Research into practice

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)

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