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Sex is surely no longer a taboo subject but two new publications outline the difficulties in talking about some aspects of sexual behaviour and relationships. The first, from the older people's advisory organisation Counsel and Care, is written for residential staff in the form of a practice guide.¹

This guide is based on a series of discussions with those working in residential care homes for older people about the day-to-day issues they encounter. These include the difficulties faced by residents and staff alike in talking about relationships and possible misunderstandings of people's feelings and needs. The guide calls on staff to reflect on their reactions and to seek support about their own feelings and practice.


The guide reminds staff that residents' rights to privacy and to make their own decisions need to be upheld. Their rights to protection are also important and staff are advised to consider matters of consent and dignity. Lastly, it also reminds staff that behaviour that might be seen as sexual could be part of a resident's need for company or human contact. Pathologising problems can label behaviour incorrectly, but similarly missing a distressing symptom of a disease can mean treatment is not obtained. Like many aspects of residential life this guide suggests a need to seek advice and to balance competing interests and perspectives.

The guide makes reference to possible difficulties arising from a resident's dementia - or at least ascribed to this illness. The Archibald research on residential care work shows that staff can "excuse" sexualised behaviour from a resident if they think there is a dementia.² But staff views could vary in whether they really thought a person had dementia and whether they "knew" what they were doing.

If a person had dementia, staff sometimes felt uncomfortable about how to handle residents' sexual expression. At times staff felt that they had not handled situations well and could feel embarrassed. This was possibly caused by a lack of support in talking about such matters. Archibald suggests that managers should be more proactive here in helping staff discuss general issues around sexual behaviour and their feelings of responsibility. This should be addressed in training and supervision but also by attention to the culture of the home and the sensitivity that needs to be displayed to the subject as it affects both residents and staff.


Archibald considers elsewhere the position of the key worker.³ Care workers told her that keyworking was generally a valued way of supporting residents but it could give rise to difficulties. When exposed to unwanted sexual behaviour staff did not see this as sexual harassment but might see themselves as at fault or responsible. At times they did not feel able to let managers know what was happening. Archibald notes that some members of staff may find sexualised behaviour more difficult than others. She considers that they may need long-term support.

These publications relate to residential care but this is an area where day care and respite support are increasingly offered. We know little of how sexuality is negotiated in home-based care. These publications indicate a need for the subject to be discussed sensitively and for staff to be given opportunities to receive supervision and support, as well as training.

Jill Manthorpe is reader in community care at the University of Hull.

¹ Alison Clarke, Les Bright and Chris Greenwood, Sex and Relationships: A Guide for Care Homes, Counsel and Care 2002. Available from 020 7485 1550, price £5 (including p&p)

² C Archibald, "Sexuality and dementia in residential care - whose responsibility?" in Sexual and Relationship Therapy, Vol 17 (3), 2002

³ C Archibald, "Resident sexual expression and the keyworker relationship: An unspoken stress in residential care work?", in Practice Vol 13(1), 2001