Frisky Residents! Some Questions

[VivaLasViejas, ASN, RN]

I found out today that two of the residents in my ALF have been.....well......canoodling in the female resident's apartment every chance they get. Now, it's not that I personally have a problem with it; after all, they ARE adults, and old enough to be my parents. In fact, they both are in great physical health and---I've got to admit it---look absolutely adorable together.

The trouble is, a) the female resident has the short-term memory of a flashcube---she's quite a long way down Alzheimer Road; b) the male resident isn't much better off than she is cognitively (although evidently the rest of his body works just fine!); and c) the male resident is married---the wife is in another ALF across town, and even though she's reportedly a witch of a woman, the resident's daughters would FREAK if they knew of this affair.

I'd like to hear some perspectives from other DONs/DNSs who have dealt with this sort of thing before. I wouldn't be concerned if it were merely a matter of morality; unfortunately, given these residents' cognitive deficits, I'm worried about the ethics of it all. There is absolutely NO evidence that the intimacy is unwelcome; in fact, they have been heard enjoying each other's company, and it is obviously mutual. But given the fact that she is incapable of independent judgment, how consensual can a physical relationship actually be? Where does it cross the line and become sexual abuse? Does his dementia make it even more of an issue, or less? And do I have to report any of this, either to the state or the residents' families? (Both of them have children with POA.)

Even my boss isn't sure of what to do here............this relationship is certainly not exploitive, and we don't want to interfere if we don't have to because of the obvious benefits of sexual activity. But given the diminished mental capabilities of both people involved, we wonder what, if anything, we are supposed to do about it. Please help if you can......as a relatively new nurse-administrator, I've not yet had the dubious pleasure of dealing with this situation in my current capacity. Thanks!

[UM Review RN, ASN, RN]

Personally, if you give it time, the situation -- as the residents -- will resolve itself. They're already canoodling; IMO they should have their fun till they can't any more.

(And how far off is that day? Any guarantees at their age?)

The only thing that I think I would be concerned about it having either of the POA's "catch" them and start judging their relationship on "normal" terms.

Elders are pretty frail emotionally. Once they form a bond, it bodes ill to force that bond apart.

Hear no evil, see no evil.

[gracenotes1]

It is definetly a fine line.

When I was DON in LTC I had this problem but both were consent adults with repsonsiblity for themselves. So we closed the curtain and door and gave them privacy.

Both of these residents you have have been declared mentally incompetent to manage their own affairs--right?

If that is the case then you may be bound to report the behavior to the POA. If the POA finds out and knows that you knew and did not tell them--there may be a serious problem.

This is my opinion--you take it for what it is worth--

I would call the families in for a conference. It may be difficult at first but at least you are putting it into the hands of the ones responsible and not in your hands.

I would report the behavior to the family and let them make the decision as to what to do. Keeping in mind Resident Rights. Document well.

It may work itself out but because you have knowledge of it--you may be obligated to involve the family. This is really something that you don't want to have on your plate alone.

Treat it like any other behavior. Take the sex stigma out and think of it as any other behavior that should be reported.

I don't think you have to report it as abuse--but I would do an Incident Report and began taking measures to advert the situation. Be creative. Have the staff redirect---Use measures that you would use to advert any other untoward behavior.

Hope that helps

Angela RN BSN former DON

[wtbcrna, MSN, DNP, CRNA]

I would bunt this one to the social worker for advice (assuming that your facility has one), but as long as they are both willing participants I don't really see what you can do about it.

[psalm, RN]

I would bunt this one to the social worker for advice (assuming that your facility has one), but as long as they are both willing participants I don't really see what you can do about it.

I think the POAs need to know and have some input. Suppose the female participant develops physical problems, UTI, lady partsl tears, STDs, or wants to say "no". Is she capable of saying no, and is the male resident capable of understanding "no". The male also may be prone to physical problems as well.

And what happens if/when this couple "breaks up"? Will Romeo look for action somewhere else? With maybe someone who isn't willing but maybe incapacitated and can't stop it?

I have a mentally retarded brother in his 50s who lives in a group home. One day there was a talk on AIDS at the group home and afterwards my brother went to one of the attendants and told him that so-and-so and he were "doing that". My brother was afraid of getting AIDS, as far as sex, all he knew was that it felt good and it was a "secret". My parents got involved after this was known and my brother had to go to a new group home, and knew not to "do that" and to tell the attendant if anyone tried it with him. I don't know how the rest was handled, as I live a few states away.

But sexual activity is an issue to be dealt with. Let us know what is decided.

[VivaLasViejas, ASN, RN]

I would bunt this one to the social worker for advice (assuming that your facility has one), but as long as they are both willing participants I don't really see what you can do about it.

We're a small facility (42 units) and don't have a social worker, and neither resident is on Medicaid so there's no case manager to bounce this off of either. Thanks to all who have posted thus far.

[XB9S, BSN, MSN, EdD, RN, APN]

Not sure what provisions you have in the US but over here we have something called Protection of Vunerable adult teams, part of our team is a consultant nurse specialsing in care of older adults and she is really well versed in capacity issues and legal / ethical standpoints for situations such as you have described.

Not sure if have anything similar

[Nascar nurse, ASN, RN]

Both of these residents you have have been declared mentally incompetent to manage their own affairs--right?

If that is the case then you may be bound to report the behavior to the POA. If the POA finds out and knows that you knew and did not tell them--there may be a serious problem.

This is my opinion--you take it for what it is worth--

I would call the families in for a conference. It may be difficult at first but at least you are putting it into the hands of the ones responsible and not in your hands.

I would report the behavior to the family and let them make the decision as to what to do. Keeping in mind Resident Rights. Document well.

It may work itself out but because you have knowledge of it--you may be obligated to involve the family. This is really something that you don't want to have on your plate alone.

Treat it like any other behavior. Take the sex stigma out and think of it as any other behavior that should be reported. :

I agree with this 100%! Just think how you would explain later that you all knew of this and didn't share this with responsible party. It could get real ugly!

[ktwlpn, LPN]

I've seen a few similar situations.In every case the families were not supportive of their loved ones' relationships-in a few cases they had their loved ones moved to other facilities to keep them apart from their special friends.In our LTC we tend to see these behaviors in our secure units-In some cases families have complained and the dept of health actually considered the behaviors assaultive and we had to "protect" the residents from each other.Incident reports out the ying yang...I think a meeting with the POA's is the way to start....

[gracenotes1]

I also wanted to add that you might as an intervention put them both on behavior management.

Just an additional thought.

[VivaLasViejas, ASN, RN]

Thanks to all of you who have posted so far.

Naturally, the rumors have been flying like crazy, and several of my staff swear they've been scarred for life due to having caught this couple in flagrante delicto. My admin and I have called conferences with the families.......the gossip is all over the building, and it's only a matter of time till SOMEONE reports it to them, so we're going to be proactive. Thank you all for your advice!

[gracenotes1]

Great--you are doing the right thing.

Just make sure that when the family comes you have an answer to the question--"well what are YOU going to do about it?"

:)