The Nursing Home Resident with a History of Pedophilia: Issues and Challenges

In many ways, the nursing home environment is a reflection of society at large. And although this sense of community within the nursing home environment can be beneficial for older adults, it also means that the nursing home is not immune from the troubles that exist in the outside world. Unfortunately, that means nursing home administrators and staff must deal with problems that exist in the community such as abuse, neglect, and theft. One issue that presents tremendous challenges for the nursing home community, but has not received any attention in the literature, is the nursing home resident with a history of pedophilia. Despite the stereotype of the “dirty old man” that invades popular culture, most who work in long-term care would never suspect that a nursing home resident might sexually molest a child. And for the most part, this is probably a safe assumption. Still, child molesters do get old and disabled and end up needing longterm care. And although there is no research published in this area, there is also no evidence to suggest that pedophilic urges diminish with advancing age. In fact, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IVTR) (American Psychiatric Association, 2000), pedophilia is a recurrent, chronic, and lifelong condition, and sexual activities may increase in response to psychosocial stressors or in situations that present increased opportunity. Anecdotally, the problems involving pedophiles in nursing homes are generally denied or ignored. Nursing home administrators and staff who have become aware of a resident’s history of pedophilia report being at a loss as to what to do or how to proceed. Oftentimes they respond by hoping that problems will never surface or will go away on their own. The secrecy and denial that surrounds this issue makes constructive problem solving extremely difficult. Over the past 5 years, the staff in our Veteran’s Administration (VA) nursing home have encountered several situations involving nursing home residents with a history (or alleged history) of child molestation (Table 1). It is important to point out that these were not individuals who had developed sexual disinhibition as a result of advancing dementia. Instead, these were cognitively intact residents with a history (or alleged history) of child sexual molestation who behaved in ways that generated serious concerns by the nursing home staff. While some of their behaviors may seem innocuous in themselves, they take on new meaning when viewed in light of a history of child sexual molestation (eg, a resident on parole for pedophilia who was coaxing a toddler to sit on his lap). The awareness of a history (or alleged history) of pedophilia came from a variety of sources. In most situations, it was the family who shared the information out of concern for children visiting the nursing home. In other situations, this information came from the resident’s medical records or law enforcement agencies who were still involved (eg, parole officers). In each situation, we faced incredibly complex challenges to our care environment as we tried to balance the needs of the resident with concerns for the safety of children who visit our nursing home and the accompanying disruption to the therapeutic milieu. As we struggled to address the myriad concerns that arose in each situation, we looked to the literature for insight and guidance but could not locate anything that has been published on the topic of pedophiles in the nursing home setting. Therefore, we established a multidisciplinary task force to help us grapple with the complex issues in order to develop some policies and procedures to address the care of a resident with a history of pedophilia in the nursing home. The task force included representatives from nursing, administration, recreational therapy, medicine, legal counsel, psychology, and law enforcement. The purposes of this article are to: (1) share Disclaimer: The contents of this publication do not necessarily reflect the views or policies of the US Department of Veterans Affairs, nor does mention of trade names, commercial products, or organizations imply endorsement by the US Government. The authors assume full responsibility for the accuracy and completeness of the ideas presented.