Supporting Intimacy in the Rehabilitative, Assisted, and Long-Term Care Settings

In 1987, OBRA Regulations were instituted in long-term care with an emphasis on facilities assisting residents to attain or maintain their "highest level of practicable physical, mental, psychosocial well-being. "In addition, there was an emphasis on resident rights. The resident has the right to a dignified existence and communication with and access to persons and services outside the facility. A nursing facility must protect and promote the rights of each resident. These rights cover the following areas: privacy and respect, medical care and treatment, freedom from abuse and restraint, freedom of association and communication in private, activities, work, personal possessions, grievances and complaints, financial affairs, transfer, and discharge. It is this author's opinion that these imply that residents should have the right to express themselves sexually. Sexual expression between 2 consenting adults who may be dependent for physical capacity but not for decision making and mental capacity should be addressed with respect and a resident-centered approach. The challenge for long-term care facilities is assessing the difference between sexual expression and aggression, which implies the lack of consent.