Most of us cringe at the idea of elderly people being sexually active. It's a visceral response, like that of a child realising his parents might do more than just sleep in their bedroom.
So it's mostly hidden and taboo, only rarely acknowledged in a comical or lewd "dirty old man" kind of way. But the reality is that older people don't exist in a vacuum of serene celibacy: they kiss, touch and experience the same urges as everyone else.
"They never stop feeling," says Lyndell Cohen, the exuberant service manager of Garden Suburb Aged Care Facility in the leafy outskirts of Newcastle in NSW. "We don't have any right to judge them."
With a rapidly ageing population, Australia is facing a surge in demand for aged care services and a concurrent sexual revolution on the nursing home floor.
When you factor in the rising incidence of dementia and its propensity to cause people to lose their inhibitions, the result is more and more nursing home staff dealing with residents who want to maintain a sex life – whether solo, with existing partners or with ones they find in the bed next door.
The ramifications are complex: determining consent, negotiating infidelity and preventing sexually transmitted diseases (STDs) to name but a few.
To accommodate this shift, experts say the sterile institutional model of nursing homes needs an overhaul.
Anita, who arranged for a sex worker to visit her late 93-year-old father in a Sydney nursing home on his request last year says, "One of the problems with nursing homes is people can become trapped. If you have a sexual need that's not being met it's like torture."
Experts says the most significant obstacle for older people wanting an intimate relationship in a nursing home is often their own families.
Adult children often feel it's inappropriate, immoral or disloyal for their parent to be sexually active, while partners living at home may understandably be deeply upset.
Some families have even attempted to legally intervene if they believe their relative is unfit to make their own decisions about sex and relationships.
In a documented case in the healthcare report Sexualities & Dementia, a shocked husband "felt deeply betrayed" and blamed nursing home staff when they revealed his 79-year-old wife Mary had been found lying naked in bed with an 83-year-old widower, John. A nurse separated them and ordered them to no longer have sex.
Although Mary was usually the initiator of their time together, her husband insisted it was "out of character" and two of her children feared she'd been taken advantage of by John.
From the same report, the daughter of 69-year-old Valarie intervened when she learned her mother had become involved with another woman in her nursing home after 48 years of marriage. A nurse had walked in on the two women, both of whom had Alzheimer's disease, in bed together kissing and fondling.
While Valarie's daughter insisted her mother was heterosexual and would be "dismayed" if she could appreciate her behaviour, dementia is known to cause people to lose their inhibitions and act out long-suppressed desires. Perhaps significantly, Valarie's son noted his mother seemed decidedly happier than before she had dementia.
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Late-in-life gay relationships have been known to cause other problems. Staff working in the sector report that nursing homes with religious affiliations have hindered support for elderly people who wish to maintain or embark on same-sex relationships.
Some residents have told of being discriminated against by fellow residents, families and staff - or even forced back into the closet when they enter aged care. A desire for an inclusive alternative led Peter Dickenson to develop Linton Estate, a world-first residential village in Ballan, Victoria, that will cater for elderly gay, lesbian, bisexual, transgender and intersex people.
"Linton will allow the community to be themselves and safe," says Peter. "People can kiss, hold hands and what they do behind closed doors is their own business."
For a minority of sexually frustrated residents with high libidos like Anita's father, a visit from a sex worker can be a solution. A growing number of more progressive Australian nursing homes are agreeing to what would until recently have been an unthinkable measure.
Sydney-based sex worker Emma, who has been in the industry for 30 years and only sees older clientele, says it's mostly daughters who get in touch for their fathers.
"Usually day to day life in a nursing home is quite clinical," she says. "So you're there to be one-on-one intimate with them," she says. "You are there to touch gently, lie with them, sip a wine with them and look at photos from their youth."
Emma says her elderly clients don't mind using condoms, which they may have used to prevent pregnancy in their younger years. Not all older people, however, are practising safe sex which has led to a push to boost STD awareness in the 40-85 year old age group following a major increase in incidences of chlamydia and gonorrhoea.
Other diseases can also get in the way. From arthritis and erectile dysfunction to paralysis and tremors, the physical side of romance may not be as simple or spontaneous as it once was for older people.
Newcastle ex-nurse Elaine White, a pioneering sex educator and author of Dementia and Sexuality: The Rose That Never Wilts, helps nursing home staff and residents tackle what can be an awkward issue. The 81-year-old great grandmother says sexuality is a human right and "the very thread of human existence."
Her presentations include practical advice. "I talk to the ladies about using KY gel for lubrication," she says. "People may need to plan sex beforehand – those who have had strokes may need to take pain relief and gentlemen may need to take Viagra. They may need pillows to support limbs. I bring in sex aids and vibrators. I talk about how to use them – you've got to check they are able to use them and know about hygiene skills like cleaning equipment afterwards."
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Elaine is often called in to deal with challenging sexual behaviour, for which she recommends massage, essential oils, music and investigating potential causes.
Milder behaviour like suggestive remarks, risqué jokes and patting the bottoms of female nurses is more common. Ex-military dementia patient Vinnie has a reputation as a ladies' man at Garden Suburb, where good-humoured staff are used to his antics.
"I used to say to him, 'you are going to get into trouble one of these days – someone will get you for sexual harassment," jokes his devoted wife Marie. "He has always been a bit of a flirt."
Most nursing homes don't have double beds, which are trickier for care staff to negotiate. "We do have quiet rooms with reclining chairs and we encourage residents to go home for a night if they wish," says Lyndell. Elaine counsels nursing homes to join beds together for elderly couples and use Do Not Disturb signs.
Supporting those who want to express their sexuality in nursing homes, however, is often more complicated than bed space. Consent is a minefield, particularly when residents suffer from dementia.
However, considering many people of sound mind have sex without rational thought, this doesn't mean dementia patients can't give assent. Non-verbal cues like actions and emotional responses may need to be considered by staff, who have a duty to protect their privacy.
"Nothing is textbook," notes Lyndell. "It's all about considering the needs of that individual person." At the same time, staff have to be vigilant to prevent sex abuse of vulnerable residents.
Nursing home operators are facing increasing demand for places and a lack of funding so better accommodating the sexual needs and behaviour of residents will be a challenge.
However, attitudes are improving and an Australian Government-funded sexual assessment tool with guidelines on how nursing homes and staff should support older people in expressing their sexuality was published last year. Among suggestions are cocktail hours, the availability of sexually-explicit material on request and double rooms for those who want to live as couples.
They're the kind of ideas that would seem well-suited to the next in line to enter the aged-care sector: baby boomers, a generation that's highly unlikely to put their sexual freedom into retirement, irrespective of hip replacements or society's expectations. Demand for Viagra looks likely to rise.
For most elderly people, however, sexuality is more about maintaining intimacy and touch than swinging from the chandeliers. Not that it has to end there, of course. As grinning dementia patient Vinnie remarks suggestively, with a cocked eyebrow and sparkle in his eye as he pulls his wife Marie towards him: "you never know what might happen, eh?"
Some have been names changed to protect privacy
A version of this article first appeared in the February 2014 issue of The Australian Women's Weekly. All statistics mentioned were accurate at the time of print.