Sexual Expression in Alberta’s Continuing Care Homes: Capacity, Consent, and Co-decision-making

Brassolotto, J., Howard, L., & Manduca-Barone, A. (2020b). Sexual expression in Alberta’s continuing care homes: Capacity, consent, and co-decision-making. Canadian Journal on Aging / La Revue Canadienne Du Vieillissement, 40(1), 156–165.

In this article, we explore the role of substitute decision-makers (SDMs) in matters of sexual expression for continuing care residents with diminished cognitive capacity. We examine how Alberta’s current use of SDMs can enable an “all-or-none” approach to competence, wherein a person either has capacity to make all decisions or is incapable of making any. We offer several recommendations for how we can better support residents’ sexual autonomy in continuing care and avoid pitfalls of the “all-or-none” approach to competence.

Recommendations: At the care home level, we recommend that managers facilitate conversations with their staff to discuss personal values, beliefs, and attitudes and reflect on how these may affect their work. Staff members should receive targeted sexual expression training. A care home’s physical and social spaces make it difficult for residents to exercise privacy in their intimate lives. There is an opportunity for managers to re-conceptualize how the space is navigated with an aim of ensuring residents’ right to privacy. These efforts could enhance general quality of resident life and better utilize physical space. We also recommend a continuing care policy on resident sexual expression.

At the continuing care sector level, our findings demonstrate the need for a service provision standard about resident sexual expression. A coordinated, multi-level approach that contextualizes sexual rights in continuing care could go a long way towards supporting safe, healthy, and dignified sexual expression.

These recommendations serve as an important starting point to address the tensions described above. These changes at site and sectoral levels will make it easier for managers and care staff to navigate these tensions and to better uphold the sexual rights of continuing care residents. Our findings reveal the breadth and urgency of the work to be done.