Sexual Consent Capacity: Ethical Issues and Challenges in Long-Term Care

More than two million Americans live in nursing homes and other long-term care facilities. Available research suggests that the majority of older nursing home residents, including those with some degree of cognitive impairment, place significant value upon a variety of sexual activities. With nearly half of all residents suffering from dementia, psychologists and other mental health professionals often face significant challenges in the assessment of their patients’ sexual consent capacity. A primary ethical issue is to balance an individual resident’s rights to autonomy and privacy with a facility’s need to protect residents from harm. Sexual consent capacity functions on a continuum across time and behavior. It also cannot be predetermined by proxy, in which an individual prepares legal documents ahead of time to identify a surrogate decision maker; sexual consent capacity must be determined by information obtained in the present moment. In this paper, an approach to the assessment of residents’ sexual consent capacity, encompassing knowledge, reasoning, and voluntariness, along with a brief overview of sexual activity among long-term care residents, will be presented. A case example is offered to illustrate complex clinical dilemmas involving staff attitudes, residents’ rights, and family dynamics.