The CRNCC is supported by funded from the Social Sciences and Humanities Research Council of Canada and Ryerson University.

Transcription

1 Leading knowledge exchange on home and community care Setting the Context Janet M Lum, CRNCC Co-Chair Chair The CRNCC is supported by funded from the Social Sciences and Humanities Research Council of Canada and Ryerson University.

2 Research Team Sanja Bislimovic Ashma Patel Thomas Kais-Prial Jennifer Sladek Alvin Ying Quest Atkinson Special thanks to Gerrie Burnett, Tim McCaskell, Faith, Henry and many others

3 Sexuality and Integrating g Care Mantra of integrating care: Top line - good for individuals Bottom line - good for sustainability of healthcare system Definition of integrating care puts older persons at the centre -- client-centred care a well-planned and well-organised set of services and care processes, targeted at the multidimensional i l needs/problems of an individual client, or a category of persons with similar needs/problems (Nies 2004, p. 12).

4 What do we mean? Take the person as the starting point Sexuality means different things to different people

5 Looking and Feeling Good 5

6 Companionship p

7 Emotional Connectedness birds and the bees do it, why can t I do it? I feel happy feel whole complete Emotional intimacy probably outweighs sexual intimacy so people can be very close and not have much sex even though there is still physical intimacy sexuality changes through peoples lives Tim McCaskell, educator, author, equity & antihomophobia activist

8 Romance and Relationships 8

9 Emotional Intimacy 9

10 Physical Intimacy

11 Sexual Identity and Orientation 11

12 Zest For Life

13 Why Is Sexuality and Aging Important? t? Sexuality applies to all of us regardless of age Contributes to healthy aging promotes mental, physical and social well-being that add up to a sense of self-worth and quality of life

14 How are new generations of older persons expressing their sexuality?

15 Changing g Values 14% of Canada s population p is 65 years or older and is projected to rise to 25% in 2031 Boomers are poised to bust myths around sexuality, aging, and sensibilities about sexual orientation and identity

16 Are care planners, policy planners and providers ready?

17 Issues For Providers Do care managers ask about sexuality issues in their assessment? Front-line providers role? Acknowledge that sexuality in all its dimensions is part of healthy aging and facilitate it? Help with his lipstick, hair & mini skirt? Provide transportation t ti to speed dating? Assist in shopping for sexually explicit materials, condoms, sex toys?

18 Front-Line Provider In my gerontology program, I can remember that we had a chapter in our textbook on sexuality and aging we skipped it maybe because the instructor thought ht it wasn t important t or relevant

19 Front-Line Provider these two clients were holding hands some staff believed that it would lead to sexually inappropriate behaviour and wanted to separate them. But they were happy some people are just good with holding hands it s very comforting it s very reassuring. Maybe that s the comfort that they need just holding hands but we don t have guidelines we separate them because we re afraid something will happen

20 Enhanced Education and Training For Front-Line Providers Tools to check personal assumptions Older people are interested in sexuality, aren t easily offended, aren t straight Guidelines to distinguish between personal morality and safety issues Clients holding hands Sexually explicit materials when you clean Escorts entering the premise Cheating in LTC facilities Ways to foster a safe climate to talk about healthy sexuality Protocols to help older people balance their safety, independence and personal autonomy around sexuality

21 Balancing Liabilities, Risks and Healthy Sexuality At what point do we deem someone incapable of providing consent for intimate relationships? Preempt potential liability problems for the institution before they develop

22 This woman was cognitively impaired she would basically do anything that you d say. You have patients suffering from dementia who resist everything but some are very passive this particular female resident is very passive. If you want her to follow you, she d follow you she d do anything you d say. So, we felt this resident would be exploited by male residents so so we d always intervene to separate her and whoever

23 Residents Bill of Rights

24 Standardized Regulations There are no standardized rules/ regulations allowing for the expression of sexuality in long term care facilities What rights do people have around g p p sexuality if they live in facilities?

25 Newfoundland and Labrador Regulations in Long-Term Care Facilities Explicit references to residents rights to: develop friendships and enjoy meaningful relationships without hindrance or embarrassment meet sexual needs with privacy, respect and dignity regardless of their sexual orientation privacy staff must knock prior to entering bedrooms, bathrooms and other personal space can lock their door, if desired;» les/longtermcarestandard.pdf

26 Ontario: Long Term Care Homes Act, 2007 Proposed Residents Bill of Rights Residents have the right to: form friendships and relationships have their lifestyle and choices respected meet privately with their spouse or another person in a room that t assures privacy share a room with another resident according to their mutual wishes Has NOT been proclaimed into force All the regulations necessary to carry out the Act have not been drafted Regulations are subject to public consultations before they can be finalized

27 Toronto Long Term Care Homes and Services Policy ygoverning gits nursing homes Broad definition of intimacy and sexuality Specific definition of capacity to consent adapted from the Health Care Consent Act Based on capacity to understand the information relevant to making a decision Ability to appreciate foreseeable consequences»

28 Toronto Long Term Care Homes and Services - Resident Care Manual Resident s Bill of Rights relating to intimacy and sexuality Based on assessed competency Decision-making tree for managing intimacy and sexuality for RN/RPN, physicians and counsellors»

29 International Jurisdictions United States Federal law requires each State to institute a Bill of Rights that includes issues of sexuality for nursing home residents» _billofrights.pdf Australia Charter of Residents Rights and Responsibilities New Zealand» CA256F C/$File/charter.pdf Standards under the Health and Disability Services (Safety) Act 2001 explicitly protect consumers rights to intimacy and sexuality»

30 Issues for Facility Design Facilities are not designed for privacy Few facilities can accommodate couples, or more casual relationships among heterosexual or same sex couples Double beds? Locks on doors?

31 Health Issues

32 Health Issues Do doctors and other care providers routinely ask older people questions about sexuality and sexual health during checkup visits? Only 22% of women and 38% of men had discussed sex with a doctor since age 50 (Lindau et al, 2007)

33 Health Consequences Older adults may not feel the need to practice safe sex as they consider condoms merely as methods of birth control AIDS Calgary Awareness Association, In 2006 in Canada, people over 50+ accounted for 14% of all positive HIV test reports, double the rate reported in Government of Canada. (2007). HIV/AIDS Epi updates November Ottawa: Public Health Agency of Canada.

34 Several months ago I met a woman at a little funeral celebration We had several dates, she was about 70 years old, extremely sexually turned on after about 4 dates, she told me she had herpes

35 Family Concerns Have Fun But

36 Continuum of Family Attitudes Ignore too old and they don t know what they are doing Steer mother in another direction when she wants to look for a partner..very protective and more particular about whom Id date than I am 100% supportive Help out mom by buying a sex manual she wants for her new companion

37 Educational Resources For family members and older people themselves Dispel myths around aging and sexuality Help advocate for rights to intimacy and sexual expression in facilities Enhance safety and security while finding companions Educate on health issues trust me in her day, she never used condoms and doesn t know what one looks like

38 what I wish for my mom are moments of happiness whether it s meeting somebody who spends weekends with her, takes her out for dinner, movie or whatever they want to do I m good with that who t h on earth would be uncomfortable with that I just want to make sure about health, safety and security issues» Gerrie Burnett, Daughter

39 Moving Forward - Implications for: Community Service Agencies Supportive Housing Managers Long Term Care facilities Health care providers Family members

40 AIDS Calgary Awareness Association. (2007). HIV/AIDS and seniors: Briefing document. Retrieved from Australian Government. (2007). Charter of Residents Rights and Responsibilities. Canberra: Department of Health and Aging. Retrieved October 10, 2009 from Government of Canada. (2007). HIV/AIDS Epi updates November Ottawa: Public Health Agency of Canada. Government of Newfoundland and Labrador. (2005). Long term care facilities in Newfoundland and Labrador: Operational standards. St. John s, Newfoundland: Department of Health and Community Services. State of New Jersey. (n.d.). N.J.S.A 30:13-5. Nursing Home Residents Bill of Rights. Trenton, NJ: The New Jersey Office of the Ombudsman for the Institutionalized Elderly. Retrieved October 10, 2009 from Government of Ontario. (2009). Long-Term Care Homes Act, 2007: Summary and proposed Part 2 Initial Draft Regulation under the Long-Term Care Homes Act, Toronto: Ministry of Health and Long-Term Care. Retrieved October 10, 2009 from Lindau, S. T., Schumm, L. P., Laumann, E. O., Levinson, W., O Muircheartaigh, C. A., & White, L. J. (2007). A study of sexuality and sexual health among older adults in United States. New England Journal of Medicine, 357(8), Nies, H. & Herman, P. C. (Eds.) (2004). Integrating services for older people: A resource book for managers. Dublin: European Health Management Association. Standards New Zealand. (2008). New Zealand Standard: Health and Disability Services (Core) Standards. Wellington: Ministry of Health. Retrieved October 10, 2009 from Toronto Long-Term Care Homes and Services. (2008). Diversity our strength: LGBT Toolkit. Toronto: Author. Retrieved October 10, 2009 from

41 Leading knowledge exchange on home and community care The CRNCC is supported by funded from the Social Sciences and Humanities Research Council of Canada and Ryerson University.