title: Sex in Nursing Homes: A Survey of Nursing Home Policies Governing Resident Sexual Activity.
abstract: OBJECTIVE
  To identify nursing home (NH) standards related to sexual activity and sexual relationships for residents through a nationwide survey of directors of nursing (DONs).
  
  
  METHODS
  A national survey was distributed online and was completed by 366 DONs of skilled nursing facilities. The DONs answered questions concerning policies and experiences related to sexual activities of their residents including types of resident sexual activity they have encountered, perceptions about residents with dementia engaging in sexual activity, and policies pertaining to sexual activity including masturbation.
  
  
  RESULTS
  The results of the survey demonstrated that the vast majority (71.2%) indicated that there had been issues regarding residents' sexual activities in their facilities with over one-half (58%) of the DONs reporting situations of resident with resident sexual activity and 60% with situations of resident masturbation. More than one-half (56.6%) require a family or designated representative to approve sexual activity for a cognitively impaired resident. For a cognitively intact resident, 12.4% of facilities still require family or designated representative to approve sexual activity. However, despite the prevalence of sexual activity, the majority of NHs (63.4%) actually do not have policies dealing with resident sexual activity. Of the NHs with policies, 58.6% have written policies in place, with 11.2% requiring a physician order to allow sexual activity and 9.5% requiring a physician order to restrict sexual activity.
  
  
  CONCLUSIONS
  Issues related to sexual activity in NH residents are quite prevalent, however, the rates of policies related to sexual activity are low and the policies and restrictions are not uniform. Our study suggests nursing homes should have a clear policy addressing resident sexual activity. It would be beneficial for such a policy to be communicated to residents and their families as part of an admission package instead of waiting for sexual interest to be noticed. This would enable residents to engage in sexual activity with understanding and support rather than hiding.
authors.affiliation: Division of Geriatric Medicine, Winthrop University Hospital, Mineola, NY; Department of Internal Medicine, SUNY Stony Brook, Stony Brook, NY. Electronic address: PLester@Winthrop.org.
authors.forename: Paula E
authors.initials: PE
authors.lastname: Lester
authors.affiliation: Department of Behavioral Medicine, Winthrop University Hospital, Mineola, NY.
authors.forename: Izchak
authors.initials: I
authors.lastname: Kohen
authors.affiliation: Thomas Jefferson University College of Population Health, Philadelphia, PA; MercyLIFE, Philadelphia, PA; The Access Group, Berkeley Heights, NJ. Electronic address: Richard.Stefanacci@Jefferson.edu.
authors.forename: Richard G
authors.initials: RG
authors.lastname: Stefanacci
authors.affiliation: Department of Biostatistics, Office of Academic Affairs, Winthrop University Hospital, Mineola, NY.
authors.forename: Martin
authors.initials: M
authors.lastname: Feuerman
mesh_terms: D001291:Attitude of Health Personnel; D003704:Dementia / Q000523:psychology; D006801:Humans; D009718:Nurse Administrators; D009735:Nursing Homes / Q000592:standards*; D016134:Organizational Policy; D012725:Sexual Behavior; D011795:Surveys and Questionnaires; D014481:United States
keywords: Nursing home; dementia; elderly; masturbation; sexuality