hi i'm tom callahan and welcome to all the seniors we're going to be talking about sex yet again and seniors my guests are melanie davis a sex and aging consultant also the co president of the sexuality  aging consortium and terry clarke also a member of the sexual nature consortium and the prevention services coordinator for action aids ladies welcome back again to only seniors sank you happy to be here  our last show we discussed a lot about aging and sexuality and we were just begin to start on the topic of long term care settings and sexuality and how they can be both a hindrance and what the policies are and the expression of so when somebody is looking to move into a long term care facility and they have let's say in assisted living mom's movie in but she had this boyfriend who's still living independently in the community what what can happen i mean you know he comes over to visit and things get hot and heavy and then what well maybe nothing because in a lot of these settings it's not allowed to have your door closed and have a partner come visit you so one of the things that we advocate for is for people looking at the fine print on the paperwork that they sign before they select a place residency  very often there is nothing on paper that says what places values are on sexual expression but you can talk to the staff and see you know well are there couples here is that can i close my door can i put a do not disturb sign on to you can can talk about those things sometimes you get a facility that has a policy that says we respect our residents rights to to be sexual sexually active but the staff aren't necessarily copasetic with that and are not necessarily creating opportunities for privacy so it's been have been made aware of the policy right right so it's very important to to do that detective work and you know mom and dad aren't necessarily always cognitively able to check that out themselves and so that's where adult children need to be advocates for their parents you know when you look at a long term care setting we usually thinking assisted living or skilled nursing home you know unfortunate people combine the two in their heads and i think one is the same as the other and what they think it's you know the old folks home that has changed a lot within the communities you know a and this is a living community as i like to scribe it is a apartment setting with a safety net underneath it whereas a long term care facility like a nursing home is more of a step down from a hospital certainly we're seeing the development of the nursing homes now is more private room so the people do have the privacy but when thinking about somebody living in a nursing home trying to be sexual with somebody they met or were you know develop a relationship that's developed a number of things start popping my head you know thirty things but you know what where how are you storage of if you can speak to that who well for example let's say that you have a private room but you have a single bad and if you want to have company that single bed can be problematic so do you have you do you have a right or the ability to get a double bed so that you can have a little more play space or is the staff willing to put a mattress on the floor so that you don't have to worry about falling and breaking a hip if you're put up with a partner you know i mean it's really having to get to these needy greedy conversations i i met with an administrator of a long term care facility and i was very encouraged when he said yes indeed we have a private room so our residents can actually access this room and i said well how would they do that you know who uses the room now and he said although we use it for board meetings well if they're using this private room for board meetings it's clearly not being used for romantic interludes right so there was a perception of say oh god i'm glad you know there's like this bedroom but they were using as a board right so what kind i don't even know maybe or they have i don't know or you know but but but they had in their mind a perception that they were effects positive facility when they really weren't i asked about condoms and they said oh we don't need those here nobody here has assegai i state or do you test for them and they said well no we don't need no more side course they wouldn't know any even let hypothetically let's say you have one hundred fifty residents and all of them test negative it takes one person to come in who has an s hiv to create a whole different set of issues so you know it's there's a lot of training that has to happen all in in having staff i mean oftentimes folks need assistance right so they might and need assistance positioning or getting into better out of better understanding like if something happens it's ok to pull the call button it will respond or you know all those you know almost case by case kind of conversations that need to happen with the individuals with their partners with the stand and the staff on multiple shifts with family members so it's a complex issue when oftentimes people so we just don't want to have to deal with it until something happens so then you're dealing with things in a reactive way instead of a proactive way and again supporting an older adults right of sexual expression and it really does oftentimes come down to a rite of sexual expression so it's it's interesting  physical disabilities so yes you can ask a staff person to position somebody with a pillow behind them to prop them up you can hand them a toy you can clean them up afterwards but you know  it's depends on you know you don't want to force your staff people to do something that they're tremendously uncomfortable with but this is again where training comes in to play it comes into when you are a new resident in one of these facilities what's in your care plan who's on the care team that's involved in making decisions about your sexuality and your sexual rights that's part of the work that members of the consortium do is going in and helping with the needs assessment and creating policy and doing staff training  to help people realize you know ok whatever your attitude is for example about a same sex couple you can have that attitude but while you're here at work our policy our value is that everyone has a right to be sexually expressive in the way that they feel suits them so you know you're not allowed to be disrespectful of anybody's choices while while you're here in remember to how in the last show we did we talked about the difference between sex and sexuality and that sex is a whole range of behaviors so do older adults have penetrative sex absolutely but a lot don't necessarily have penetrative sex like we think oh sex penis and vagina right that there's a whole range of expression of intimacy and that may involve sex toys it may involve touching genitals it mean fall touching breasts at me involve hugging kissing so the again we we need to kind of think holistically in terms of the behavior and work with the individuals  the staff to help them understand that to people say oh people are being sex on the nursing home right like it's like henny penny the sky is falling it's like well let's take a step back let's talk about what does that mean what does that really look like what's the realistic but but you know it shouldn't be dismissed i was going to say out of hand but that's wrong it shouldn't be treated as something that's unnatural it just needs that person needs to find a private space in which to enjoy their body and it can be actually really therapeutic it can be very helpful for people because you know we have that need for touch we have desire we need to express that in a safe supportive way and masturbation is not you know hurting other people i mean you know again if someone is not concerned with consent touching another person that's a different issue but masturbation in and of itself in privacy can be very beneficial  well for example if you have somebody who is what a staff person michael acting out because they're agitated or they're groping other residents or staff it may be that they have sexual desires that they need to release so if they are able to go into a private shower or bath or their own bedroom and masturbate they can help them sleep it can help with agitation it may help decrease the groping that somebody with you know with cognitive issues makes you feel good as a former staff member and you know it would be very it's would just be strange but i think you know again with training telling somebody maybe should just go spend on some alone time with yourself to  because you know how would you approach that residents to suggest that well part of it is if you have a policy right so the person becomes a resident and is aware we honor sexual expression here this is a right that you have so it's right out there it's in print that everyone knows that some place like hebrew home at riverdale in new york was the first place to have a policy about sexual rights to sexual expression right on there for their home pages and you look under about us their policy on sexual expression is right there it so they don't make any secret about it so sure oh yes so so you can absolutely know where you stand and then again if you're if you're care plan says that you have the ability to consent to sexual activity then your care team knows this is your right and it's their job to help you if you are looking for sexual outlets and privacy it's their job to help figure out ok how can we make this work for you in a way that also respects other residents and staff in sometimes we think well i could never talk about masturbation with this resident but you know the president has probably masturbated in their life if we had an honest conversation about maybe this would really be helpful right and it does have to be the appropriate staff person and not everybody is going to want to have a conversation about this and it's got to adults they want to talk and they want to be given permission in a safe supportive place to ask questions to talk about experiences to get information i was just in a senior residence this past week yesterday the day before older adult in a mobile wheelchair talking about how she masturbates regularly because it makes her feel good and it helps her with her depression so here's this person to look at you say well you know she doesn't have doesn't have great mobility you know she's in assisted wilt electric wheelchair you know she had you know probably had suffered some kind of a stroke but she had some physical limitations but yet she finds a way to pleasure herself with purpose and you know benefit and she was sharing that with other it was an all women's group at the senior residence and they were all sort of chimey and supporting each other i mean i don't have to say anything they we lou and they were actually educating other people and it was just absolutely delightful so to say that you know we can talk to older adults about this well yes we can let's just take some training i mean you know like anything you know some people drive a car but some point you have to learn how to get in you know to do it in order to be able to to do it and that's what i think the proper training with staff would accomplish i know yeah but i was an innocent living i was the marketing director and you know they came time to for that discussion came up and you know every with a staff member turned to me it was like you do it  because i know if when the time comes if i have to choose between long term care facility a b or c and one of them has a policy that says you go for girl i might choose that one over the other two all and they start finding a partner and suddenly the step to do with this yeah there's there are said some real unique concerns and issues that l g p two older adults face and part of that comments praying over them that the you know that that their gayness will leave you know the sort of thing so all this very unprofessional behavior that it's targeted at people who are in same sex relationships or who are perceived to be gay and in a long term care setting oftentimes they did they can't advocate for those rights so really important to have staff training to work with you know bud's men so that the staff understands that if someone is there who identifies as gay or lesbian or bisexual or transgender that they need to be treated with the dignity and respect as their heterosexual peers do and we find too with aging l g b to older adults that because of the lifetime of stigma that they faced over the years with on the american psychiatric association did not classify being gay until nine hundred seventy three so up until nine hundred seventy three which is not all that long ago being gay was a sociopathic mental disorder pretty severe disorder disorder and they were sent to electric shock therapy they bring karsh aerated they were institutionalized  seen as criminal as in moral sense respects we still see that population is a moral today but so they've lived this lifetime the stigma that is really kept them in the closet and fearful of reaching out for services from our aging services in general so not necessarily just long term care but basic health care providing so you know they don't want to go to the doctor to get an element checked out because they fear that that healthcare provider is going to treat them in a discriminatory way they've lost a lot of their their they rely on families of choice so we know in you know in this country we rely on our biological families right our kids our grandparents our cousins our nephews to take care of us as we age well if we don't have those biological family structures in place who takes care of us with l g b t community oftentimes it's their friends and their friends our age and like they're aging so there's some some challenges there and then the last unique challenges were the discrimination under laws and policies and even though we have same sex marriage in this country now the state by state can still discriminate so you can get married in pennsylvania and in new jersey today but in pennsylvania we don't have a state wide nondiscrimination class so you can get fired from your job or get kicked out of your house because you're gay well and then what happens when you need somebody to put power of attorney if you go into long term care or if you have cognitive decline if you're transgender who do you have advocating for you so that you're treated as you or your true gender you know of it instead of what someone perceives your gender or your sex to be you know it's hard when you don't have the guaranteed rights that other people have and  it's you know it's it's an unfortunate thing for older adults they have to deal with that there is a wonderful movie documentary called gen silent that profiles six people who  are are trying to decide you know do i go into long term care do i try to stay at home do i agent i mean most people do age in place but as terry said you know eighty percent of people are cared for by their adult children and if you haven't had children i mean now more and more gay couples are becoming parents but the people who are now in long term care were not of a generation where it was a real popular thing to have kids and be in a same sex relationship so who's taking care of you and that's an important area that advocacy is really needed in and then we also see older adults coming out later in life or transitioning later in life right so maybe up until they were seventy they had their family in place but now that they've come out or that they've transition so transition their gender from one to the other that now their family's not place anymore and you know what does that look like for their care provision and what does that look like for their individual mental health issues so lots of reasons to be talking about this with with people and i you know working with with the senior center to help them become inclusive and welcoming right so we know that l g b to older adults are in more need of aging services but less likely to access them so how do we work together as advocates and educators and therapists and the aging professions that professionals that we are to create inclusive more training is necessary where can somebody get this training or how do these training sessions work in some force work in somebody's front of a training session for staff if i'm running a long term care facility and i want to have a sex positive the soli where would i reach where is a good starting point for me to reach out for training of my staff well the sexuality of aging consortium at white new university is a great place to start because many of our members have the expertise necessary to help do trainings our members have different kinds of expertise some do mostly consumer work some work with long term care some work with medical providers some are more generalist and do a little bit of everything  but but the sexuality and aging consortium is a great place to start ok and then there's also the national resource center on l g b to aging so i'm one of their certified trainers and go out across the state  to work with aging providers to talk about providing inclusive services and they they not only provide trainings but they have a whole resource center on line free downloadable great reports guidelines really user friendly materials that people can access and begin to use in you know in their work so there's another great resource there too and between the two there's plenty of information yet if in a facility is interested in just seeing what a policy looks like i would say go to hebrew home and look at their policy and say gee does this look anything like what we already have in place or do we need to bring in help to refine our policies so it's more sex positive  confront a consultant to help them with not only their policy but them but the training what would a training program look like i mean you know we're talking about treating the surf in this way what are we training them to do well i can tell you what it's not i went to one place and they place i mean maybe what they've got is close so they don't need too much or maybe they're so far off the mark they need a lot of work so sort of talk what is the board's opinion who do you a board support for having a policy in place and then the boards online what's the administration and there are they supportive of this and then you know what's draft a policy and once we have a policy let's talk to the staff but it's not just a matter of the reason i say it they can't do it in half hour it's not a matter of saying here here's the policy follow it it's really helping people wrap their brains around what this like the whole thing what sexuality is as opposed to just genitals what gender identity is and what that means because some people think well you're a man or your woman and that's it and you know part of the training is well know you may have people who were transitioning or queer and you need to honor that so there's a lot of attitude work that needs to be done and then there's the pragmatic stuff condoms pillows for positioning if you're going to offer to purchase adult toys for your residence well you want to get the kind that have big buttons so that people can actually operate the toys so there's a lot of you know logistical practical stuff that needs to go into it as well and i think some of the pieces that come in when we're talking about creating inclusive spaces for  adults is looking at the history of discrimination the history here in the united states of what they've lived through and that can help staff really kind of better understand and emphasize right so a lot of this the work is building empathy looking at you know what does it feel like to be excluded right we've all felt the time in our lives and we've been excluded right what does that feel like doesn't feel very good we've all felt the time when we've been included what does that feel like that feels really good welcoming supportive so we as aging professionals want to create a inclusive welcoming environment so a lot of it's knowledge it's empathy building aspect of skills and then the skill building right how to have the conversation you know how to do things in it that the skill level so basically it's empowering the staff oh allaying their fears i think because this step would have a lot of around this as well you know it's like oh my god i have to be in the room and like you said no i don't have to be in the room but you know i think there's a lot of you know some time staff get society of you know i'm caring for my mother and they get they put that on well and they're talking about th e personal and the professional right so what's what are the differences there right when we come in to do a training we're not saying we're here to change your personal values what you believe around sexual expression or gay people whatever is your personal value but here in this agency as an employee of blah blah blah your role is to provide services that respect the dignity of everybody and this is what the expectation of the training is right that's really it's not to change people's personal values so i would like to say that there are a lot of places that are getting it right even if they don't have a policy that a lot of staff people are very empathetic and very interested in doing what they can within the scope of their work to make it possible for people to be sexually expressive so i don't want it to seem like everything needs to be fixed because there are a lot of places that are doing a really good job already because we have to wrap up how can somebody get in touch with the consortium on sexuality our website address is white inner edu slash sexuality and aging and how can somebody get in touch with you personally my website addresses melanie davis ph d dot com terry terry clark t clark at action aids dot work to six seven nine four zero five five zero two zero thank you both for being on the show only seniors so that you can enlighten folks