Clare Greensmith MPH 2015
Sexuality and intimacy are recognised as crucial aspects of being human. Our sense of self and identity is maintained through our relationships with others, and existing literature suggests that concepts of sexuality and intimacy are important throughout the lifespan. Whilst sexual liberty has increasingly been seen as a basic human right, this view has tended to exclude people with disabilities, compromised cognitive abilities and people who live in residential care settings. The debate over the last 40 years has tended to view these groups of people as vulnerable and requiring protection, despite the literature suggesting that later life relationships are focused towards intimacy rather than sexual behaviour, and that maintaining relationships is a key aspect of quality of life for older couples.
The situation for older people is compounded by the evidence which suggests that it is difficult for Westernised societies to consider their sexuality and intimacy needs in general, and that Residential Care Facility (RCF) staff are not exempt from this discomfort. Staff may fail to recognise the differences in later life relationships, which can then impact on the provision of holistic care.
In order to examine this situation in a contemporary New Zealand care setting, in-depth qualitative interviews were held with twelve home-based partners of RCF residents, and three focus groups comprised of sixteen RCF staff were held across Otago and Southland. A thematic analysis revealed that grief and loss was a significant factor for partners, and finding ways to maintain connections with their partner within the RCF setting was as a way to manage this in a practical way. Continuing to offer aspects of care, having privacy to talk with their partner and being able to maintain physical proximity and closeness, for example, by occasional bed- sharing, was valued highly by partners as an important way to continue an intimate connection. Whilst many staff recognised grief responses, ways to maintain intimacy and connection and the needs of later- life relationships were not well understood. Privacy requirements were commonly interpreted as associated with sexual behaviour rather than with intimacy and connection, which then raised concerns about surveillance and protection which were not confirmed by the data from partners. In general staff found it difficult to assess the intimacy and sexuality needs for RCF residents and community- based partners and therefore to consider this aspect of care.