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AMDA Model Care Facility

Medical Staff Policies and Procedures

Policy Number: Clin.CLI.13

Subject: Privacy and Sexuality

Purpose: The Model Care Facility Medical Staff acknowledges that there is a Constitutional right to privacy and presumes that sexual activity conducted lawfully in private is protected. At the same time, under circumstances frequently encountered in nursing homes, countervailing risks may attend upon sexual activity, which fall to the facility to manage. The Medical Staff will support the Facility in making reasonable and appropriate accommodations for residents who choose to engage in consensual sexual activity with others. The Medical Staff will assist in identifying and managing risks associated with sexual activity through individualized care planning.

Rationale: See Commentary, below.

Primary Responsibility: Attending physician, inter-disciplinary team

Scope: All facilities and programs

Policy: The Facility assigns to the Inter-Disciplinary Care Plan team for each resident the responsibility to assess and manage the benefits and risks of sexual activity with others. Physicians will assist the inter-disciplinary team as members of it. NOTE: "Sexual" behaviors not involving others shall be addressed under other applicable behavior management policies, including masturbation, use of pornographic media, and unwelcome sexual gestures or remarks directed at staff members. Likewise, disinhibited socially inappropriate behaviors associated with dementia shall also be addressed under applicable behavior management policies.

Procedure:

  1. For residents thought to be actually or potentially sexually active, the attending physician and inter-disciplinary team will arrange a multi-disciplinary assessment including the following elements:
    • Health status: Presence of sexually transmissible disease or other health risks, including cardiopulmonary, genitourinary, and musculoskeletal
    • Mental health: Stress, inter-personal dynamics, mental and behavioral risks
    • Safety: Risk of falls or injury
    • Regulatory: Marital rights; limitations of right to privacy due to considerations of health, safety, and welfare.
    • Legal: capacity to consent to sexual activity
    • Welfare: dignity, pregnancy exposure, privacy, effects on previous family and social relationships.
  2. The inter-disciplinary team shall review the multi-disciplinary assessment as well as viewpoints from
    • Caregivers, including their ethical, moral and religious perspectives
    • Facility administration, including internal and external stakeholder issues.
  3. The inter-disciplinary team shall propose an individualized care plan based on considerations in procedures 1 and 2. The proposal shall be reviewed with the resident or responsible party in a supportive fashion. A care plan shall be approved by the resident or responsible party, the inter-disciplinary team, and facility administration.
  4. Any off-label or investigational use of drugs that modify sexual behavior requires prior approval by the Medical Director regards compliance with applicable laws, regulations, and facility policies.
  5. Attending physicians shall support facility policies that affirm resident dignity including age- and gender-appropriate social roles, such as
    • staff education on sexuality
    • professional, non-judgmental management of resident sexual concerns
    • accommodation of privacy needs and considerations of dignity
    • age- and gender-appropriate grooming
    • age- and gender-appropriate approach and interaction
    • promotion of appropriate sensory stimulation (for example, pets, stuffed animals), intimacy expressions (for example, hugs), and social interactions
    • family education and counseling.

Cross-References:

  • Federal regulations (Tag): 42 CFR 483.10 (m) (Tag F 175) Room sharing by married couples; 42 CFR 483.10 (e)(1) (Tag F 164) Personal privacy; 42 CFR 483.20 (d)(1)(i) (Tag F 279) Highest practicable level of function (see also 42 CFR 483.25); 483.20 (d)(2) (Tag F 280) Comprehensive care plan
  • State regulations:
  • JCAHO standards: RI.2.3 Privacy

Other Facility Policies:

Key Words: Assessment; Behavior management; Care plan; Falls; Infection control; Informed consent; Injury; Privacy; Resident rights; Risk management; Sexuality.

Author: Duncan S. MacLean, MD, CMD

Commentary: MacLean, DS, "Sex: A Matter of Policy?" Caring for the Ages, Vol. 3, No. 2, February 2002, pp. 20-22. For more information or to subscribe, contact caring@lww.com.

Copyright: The author places this policy in the public domain. Attribution is requested.

Disclaimer: Use of this Policy is subject to the Terms of Use published on the AMDA Web site (www.amda.com). Neither AMDA nor the author assumes any responsibility for the consequences resulting from use of this model policy. Users are hereby advised to seek professional advice before implementing any policy.

Date Posted: April 11, 2002

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