Negotiating Sexuality and Intimacy in Assisted Living: - PowerPoint Presentation

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Negotiating Sexuality and Intimacy in Assisted Living:Findings from a two year qualitative study

Elisabeth O. Burgess, Ph.D

Presentation for:Slide2

Why this topic?Who am I?

Social GerontologistSexualities ScholarSociologistFeminist Researcher I am interested in where

people are socially located (e.g. assisted living facilities) and how that location influences their experiencesSlide3

AcknowledgementsNational

Institute on Aging at the National Institutes of Health (Grant #R21 AG030171). Collaborators:Dr. Alexis A. Bender, Assistant Professor of Medicine, Division

of General Medicine & Geriatrics, Emory University School of MedicineDr. Christina Barmon, Assistant Professor, Department of Sociology, Central Connecticut State University

Faculty CollaboratorsDr. Molly M. Perkins, EmoryDr. Candace L. Kemp, GSUDr. Mary M. Ball, Emory

Research Assistants

James R. Moorhead, Jr.

Marik Xavier-Brown

Abinandan

Batra

J. Lloyd AllenSlide4

Sexuality, Aging, and Well-beingMajority of older adults are interested in sexual and intimacy

Engage in a wide array of intimate behaviorChronological age alone does not lead to decrease in sexual behaviorLack of partnerHealth or cognitive declineAgeism

Sexual activity and intimacy are positive for overall well-beingSlide5

Assisted LivingPhilosophy

Provide a home-like environmentEmphasize resident choice and controlDemographicsApproximately one million older adults in U.S.Majority widowed white women in their 80s who need assisted with at least 2 ADLs

Changing ContextIncreasingly frail and cognitively impaired Slide6

Sexuality and Assisted LivingAutonomy

Facility factorsRules and routinesResourcesPerceptions of resident care needsHealthWell-beingSlide7

Research AimsThis qualitative study explores how

sexuality and intimacy are negotiated in Assisted Living Facilities (ALF)Perceptions and knowledge of sexuality and intimacyNegotiation and management of sexuality and intimacyRole of administrators, staff, residents, and family membersSlide8

MethodsGrounded theory methods

Informed by Symbolic Interactionism & Feminist GerontologyPurposive sampling of 6 medium to large assisted living facilitiesData collection included:Observations (over 200 hours)

Focus groups with staff (in each facility)Individual interviews with administrators (6), staff (22), residents (24), family members (9), and 6 staff focus groups (24)Slide9

Methods - Setting

Rosewood HillsMedium-sized home43 residentsSeparate DCUSomerset ManorMedium-sized home

48 residentsTransitional wing for cognitively impairedWhite Sands PlantationMedium-sized home40 Residents

Separate DCUForest GlenLarge-sized home 90 residentsDCU in separate building on same campus Aster GardensLarge-sized Home

65 Residents

Separate DCU

Sycamore Estates

Large-size home

58 Residents

Separate DCUSlide10

ThemesBarriers to

Dating and Repartnering in ALBurgess, E. O., Bender, A. A., & Barmon, C. “There’s no nice men here”: The gendered context of dating and

repartnership in assisted living. (Working Manuscript)Sexual Freedom and Autonomy – Discourse of Rights

Barmon, C., Burgess, E. O., Bender, A. A., & Moorhead, J. M. (2016). Understanding Sexual Freedom and Autonomy in Assisted Living: Discourse of Residents’ Rights According to Administrators and Staff. Journal of Gerontology: Social Sciences. Published online in advance of print: doi: 10.1093/

geronb

/gbw068

Sexual Harassment of Staff

Burgess, E. O.,

Bender, A. A., Barmon, C., Moorhead, J. M., & Perkins, M. M. (2016) ‘That is So Common Everyday. . . Everywhere You Go’: Sexual Harassment of Workers in Assisted Living."

Journal of Applied Gerontology.

Published online in advance of print:

DOI:10.1177/0733464816630635Slide11

Resident Profile71% female

92% White33% Aged 80+54% High School diploma or less47% lived in this AL for atleast a year

79% perceived health as good or excellentSlide12

AL is not a swinging sexual marketplaceSlide13

Widowhood is a Salient Identity

Speaking frequently of spouse

Sharing memories and stories from marriage

Maintaining cherished markers of their marital roleSlide14

Somerset Manor – Staff Focus Group

Marsha: …to hear her speak of him he was a saint among saints—[Chuckles among group] —you know. And I thought, well, if all of us could have a husband like this—[Group laughter]—then we’d just be having a good time, you know. But then again she would be so mad—

Jan: Yeah. It’s painful.Marsha : —at him, God, and everybody else for taking him, you know. You know and but they were married, from what I can understand, for about seventy-five years. ‘

Cuz she’s in her nineties. They married very young and I believe her daughter told me that they were married for about seventy-five years.Amanda: But in spite of it, they will continuously talk about their husbands. They will tell us about their married lives and, “how he loved me and all he did for me and I miss him so.” In some way I think they can relate that something is missing because that never dies out. They will tell you, “Oh he was so nice to me.” You know, “he was the most wonderful man.” Slide15

Widowhood talk was genderedSlide16

Desire for Intimacy

Often defined by loneliness and absence of affectionYes, you find quite a bit of that [desire] in assisted living . . . You know just the other day I was talking to one of the residents; I says “oh you got a love letter.” She says, “No I don’t even get love letters no more. I don’t even have a love in my life. I miss that. I miss the companion, you know of it all.” (Alice, Somerset Manor Staff)

Redirected toward friendship and other acceptable outletsExpressed through sexual teasing and flirting Directed at residents, staff, family members, and visitors“I kid with him all the time. Tell him he’s a good looking man.”

Mildred, Rosewood Hills ResidentSlide17

Residents’ Experiences were shaped by AL

DemographicsSex RatioHealth and Frailty of ResidentsEnvironmentPhysical structureStaff and Administrator Perspectives

Community NormsSlide18

Staff in AL

90% female

65% under 45

67% African American96% High School Degree or less51% Have worked in LTC for 5+ yearsMajority

Caring and Compassionate

Overworked

Minimal Formal TrainingSlide19

Discourse of Residents’ RightsSlide20

Affirmation of Residents’ Rights

You know, this is their home. It’s not ours. We just take care of ‘em. They just pay us to take care of them. Alice, Support StaffSlide21

Qualifying Residents Rights

Lisa: Free to do what they want long as it doesn’t—Frieda: I think they’re free to do whatever they want.Maria: They can do what—exactly.

Lisa: Yeah, as long as it doesn’t harm anybody. Maria: As long as it doesn’t have any harmful effects on them.

Frieda: —on them, yeah.Maria: Physically, mentally, they’re free to do whatever they want to do. We are just here to provide care, and if um the freedom they have would interfere with their care then we might have to do something.Slide22

Watchful Oversight

Once again, going back to residents’ rights—that we just—we did a whole—a whole in-service—yeah, a whole series on—on privacy, dignity, residents’ rights, knocking on the door to enter. I think at the end of the day, the message that we try to convey is that we are responsible. At the end of the day, we are responsible for the safety and well-being. I mean, if you go back to our regulations, that shade of grey is that [laughs] at the end of the day, the assisted living community is responsible.

- Heather Aster Gardens AdministratorSlide23

Family Concerns

If something develops into something more romantically—if it’s okay with the families, then it’s okay with us. We would definitely discuss it with the family to see—to make sure that they are on board with it.- Hope

Forest Glen AdministratorSlide24

Consent

I had a gal who probably should have been in a dementia unit. We didn’t have space at the time and the family wanted her here. Physically up and walking, but I would say at least moderate dementia. The fella, more high functioning, was beginning to show signs of dementia and we would find her in his room sitting on his lap or he began to be very mobile and go to her room. That was incredibly awkward and that was probably within the last 15 months. We did have to get families involved. And it was a little bit embarrassing with both families, but our responsibility again was if there’s dementia on both ends of this and he was much higher functioning…I have, you know it’s my responsibility that with her dementia that she not be abused

- Betty

Rosewood Hills AdministratorSlide25

Environment of SurveillanceContradictions in the philosophy of assisted living

Competing ideas shape an environment in which people talk about rights but violate them in both subtle and overt waysEnvironment that discourages sexual freedomStrategiesReporting

SteeringSlide26

ReportingBasically if you notice something, you know something is going on, you have to report it to management. You know what I’m saying? And they in turn go to the family members, discuss it—you know, as I said earlier. Then they determine—they make the final--they have the final say-so as to what lines are drawn, how far things can go, whether they want their family member in a relationship or not. And then we have to—we have to follow that.

- Maggie

Aster Gardens Focus GroupSlide27

Limited amount of private spaceSlide28

SteeringBut if we catch them before it happens then we can have something to say, you know…And that’s one reason why when it gets to the point where the family disapprove of it or something like that then we have to disband them. And one go this way, one go that-a-way. We got to keep them apart. But I mean that’s when the staff plays security guard.

-Marcus

Forest Glen Focus GroupSlide29

DiscussionRights affirmed but regularly undermined

Shared meaningsPhilosophyStructureSocial meanings of aging and sexualityDisconnect between language and practice

Order and efficiency supersede sexual autonomySlide30

Discourse of Residents’ RightsSlide31

ImplicationsPolicy and practice

Training and rules should be more explicit as they relate to sexuality and autonomyAcknowledge contradictionsFuture researchRegional variationsLarger sample

Consent and dementiaSlide32

Thank You!For more information:Elisabeth O. Burgess

eburgess@gsu.eduhttp://gerontology.gsu.edu