Advanced Care Planning – Sex


About a month ago I engaged in a twitter exchange with @WhoresofYore on the matter of sex, aging and nursing home “care”.  In the exchange I mentioned a horrible incident reported in a book  I had read on the need for changes in Aged Care. The incident related to the abusive, slut shaming treatment of an elderly woman who liked to masturbate in the “privacy” of her room. It was reported in the book that a staff member had referred to her as a dirty old pig, based on her opinion that the elderly woman should not have been doing that at her age.  The book I mentioned was at least 15 years old (I’m sorry, it was not in my collection, I did not document details and I am not able to get the correct reference ATM – which is poor form on my part). While I cannot recall where the study was done, I recall thinking at the time I read the book, that I sincerely hoped that there have been substantial improvements in approaches to Aged Care in Australia (where I live) and other countries where there is an established aged care sector, since it was written.

A quick review of recent material on the internet suggests that while there may have been some progress, there is still considerable staff and family prejudice as well as institutional fear and lack of training around issues of age and sexuality, especially in dementia care.

A post from last year entitled The seniors leading Australia’s latest sexual revolution by Samantha Selinger-Morris, in the Australian Broadcasting Commission news (2 August 2016), canvases a range of  issues around sexuality and aging, including intimacy between residents who meet in Aged Care facilities, between couples entering facilities,  LGBTI rights and the use of sex workers for aging residents, including those with dementia. The article also highlights positive moves from within the research sector, around the need for consideration of sexual rights in Aged Care in Australia.

However the article also makes it clear that advocacy and advances toward positive aging are also met with concern and conservatism around a number of issues. These include the valid need for protection of those who may be vulnerable to sexual exploitation, entrenched negative attitudes towards age and sexuality amongst staff – coupled with inadequate or non-existent staff training, family attitudes around individual sexuality, sexual friendships and established intimacies and the conservative attitudes of some religious organisations who run various Aged Care facilities.

Distressingly,  (I cried) the article reports relatively recent findings by PhD researcher Alison Rahn, who revealed an instance of a couple in their 70’s who were forced to sleep in separate beds in opposite corners of the same room, because of concerns that the man – who had mild dementia, might act “inappropriately” toward his wife (who did not have dementia). According to Rahn, the man cried himself to sleep every night deprived of the intimacy of sleeping with his wife. Unfortunately the attitude of the wife and any immediate family to what seems to be yet another incidence of institutional cruelty, is not highlighted in the article, so it hard to know if and why the wife was unable (or unwilling) to intervene in the situation.

Often arrangements such as this are made quite quickly under emotional duress, without any prior research conducted about the suitability of the course of action (or the facility) for the needs of both partners. When we brought my father home from hospital for what ultimately proved to be only a few days after his terminal lymphatic cancer diagnosis, we made him up a separate bed in the room with mum, but he, quite understandably, sought his own bed in the company of my mother. Mum found this very difficult as she was grieving, emotionally exhausted and unable to get much sleep as he was extremely restless, the illness affecting his brain in the aftermath of  the diagnosis.

Despite distressing incidents such as the one discussed above, the overall article outlined above provides small glimmers of hope alongside ongoing causes for concern. Mention is made of the need to reference LGBTI rights, although the exact implications for LGBTI individuals and couples under the current Aged Care system are amorphous. Australia’s Opal Institute (Older People And SexuaLity) is a strong advocate in these matters. Conservative lines are already being drawn (on religious/moral grounds) around various institutions such as schools, churches and aged care facilities in Australia as we await the outcome of our recent vote on same sex marriage, so this will either sharpen or blur the attitudes and approaches in the immediate future.

However, if conditions in the aged care sector are still not optimal for mainstream seniors who want and need to maintain some form of ongoing sex life and if the needs and rights of same sex couples are only just being considered, where does this leave the members of the diverse Kink community?   Are we all aiming to “grow old disgracefully”, or is there a plan B?

At the moment I am single, and can see no likelihood of that changing any time soon, although my emerging involvement in Kink may lead me to change my mind on that. While I abhor the whole concept of Retirement Villages and I have no intention of ending up in some form of Aged Care Accommodation, the question arises where would I live, if living alone in my own home was no longer an option. The obvious answer would be with my daughter, however this would mean that my sexual expression would need to damped down considerably for a whole range of reasons. Another alternative – one I’ve favored for a long time is to become part of an intentional creative community, this would probably work well if I was poly, or if we all had our own private space as well as communal areas but ATM I am not in a position to begin that exploration.  Still even this mini-exploration raises questions of my own aging and continuing sexuality to a point where these are matters I am beginning to feel the need to urgently address. Therefore while public education, staff training and battles with religious conservatism are issues which largely remain outside my sphere of influence, there is one area in which I can make my attitudes and desires clear, and that is by incorporating sexual directives in my Advanced Care Planning document. The thought of doing this hadn’t really crossed my mind until I saw what Joan Price had to say on the subject, and now I am most definitely thinking about what I need to say.

Naked at Our Age – Joan Price – Sex & Aging Views & News: Do you have an Advance Directive for Sexual Rights?

At age 64 I may be theoretically closer to the pointy end of the matter than many of my followers, however, the thing is, while Joan is focused on older people, what she has to say really applies to everyone.
What if, my lovely kinky, sexually active fellow bloggers, for whatever reason, at whatever age, you ended up in some form of permanent care, what sexual rights would you want to have?

Joan’s draft document and that of another blogger, Mac Marshall, who replied to her post; discussed the following criteria: the need for freedom to express intimacy and sexual desire with another consensual partner in private, the importance of individual rights to privacy, use of/storage of toys and supply of condoms/dams (to which I would add access to plentiful supplies of lubrication, the right to access legal pornographic stimulus).

Taking up the first point, aside from encounters with an existing spouse or significant other, what about more than one partner? How would the facility cope with  consensual liaisons with more than one resident? And does the consensual other need to be part of a “romantic” involvement? 

In the ABC News report which formed the stimulus for this post, mention was made of a Sydney based sex worker “Emma” who was regularly visiting a number of  aged care homes at the request of patients and/or their families. The report mentioned her paid interaction with “George” a 91 year man living with Dementia. It detailed the difference her services made to the quality of George’s life, and the attitude of his daughter (who arranged the service), and staff at the nursing home (aware and apparently positive).

Should I then, in my Advanced Care Directive, mention my desire for a regular sexual encounter with a sex worker? And if I was to do so, what form of encounter and how might this be fulfilled?

While I’m far from ready to consider myself a candidate for any form of Aged Care just yet; my sex life, albeit conducted in a solo manner ATM, is very much alive and well. I manage my sexual needs pretty well with assistance from my lovely collection of sex toys,* and a bit of inspiration from my fellow bloggers. But the desire for intimacy and touch is another matter altogether. Therefore the answer to the first question above may be YES, but the second may be that I need to be touched, massaged, cuddled, even fondled, rather than fucked.

In a  few recent blog posts I chronicled my encounter with John Oh, a male escort who also lives in Sydney.  John is professionally accomplished. He is good at what he does whether that includes sexual intercourse, oral and/or manual stimulation but he also does a fine sensual massage, which speaks to his understanding of the importance of touch and physical intimacy in people’s lives.  If I was to spend more time with him it would involve more touch, less sex (though I wanted it the other way around the first time). I initially chose John for a number of reasons, firstly because he wasn’t marketing himself as a young “stud”, but rather as a mature, average sort of bloke (who takes care of himself) with whom I could feel relaxed and comfortable.
The other thing that drew me to him was his care and advocacy for peoples’ sexual rights. Because John, like Emma,** makes a point of working with clients who, for whatever reason, do not fit the norms so much of society is overly fond of when they think of people engaging in sexual activity. John makes it very clear  on his website that he’s straight, so I’m not discussing LGBTI matters here, nor for that matter, am I talking about BDSM, or necessarily, about intercourse. But rather, I’m referring to John’s preparedness to work with people whose cognitive and/or physical abilities create sexual/physical intimacy limitations in their lives. As John writes in his blog, his clients include those people who  may “find it very, very hard, or impossible to have a safe, consensual sexual experience because of their disability.” While aging isn’t a disability in the sense in which it is usually used, it may bring about a loss of ability, which means that ultimately a person may find it impossible to engage in physical intimacy let alone safe, consensual, sexual experiences either at home or in care. And of course illness at any adult age, may bring about conditions that create temporary or permanent loss of our ability to engage in or take care of our sexual needs, and/or need for physical intimacy.

The importance of  intimacy and touch, as well as sexual expression for people in Aged Care, was acknowledged in a recent (2017) article by Annie Waddington-Feather entitled “It’s Not Just About Sex”. Wadding-Feather also highlights the work of Dr Catherine Barrett, who has developed tools, including a sexuality policy template as well as conducting workshops for providers through OPAL. One  Victorian Care Provider, Cooinda has already developed a sexual policy template as a result of attending OPAL workshops and training in sexuality and intimacy is also now compulsory for staff.

In what sometimes seems to be a depressingly conservative environment where matters of sex are concerned I’m happy to see even this small result. Because, as we, in the sex blogging community well know, sex (and physical intimacy) does matter! It gives us a reason to get up (or stay in bed) in the morning, puts a spring in our step and generally makes living in a sometimes shitty world worthwhile.


*In a pre Advance Directive manoeuvre I’ve asked my friend “Lilith” to round up my toys in the event of a sudden departure from this life, to save my daughter from having to contend with the full extent of my delightful depravity. But I may also, in a little while, start to de-clutter and winnow down my collection of toys to my absolute favourites. And then I have the issue of what to do with a collection of expensive toys which in some cases have only been used once…

**Emma and John are not the only sex workers who offer what is still a relatively unique service. John’s blog post also mentions organisations in the UK and Australia who specialise in linking up clients with special needs. These include Touching Base in Australia and TLC Trust UK.



4 thoughts on “Advanced Care Planning – Sex

  1. Wonderful article on a difficult topic. My work is advocacy for low-income seniors. In all honesty, most of the single women have given up on sexuality and even love. At 64 you are really still quite young. You may have more years behind than ahead, but there’s still a bright sexual future for individuals at that age. As long as they want it, and you quite obviously do!


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