You probably remember the song “San Francisco” by Scott McKenzie (https://youtu.be/obsAUJHMOZs). The song was about the Summer of Love in 1967 with lyrics:

“If you're going to San Francisco

Be sure to wear some flowers in your hair

If you're going to San Francisco

You're gonna meet some gentle people there

For those who come to San Francisco

Summertime will be a love-in there

In the streets of San Francisco

Gentle people with flowers in their hair.”

About 100,000 people, mostly young adults sporting hippie fashions of dress and behavior, converged in San Francisco's neighborhood Haight-Ashbury. Although hippies also gathered in many other places in the U.S., Canada and Europe, San Francisco was at that time the most publicized location.

Hippies, sometimes called flower children, are now in their 70’s. Whether they were a “hippie” or not, these people are now entering long-term care and often don’t want their “love life” to end just because they live in assisted living facilities or a nursing home.

Many older Americans routinely engage in vaginal intercourse, oral sex, and masturbation, according to a federally funded study published by the New England Journal of Medicine. Researchers found that 73 percent among those 57-64; 53 percent among 65-74 and 26 percent of those 75-85 said "affirmative" to sex.

One in seven were using drugs to increase performance.

"Sex changes as we age, but for every problem, there is a solution!" says Joan Price, advocate for ageless sexuality, media-dubbed “senior sexpert,” and author of three books about senior sex:

  • The Ultimate Guide to Sex After 50: How to Maintain – or Regain! – a Spicy, Satisfying Sex Life, Joan Price's new, definitive, in-depth guide to sex and aging.
  • Naked at Our Age: Talking Out Loud about Senior Sex, winner Outstanding Self-Help Book 2012 from the American Society of Journalists and Authors and 2012 Book Award from the American Association of Sexuality Educators, Counselors, and Therapists (AASECT).
  • Better Than I Ever Expected: Straight Talk about Sex After Sixty, Joan’s sexy memoir.

Joan is now age 74 and she still loves sex.

“I plan to continue to celebrate the sexual pleasure my body can give me. Things may change, and I will adapt to them, but I say, sex has no expiration date,” said Price quoted in a recent article in Next Avenue ( http://www.nextavenue.org/sex-long-term-care/).

“Residents in long-term care get no privacy, so how can they explore their sexuality with another resident or solo when they can’t lock the door?” she said. In fact, many facilities’ policies are “archaic, regressive and even ageist,” according to a 2015 article in Time magazine (http://time.com/3833358/nursing-home-sex/).

Price says that if you’re not in a relationship there are still many reasons to keep the sexual urge alive. Physical and emotional benefits will benefit quality of life. Often both adult children and facility management don’t want to address or acknowledge the issue. Concerns about the ability to consent, privacy and liability make the issue difficult to manage.

Long-Term Care facilities who are eager to avoid liability have started to develop guidelines that preserve residents' right to pursue sexual pleasure in privacy, while protecting them from unsafe, unwanted or abusive situations. So far only about a quarter of facilities have policies on intimacy and sexual behavior, according to a 2013 survey by AMDA — the Society for Post-Acute and Long-Term Care Medicine. Almost half said that developing a policy was "planned" or "uncertain." According to the AARP.

"The nursing home field is more highly regulated than any other, but there are almost no rules regarding sexuality," says Gayle Doll, director of the Kansas State Center on Aging and author of Sexuality & Long-Term Care quoted by the AARP (https://www.aarp.org/home-family/caregiving/info-2015/sex-in-assisted-living-facilities.html).

She defines sexual expression as anything from compliments to touch to sex.

"More facilities are becoming enlightened to the fact that this is something people are thinking about, and maybe they should find ways to help people become comfortable."

Residents in Long-Term Care facilities are guaranteed specific rights under the federal 1987 Nursing Home Reform Law. These include rights to privacy; confidentiality regarding personal affairs; right to make independent choices, personal decisions; to private, unrestricted communication with visitors of one’s personal choosing; to be free from all forms of abuse and restraints. While sex is not specifically mentioned you see it falls generally in these guidelines.

So, the right to have sex is protected but the question of consent is foggier. According to the Iowa Long-Term Care Ombudsman Office In the context of a sex act, most jurisdictions consider a variation of these to determine ability to consent:

  • Knowledge of the relevant facts concerning the decision to engage in sexual activity
  • Mental capacity
  • intelligence to realize & rationally process the risks & benefits of engaging in sexual activity
  • Voluntariness to engage in conduct without coercion

Every state agrees that a sex act occurring between two individuals where one lacks the requisite capacity to consent is a criminal offense. However, the standard used in each state court to determine capacity and intelligence to rationally process the risks and benefits in order to consent varies. Most states consider whether an individual has

understanding of the nature and voluntariness of the sex act. Some states require an individual to also be able to understand the consequences of the sex act while other states consider whether the individual understood the moral quality of the act, and whether there was evidence of a disability that would impact an individual’s ability to consent.

Another issue is sexual disease. STD transmission among the elderly is a growing problem. Chlamydia infections among Americans 65 and over has increased dramatically as has syphilis. Many caregivers are surprised because they never imaged sexually transmitted diseases to be one of the many issues they could encounter when caring for or supervising the care for an elderly loved one.

If you have a loved one in an assisted living facility or nursing home communicating with staff and the individual and their desires is key. The respect for their privacy is important but the concern for health and ability to consent should also be considered. Experts says sex for older people is usually a positive but the understanding that there are different issues with aging and sex is something to pay attention to and not ignore.

Editor's Note

An advance plan for long-term care is now a big part of retirement planning. The article doesn’t discuss the costs of caregiving, either at home or in a facility. These costs come out of savings unless you plan in an advance.

Long-Term Care Insurance will provide the tax-free resources to pay for quality care either at your home or in a facility. It will also reduce the tremendous burdens placed on family members.

LTC Insurance is affordable, especially if purchased before you retire when you enjoy better health. Spousal discounts, shared benefit plans and state partnership programs help you safeguard assets and reduce this burden.

Experts suggest speaking with a specialist in long-term care planning to help design affordable plans.

The cost of care varies as do tax advantages. Click here to see the cost of care and tax benefits in your state: https://www.ltcnews.com/resources/state-information