal of
Medicine, 357, 762-774. doi:10.1056/NEJMoa067423Stein, G. L.,
Beckerman, N. L., & Sherman, P. A. (2010). Lesbian and gay elders
and longtermcare: Identifying the unique psychosocial perspectives
and challenges. Journal ofGerontological Social Work, 53, 421-435.
doi:10.1080/01634372.2010.496478July 18, 2012, Vol. 57, Release 28,
Article 4(c) 2012, American Psychological Association--
(07/18/2012)
"Gayle Doll bravely addresses the many barriers that currently deny
the sexual needs and rights of many residents. [Her] pioneering
book provides step-by-step guidelines for agencies ready to adopt a
truly person-centered approach to sexuality."-- (04/14/2014)
"Rather than an academic treatise, "Sexuality & Long-Term Care" is
a workbook, with activities and questions designed to help managers
lead staff in creating a positive environment...Doll...provide[s] a
framework for respecting residents' sexual needs while protecting
him or her from harm."-- (01/24/2012)
"This book is long overdue. The sexuality of older adults living in
long-term care facilities has been derided at worst and ignored at
best. Gayle Appel Doll has finally brought this taboo topic out of
the shadows and into the daylight where it belongs for a healthy
discussion by all concerned."-- (04/14/2014)
"This is an excellent resource to help nursing home staff gain an
understanding of sexuality in long-term care. It tackles this
difficult and, for some, uncomfortable subject in such a simple way
with chapters, sidebars, and activities that can be done with the
nursing home staff or even students ... It is directed at long-term
care staff at all levels ... [and] can be used as a tool to tailor
discussions at any level from residents and their families to staff
and physicians ... [to] promote group discussion and inner
reflections for readers on their beliefs and opinions. The sidebars
and activities greatly enhance the learning experience ....
Grounded in research, but with very helpful practical applications,
it covers the topic thoroughly, including providing sample facility
policies that can be adapted to the individual facility."--
(04/14/2014)
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