How much responsibility does the assisted living facility have in trying to control inappropriate sexual behavior of residents?

Francesc asked...

How much responsibility does the assisted living facility have in trying to control inappropriate sexual behavior of residents?

Here's the problem: My dad is in an assisted living facility - his second. He has been in this facility since March 2010. He was in another facility from November 2009 - March 2010 and prior to that he was at home with my mom.

A couple of weeks ago (on their 57th wedding anniversary no less!) the assisted living facility called to tell mom that dad was found in his room with a female resident. She was naked from the waist down and supposedly he was standing over her touching her private area.

Dad has been an insulin-dependent diabetic since 1975, has been on Lexapro, Aricept, and Kepra for the past three years. He is in a wheel chair. He has dementia.

The female resident involved has dementia, is a wanderer and is known to have had "boyfriends" come and make conjugal visits in the past. The facility put a stop to that at some point. I do not know how long ago that was.

Mom is in total denial that dad could have even been standing over this other resident much less touching her inappropriately because of the medications he is on and his diabetes.

Mom has asked dad several times about what happened and he says that the female resident came in his room, took off her pants, and sat down on his bed while he was in the bathroom on the toilet. Dad says he never got off the toilet. The facility says there were two or three employees that witnessed the incident and they all claim dad was standing over this other resident and touching her.

The facility told mom that she needs to have dad medicated to control his libido, which mom doesn't think he even has. I'm not completely sure that mom is correct in her opinion on this, but it does seem to be a bit of a stretch considering my dad's medications and general health.

Mom has requested that the facility make efforts to keep the other resident out of dad's room but she has found the other resident in dad's room on at least three occasions subsequent to the incident. Mom has lead the female resident out of dad's room and told her she is not to be in there and closed the door. This doesn't seem to be working, and of course mom is not there all the time to guard the door.

It seems to us that the female resident is the one who needs her libido chemically controlled, not dad.

We are planning to address this with dad's doctor in a few days and see what his take on the situation is.

Has anyone had a similar situation and how did you deal with it? When mom suggested to the DON (Director of Nursing) at the facility that the female resident involved was perhaps the one to be medicated mom was told "oh, she's just out of it. We can't do anything with her." I don't exactly agree with this answer from the facility, but I'm trying to understand what steps we need to take to get the facility to address this and help ensure it doesn't happen again.

Thanks in advance for any comments, suggestions, advice.

Expert Answer

Deborah Cooke is a gerontologist specializing in dementia, delirium, caregiving, and senior fitness. She is a certified dementia care provider and specialist through the Alzheimer's Foundation of America. Cooke currently manages several multidisciplinary programs to enhance well-being for hospitalized seniors and other vulnerable patients at NewYork-Presbyterian Hospital in New York City. She also serves on the board of NewYork-Presbyterian's Patient and Family Education Advisory Committee. She has 18 years of experience working with the aging and caregiver communities.

Hi Frances. Sexual behavior in any alternative living situation such as assisted living or nursing home is very difficult to handle.

First, anyone who is considering placement in a facility should ask if for a sexual conduct policy. Many do not have this, but the word is catching on that this is totally necessary. The policy is not just for you, the caregiver, but also for the residents. So first ask for this policy and see how they handle situations like this.

Second, it is difficult to inhibit sexual behaviors, even in cognitively intact human beings. For those with dementia, the concern is augmented because you don't know what is true or untrue and the parties involved likely do not remember and cannot control these behaviors. They may even make up stories to "cover" their lack of memory. The other difficult issue with dementia persons involved in this behavior is whether or not the sexual act is consensual. In many cases, the dementia person does not know what is happening but "feels" something that is good. It's always easy to blame the other person.

Lastly, medication likely is not the answer and could make things even worse. I certainly would not want to do this for me, my loved one, or the "accused" party. Libido is natural; but for dementia persons, it may be difficult to control due to lack of knowledge, consent, or disinhibition.

At the end of the day, I would ask for a secual conduct policy and try not to "dwell" on the issue too much. The act has been "done" and you can't turn back time. Also, moving on may help any associated anxiety even though it does not take the pain, violation, or act of infidelity away.

UPDATE: I want to clarify the issue of "dwelling." Your mother is going through a significant sense of loss and this experience only aggravates that loss. Please acknowledge this. It's a difficult thing to forget. If you put it in a context of loss and grief (not directly to her), then you may be able to heal and understand his position. It's OK to be sad and disappointed.