Challenging the Sex Taboo:

One of the privileges – and challenges – of doing my job – is being invited to speak at a range of events and conferences. Yesterday I was taking part in a seminar in East Dunbartonshire Health and Social Care Partnership on ‘Capacity,
Sex & Relationships.’ I was asked to reflect on the issue of older people’s sexuality in care settings.

My preparation for the seminar highlighted for me the relative dearth of literature and academic study on what is one of the most fundamental parts of what constitutes our identity and what it means to be human. There are some good pieces of work not least from Alzheimer Scotland, the Terence Higgins Trust etc. but not a lot.

This might be because there are still massive social taboos around the issue of older people and sexual expression. Its almost as if older people and sex is for our age ‘the love that dare not speak its name.’ But people are living longer and healthier lives and why should sexual expression end when we reach a particular age, almost as if our sexual selves have a use-by date attached.

But pervasive negative attitudes serve to consolidate the taboo. People consciously and unconsciously suggest that sex is unimportant to older individuals; that it is somehow abnormal for older people to be interested in sex; that older people have no desire for intimacy; that older persons are not physically attractive and are not desirable. And of course the endemic cultural presumption is that sex is for the young and fit.

Nevertheless for many individuals sexual expression remains an important part of their quality of life. According to a 2013 Saga survey, 71 per cent of over 50s reported having a healthy sex life. Such expression is a basic human right.

Some 18 months ago Taylor-Jane Flynn and Alan Gow, professor of psychology at Heriot-Watt University in Edinburgh, carried out research on sexuality and older Scots which was published in the journal Age and Ageing. They interviewed and spoke to 133 Scottish adults aged 65 and over. Half of these lived with a spouse or partner.

What they discovered was that between 75 and 89 percent said they’d engaged in kissing, hugging and holding hands or touching. Men and women scored about the same for frequency and importance of sexual behaviours overall, and for quality of life.

Participants reporting more frequent sexual behaviour rated their social relationships as higher quality, while people who found sexual activity to be important had higher scores for psychological quality of life.

Critically they found that older adults who value sexual activity and engage in it have better social lives and psychological well-being.

So if that is a given there are clear challenges and implications for providers of care and support and for those who work in supporting older individuals.

So how important is sexual expression within the care sector?

There are obvious challenges not least with individuals with declining and reduced capacity and physical abilities in ensuring that there is a balance between protection and safety on the one hand, and enabling expression on the other. But beyond this – and there are good guides already available to help staff work with individuals who might have dementia and portray disinhibited behaviour or language – beyond that are we doing enough?
Are we able in care homes, for instance, to create places and spaces for people to be intimate and private?

Do we manage well those situations where the wishes of family members might not be the wishes of an individual resident who desires to form a new relationship?

Do we train and resource our workforce in such a way that they have confidence in dealing with what can be a challenging issue and to do so in a manner which is non-discriminatory and respectful of individual rights?

Is the regulatory framework and work of scrutiny too restrictive in this area?

Do we commission in such a way which would enable the provision of facilities to enable couples to live together or someone to initiate or form a relationship whilst in a care setting?

Do our services have sexuality policies whether in the community or in a residential location?

Do we properly understand issues of consent and capacity in the sexual relationships of the old?

Are we aware of the growing issue of sexually transmitted diseases amongst our older population, in and out of care environments?

All of us who support and work with those who are older need to not only start challenging the conspiracy of silence which surrounds this issue but proactively to start working to address some of the challenges I have just outlined.

Donald Macaskill

@DrDMacaskill

In recognition of today’s release of T2 Trainspotting, the Scottish Care National Team decided to embrace the hype with our own version of the famous monologue, “Choose Life”.

Instead of “Trainspotting”, we present to you “Carespotting”.

‘CARE SPOTTING’

Choose life.

  Choose meaningful partnership.

 Choose human rights.

  Choose difficult conversations.

  Choose inclusion. 

Choose learning.

  Choose a rewarding career.

Choose achieving things you never thought you could.

  Choose innovation.

 Choose to be brave. 

Choose to value the things that matter most, like people and relationships.

Choose living well.

 Choose dying well. 

Choose positive ageing. 

Choose improvement.

  Choose an extended family that never leaves you.  

Choose quality.

  Choose a sustainable system, that’s there for you when you’re old and your kids after that.  

 Choose where you want to be, and who you want to be with.

 Choose living to the full, right to the end.

Choose your future.

Choose life.

Well here it goes – my first ever blog! I’m Julie Hodges and I have been working with Scottish Care as a Development Officer based in Highland since July 2015.  My experiences so far have covered all ranges of emotions – great joy, sadness, and frustration. That said, the most overwhelming feeling I get and witness is one of hope and a commitment to continually improve the way we all support our older people to live the best life possible. One that is inclusive and person-centred and recognises the importance of all involved in the care home service – residents, families, and staff.

To support people to live a meaningful and fulfilling life can be difficult in trying times – but the desire to do so always seems to be there. I am delighted my role allows me to be supportive to providers (and residents/families) who are experiencing both good and more complicated situations.

Highland is further down the road with integration than other partnership areas. Because of this, I could write about numerous interesting collaborative pieces of work that are taking place on a regular basis; Highland Business Stream, the ‘Echo’ project, the 10-second pause tool, NHSH finance surgeries, NHSH & SSE contingency workshops, day-care review short term working group, complex care STWG. However, the one I have chosen to focus on is ‘Culture of Care & the impact of you’ workshops.

The workshops take place over two days and are open to anyone wishing to attend – our aim is to include residents and relatives in the future. Each group has a cross section of staff and is delivered locally were possible. The participants are introduced to some of the My Home Life tools and philosophies and reflect on their own roles in creating and supporting a positive and quality experience for anyone living, visiting, working, and dying in a care home or care setting. Workshop content is influenced by feedback from residents, staff, and relatives. The workshops are currently being delivered by the NHSH along with colleagues from all sectors who have undertaken the MHL program.

The plan is for those colleagues to present the workshops within their own services and locations to ensure a spread and share of experience and knowledge. Following on from the workshops we have created a support network for people working in care homes and care at home services. This is a supportive group of providers, managers and senior staff who are committed to sharing resources and offering help, as and when is needed, by other services and colleagues. This includes helping to identify effective paperwork/systems assistance following a care inspection or even just a ‘fresh pair of eyes’.

There is a lot to celebrate in care home life and it’s lovely to see this first hand – committed owners, thoughtful managers, hardworking knowledgeable staff, and residents who blossom with the support they have. There is also a lot of work behind the scenes – difficult negotiations and challenging conversations, and I see my role as supporting people through these in a positive way.

I’ve met some amazing people along the way and something which I notice all the time is that small things matter – the way we speak to each other, the care taken to get to know each other and to care. To care about doing a job well, whatever it is. Unlike the title of a popular book, my experience so far is that sweating the small stuff matters and many people are doing it daily. I love being part of this.