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Sexual intimacy
and dementia
Abstract:
The case against Henry Rayhons may be the first time that a husband was charged
and prosecuted with sexually abusing his wife while she was a resident living with
dementia in a nursing home. This case also illustrates the complexity of sexual
intimacy when one or both partners may have a cognitive impairment.
On May 15, 2014, during a care plan meeting, the facility informed
Rayhons that his wife did not have the cognitive ability to give consent
to any sexual activity, according to the official complaint.
The following week, a roommate of Donna Rayhons reported that she heard
noises indicating that the couple was engaging in sexual activity. A surveillance
video revealed Henry Rayhons depositing his wifes discarded undergarments as
he left her room the night in question. The facility contacted the local police and
Rayhons admitted to having sexual contact with his wife. He also acknowledged
that the facility advised him that his wife could not consent to sexual relations
because of her incapacity.
Nursing facilities have an obligation under both federal and state law to protect their
residents.
They also have an obligation to respect autonomy and resident rights. Unfortunately,
capacity is not an all-or-nothing proposition.
According to Pat Bach, PsyD, a geriatric psychologist who was involved with
AMDAs survey, Only 25 to 30 percent of the facilities in the survey had formal
training in the area of intimacy and sexuality regarding older adults. Thirty
percent had no training at all. Likewise, 30 percent of the respondents in the
AMDA survey indicated the homes they worked in had no policies. Greater
educational focus on this area is also needed among geriatricians, as the majority
of respondents (65-75 percent) received little to no training in their geriatrics
fellowship programs, Bach adds. Thus, physicians (and other long-term care
providers) are not always well prepared to effectively address these issues.
According to Lindsey Neal, MD, a Certified Medical Director and AMDA member,
notes, Residents with dementia are still human beings with sexual feelings and
desires, and often as their dementia worsens, their sexual desires increase. These
scenarios are uncomfortable and facilities often err on the side of caution and
prohibit such encounters. Physicians and medical directors should stay involved,
be a part of the discussion, spend time with the resident and family, advocate for
the resident, consider a neuropsychiatric evaluation if necessary and document
their assessment.
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