Love and Sex in the Nursing Home? Ethicist Says, 'Why Not?'

Arthur L. Caplan, PhD


September 21, 2023

This transcript has been edited for clarity.

Hi. I'm Art Caplan. I'm at the Division of Medical Ethics at the NYU Grossman School of Medicine.

I have an interesting case. A couple of years ago, a woman came in to my office with her kids in tow. She had tracked me down and she wanted to complain about something. Her complaint was that her mom, who was in a nursing home and had mild dementia, had taken up with one of the male patients and they were having sex.

She thought that was inappropriate and something the nursing home should be stopping immediately, and wanted to know if I would help her talk with the nursing home administrator about getting these two to knock off their canoodling.

I talked to her and I asked, "Do you think, even though your mom is mildly demented, that she's incompetent and that she doesn't know what's going on in this relationship at all? Is she being abused, coerced, or sexually assaulted?"

She said no. She said that her mom had cognitive deficit, but it wasn't to the point where she didn't recognize the man that she was with, didn't enjoy company, or didn't enjoy sexual activity. She didn't think that this was a matter of being preyed upon.

If someone's preying upon somebody, I think we have to step in and stop that. That's wrong. However, even with mild impairment, if you say you want to take up a romantic relationship, that isn't inherently wrong at any age in a nursing home. You're an adult. You can form your relationships.

I asked her if she felt that this was something that her mom might regret if she was fully capacitated. She said she didn't think so either. She had apparently lost her husband approximately 10 years prior, so it wasn't somehow an issue of betrayal for the mom.

I asked, "Well, is that something you feel betrayed about or does that violate your sense of what you want your mom to be?" She said, "Yes!" She was angry that this new man had appeared and didn't think that was appropriate, both for her kids to try to understand what grandma was doing and in her own eyes regarding what she wanted in her mother.

I tried to point out that it's still her life. It's still her choice. She can still make decisions about the company she keeps, what brings her fun, and what brings her pleasure. Even though that might not be totally consistent with the daughter's view about how she'd like life to be, it still was up to her mom to do this.

In fact, I think that one of the interesting things about nursing home life in general is that we don't really set things up to allow sex or to allow privacy that might be involved in romance. Most people have a double room. There are not many private places to go. I wouldn't say that this sort of behavior is encouraged.

I'm not saying that there are rules against it or that people will try to intervene all the time, but perhaps we could make nursing homes a bit more friendly institutional care for the elderly, to the idea that companionship for competent people or nearly competent people is an aspect of life that they can pursue if they choose to do so.

At the end of the day, sex makes us nervous. Sex among the elderly makes us nervous. Sex on the part of my older mom and dad may make me nervous. That may not be the reason that you should step in, saying that it shouldn't happen and trying to prohibit it. Stopping nonconsensual activities, yes. When mom chooses to have a little romance in the nursing home, my attitude is to butt out.

I'm Art Caplan at the Division of Medical Ethics at the NYU Grossman School of Medicine. Thanks for watching.

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