The Current - Talking about seniors and sex in long-term care homes

Episode Date: May 7, 2025

Most people don’t like to think about their parents having sex, but their grandparents? Educator Mary Connell helps long-term care workers get comfortable with talking about the sexual needs of seniors, especially when it comes to issues around sexual health, dementia and consent.

When a body is discovered 10 miles out to sea, it sparks a mind-blowing police investigation. There's a man living in this address in the name of a deceased. He's one of the most wanted men in the world. This isn't really happening. Officers are finding large sums of money. It's a tale of murder, skullduggery and international intrigue. So who really is he? I'm Sam Mullins and this is Sea of Lies from CBC's Uncovered, available now.

This is a CBC Podcast. Hello, I'm Matt Galloway and this is The Current Podcast. Just a heads up, this next conversation deals with aging and sexual health and there is some explicit talk related to sex. With your partner I want you to talk about how you heard about sex. How open were your parents to talking about it? How do you feel about talking about sex now? Can you speak to people living in the home about sex? We're a long-term care home in Scarborough Ontario and staff have gathered for some training about sex and sexuality.

This concerns residents in the home. Do you have any bias around sexuality? This is an important thing you need to talk about. Is it your responsibility to talk about sex as part of your job? Mary Connell leads the course. She describes herself as a champion of seniors. She's an educator who has worked as a public health nurse focusing on sexual health. Because in order to be able to do this job well, we need to be authentic. Especially today, because we're going to be talking about behaviour. And this is a topic that most people have some difficulty talking about. There are about a dozen women in this course, mostly personal support workers and nurses, along with some administrators.

How many people here got the talk from their parents? Don't you dare go out with that person. We were already in high school, so we are already like in our teen years because the more close you are the more you get into something that you don't want to do and pay for it later. They don't even say the word. We're here as part of our series As We Age because yes, sex is a topic most people have difficulty talking about, especially when it comes to seniors and especially seniors living in care. All right, so now I'm going to get you... Mary wants staff to feel more comfortable

and open with the topic, so she has an assignment to break the ice. So what I want you to do… Maybe tuck your chairs inside? Yeah, because you're going to be doing some running. So, in order to be able to talk to people about this stuff, sexuality, you've got to be comfortable with it. What are these? We want to to reduce that feeling of embarrassment. So what I'm going to do is I'm going to play a little music, a little Barry White and then you're going to have a race. You're going to run up to the banana, You're going to take a banana off. You're going to open the condom, put it on, run back. It's like relay.

Okay, you ready? On your mark, get set, go! Oh shoot, two ties! Ayy, broken! My goodness, they're broken! I'm gonna be blacked out! Mary Connell is with me in studio now. Good morning. Good morning. That sounds like a lot of fun. It's a tremendous amount of fun.

It's not like how I learned about sex, I will say. Those are not the sex ed classes that we got in school. Why does it need to be different? People are having, it's not just the Barry White, but people are having a good time doing this. It's important that they have fun doing it because then that decreases some of the anxiety. So I do a very over the top icebreaker so that whatever I have to talk about afterwards

will be much more sedate than that activity. I want them to feel comfortable. And if they do it together as a group, they'll be more relaxed and they're more likely to talk. This is a sex ed course for people who work in long-term care. And as you said, I mean, it's a topic that people are embarrassed to talk about at the best of times. Why do we need something like this? Why do we need a course like that for those people? When I do these classes, there could be 30 people in the class and very often only one

person has ever heard anything about sexuality growing up. So there's a huge amount of discomfort about it. They're in a job that requires them to be comfortable with all kinds of things. They're comfortable talking about death, they're comfortable talking about terminal diagnoses, but they cannot talk about sexuality. And sexuality, even if you're someone who has dementia, is a human right. It's in the resident code of rights. So they need to be comfortable to do this. One of the questions that you asked that we heard is, is it your responsibility, your responsibility being the people who work in long-term care to talk about sex? Is it their responsibility?

It absolutely is. It's their responsibility to talk about all hard things. And I want to make that topic not difficult for them so that they can support people to live a full life. So we asked some of the people who were in the course how they saw the need for this training. Take a listen to this. Until such time that I saw in my eyes what's happening to the resident, I won't understand.

I thought when they're already in the homes that they're already done, I thought when they got dementia it's already over for them, but no, it didn't. Until the last breath, they could be able to feel the intimacy to be with somebody. I think that the sex talk and the elderly talk is really kind of surprising to me because it's not something I've ever discussed in any previous job. At the very beginning, of course, you will feel embarrassed to talk about it, but there's still women and men and their needs and stuff like that so that we could be able to help them, you know, to fulfill those needs and affection that they need to feel love.

So this is hard to talk with seniors about or hard to talk about when it comes to seniors because there is this belief that a lot of people have that sex ends at a certain age. Where does that come from, do you think? Well, I think that's a societal belief. Nobody wants to think about their parents having sex. That's a squeamish idea that we have that I don't want to think about it, it's not happening. That's it. And so, they certainly don't want to think about their grandparents having sex. So, I think that's just the way people are brought up. Many people in this class actually say that they knew at home that even though no one said it, that they

couldn't talk about sex. So, I think that what happens in the family is just a reflection of the larger society. What happens if we aren't talking about that? I mean, you could talk about that when it comes to sex generally, but if we are speaking about seniors and sex, if we aren't speaking about it, if we're afraid to talk about it, if we want to assume that it's not happening, what's wrong with that? It doesn't support those seniors to meet their full selves. This is a basic human need and it's not just the act of having sex, it's all about intimacy. They're not even comfortable with seniors holding

hands, nevertheless having sexual intercourse. How do you get beyond that? In the classes, and so this is just one of seven classes that they have, we develop empathy and we want staff to see that these are just human beings just like them, they have exactly the same needs. Because they live in this building in their certain age does not mean that they don't have those needs. And it's important that they support them. Is it difficult to develop that empathy

on a topic that, as we've been saying, is uncomfortable for so many people at any age? I think that in those classes, they welcome the discussion because as that one staff person said, no one's ever spoken to them about it before. And it's probably something that they come up against in their job constantly. And we teach them how to manage every other situation in their work except for this situation. So I want to go back to the class because the class is so interesting. We should say,

I mean, it's this sex ed, so there's language about sex. What do you say? There will be an acknowledgement of sex in this conversation. You play things from TV for some of the participants, including this from Seinfeld. What's the matter? My mother caught me. Caught? You're doing what? You know.

I was alone. You mean? She got you where? I stopped by the house. My mother had a glamour magazine. I started looking for it. Glamour? So one thing led to another. Okay, so that, like we all knew what they were talking about, but they never said the word. Right?

Because masturbation is not the topic. So yes, masturbation is a dirty word, right? And in some religions, it's a no-no, right? So we have that to deal with. So what would you do if you had a female resident that wanted to masturbate? Go for it. Now privacy, and we understand it, right? I know we have somebody up there right now that is accommodated in that way.

Thursday mornings, they support this individual to sleep in because on Thursday mornings he masturbates. Did you know that? Well, that's good. Now, I don't know whether that was facilitated because the nurse he spoke to is a male Would you as a female? Be as able to support him. Yes. Okay. Yeah. Yeah, no problem when you speak as Directly and openly about this as you are in that clip, how do people respond? I mean, Seinfeld didn't use the word television, but it's a word, masturbation is a word that

can make people cringe in some ways, do you know what I mean? And that's why I intentionally use it, and I use a lot of that language to remove the shock value of it, and you'll notice once I said it, it was almost like giving them permission. They said it too. They said it too. It became safe. Do you find resistance to that at all? In all the classes I've done, it's only happened maybe one or two times that people were uncomfortable.

And I understand that. I don't know what people's backgrounds are when they come to these classes. It's just like maybe we broadly have this idea that these are things you can talk about until you start talking about it and you realize that people actually do want to talk about this. Well, that's true. And there are actually some homes that would not be receptive to this education session. What do you do then? Well, you plant the seeds.

You plant the seed and you keep going back to them and talking about human rights and the resident code of rights. I talk about the brain and how when people masturbate, it releases hormones that make people feel better. And that's sometimes why people with dementia do it. They're looking for comfort. And sometimes if you use a more clinical approach with people, then they understand it. I was thinking, I mean, personal support workers

have a lot to deal with at the best of times. And in a complicated workplace, this is another complication. Doesn't mean that it's better or worse, but it's part of that complication. And it's something that one of the PSWs spoke up about when it comes to one of the residents. Have a listen to this. He always do that in the room,

or sometimes the living room, or sometimes in the dining. So we just need to be very careful on what he's doing. We just sometimes cover it up with blankie. So I would say for his protection and for the others, or some people might just find it offensive, but you also want to protect the dignity of that person Right think of yourself as a human being when you don't have those kind of controls anymore You would hope that somebody probably stopped you so I agree with you. I'm glad that people aren't like oh like flipping out so

He just came from his room and he just slept on the sofa and then he just started doing it. So maybe he thought he was still in his bed. Yeah. So maybe if you see him heading to the couch and lying down, you might say to him, Let's go back to bed. So you have to find a way. Just encourage him. We know the resident. So just encourage him to go back and he most probably will just say yes.

He's very easy to do. Yeah, very easy to do. He might just say, do you need some alone time? Yeah. Do you need to be back in your room? You can hear the stress that some of those PSWs are under in terms of trying to figure out how to navigate and negotiate this. Absolutely, but the time to figure that out is not when it's happening.

Is to do it and to be proactive. I really want to hammer home that although this is something we want to support, it's always about the dignity of the human being. And that concerned me when they were allowing him to do it publicly. I don't want him to be humiliated or not be the person he was before he had dementia. Hey there, I'm David Common. If you're like me, there are things you love about living in the GTA and things that drive you absolutely crazy. Every day on This Is Toronto, we connect you to what matters most about life in the GTA, the news you gotta know and the conversations your friends will be talking about. Whether you listen on a run through your neighbourhood or while sitting in the parking lot that is the 401, check out This

Is Toronto, wherever you get your podcasts. One of the other things that you talk about in this training is that sometimes people in long-term care, sometimes people as they get older, they'll come out. That they will reveal their true sexuality as they get older, perhaps in that situation. Tell me a little bit more about that. What have you seen? So I have found it in many ways, not just around that, that people, when they have dementia, that's the one lovely thing about dementia that people don't talk about. There's a lot of negative. But people are no longer constrained by things they were in their

life by embarrassment or humiliation or societal values or biases. You see people who always wanted to be a singer sing. People who want to dance, dance. And many people, especially in the generation that we have in the home right now, if they had been from the LGBTQ community, they would have hid it. And so what I have seen in the past, I can think of one example, were two lovely women, and they were married and had big families. And we started noticing them being together on the sofa during the day, holding hands, and then it progressed to where they would lie beside each other in the bed and just embrace, just comfort each other. You said that's one of the beautiful things. I mean, again, when we talk about dementia,

we don't see a lot of beauty. No. I think it depends how you look at dementia. I know with my own father, when he had dementia, there was a softness in him that he hadn't had before. I think we always look at dementia from a place of challenge and negativity and problems, but if you look, there are some lovely things that happen. How do families react to that? You mentioned that these two women had big families, partners, what have you. How do families respond to that? In this particular situation and in subsequent situations, it's shocking. And some families accept it and they'll say, okay, we just want mom to be happy. And if this is who she is, we're okay with that. But you can imagine there's some resistance as well.

Oh yeah. Well, the other woman, her family was very resistant and they said, we don't want our mother to be with this person, she can't sit with her, we want you to separate them. What do you say? Well, I can understand why they feel that way, but the law doesn't support that. That's the one thing a power of attorney cannot do is determine intimacy for another individual. So I wouldn't just come out and say that to them, because I appreciate that this is a very difficult situation. So we talk about it and give them some more information and

answer their questions. And if it's still something that's very challenging for them, then what I have done in the past is brought in an ethicist who has a unique perspective on this type of work. We're going to speak with an ethicist in a moment, but I'm just more curious as to what is it that you can say, maybe it goes back to that idea of dignity that we were talking about earlier. What can you say to the family members that would let them understand and empathize with where their loved one is? Well, I can use the example of my father again. In the home he was in, my mother's still alive, there was a woman that he

used to sit beside and hold her hand. And I said to my mom, how do you feel about that? And she actually answered in a way that surprised me. She said, I'm happy that when I'm not here, that he has comfort, that he has friendship, that there's somebody who's able to help them in that way. And that's one of the things I find about families as well is that they go to, from just intimacy of holding hands, to being worried about the act of sex itself. And it rarely, rarely goes to that. So we say to them, this is about often friendship, it's about affection, it's about comfort, and usually they can understand that.

Can I ask you one more thing before we bring in the ethicist, and this is around the issue of consent. We talk about consent throughout society. Are there limits to consent that you explore when it comes to somebody living with dementia? So it's something that you have to be aware of all of the time. There's different types of tools that they use within long-term

care to assess someone's capacity to consent, but it's only one piece of the toolkit. And very often in long-term care, they do this assessment when the person's admitted and it's never done again. But somebody's ability to consent varies from day to day. It varies throughout the day. This is something that I think is difficult for staff to get their head around. So there was a family that was in one of the homes that I was in, a lovely woman. She was in the much later stages of dementia and was bedridden. But her spouse would come every day and he would take her for lunch and support her. But at the end of lunch, she'd go into the room

and the door would be shut. And I said to staff, what's happening in there? Why does that happen every day? And one of the staff said, well, we think that they're having sex. And I said, well, she can't consent. And they said, well, they're married. And I said, okay, so even within marriage, you still have to have consent. And that's a shocker. Even in the session that we're listening have consent. And that's a shocker. Even in the session that we're listening to this morning, that was a shock for people. So, Jill Oliver is an ethicist with the William Osler Healthcare System and has been listening into this conversation.

Jill, good morning to you. Good morning. How do you understand that and navigate that issue of consent when it comes to someone with dementia. Walk me through as an ethicist how you think about that. So, usually when I'm presented with a case, I will ask for a description of what has been happening, what is known. Sometimes it's apparent right away that the issue is not actually consent, that the people who are engaging are quite happy to be engaged

but maybe the family has misunderstood their role or they've been asked for their opinion but then the home doesn't want to implement what they've said. So really it may not be a consent issue but when we're looking at consent we have to determine if the resident is capable of providing that consent. And that can be very difficult for homes to do because there is no standard test that will tell you if this person in front of you is capable of consenting to this particular activity at this time with this other person. There's so many variables. So, one thing I suggest to homes when cases like this arise is, as Mary was saying,

they have to be comfortable in speaking to the person because that's the only way they're going to get an understanding of their appreciation of what's happening. In your experience, how often does that happen? That those who are working in those homes are comfortable in having that conversation. We've been having the larger conversation, but just how uncomfortable talking about sex can be broadly in society. So in a situation like this, what have you seen? I think it's safe to say most people are uncomfortable having that discussion. And then what I do is I try to help them to become more comfortable with it and

to help the resident become more comfortable with that conversation as well, because it can feel very invasive. I'm sure to have people from the long-term care home, you know, inviting you into an office and then having a discussion with you about something that you maybe weren't even aware that they were aware of. So one of the ways that I do that is by asking them to think about the ways they can make their role in the decision-making clear to the resident because then it can help to take away from the perception that they're just being nosy,

but that they have a legitimate role. Pete Mary, how do people respond when that sort of guidance comes from, as you said, you bring in an ethicist often, when that kind of guidance is offered, how do people respond? Mary Flaherty They're shocked. If we get to that stage where we're bringing an ethicist often, when that kind of guidance is offered, how do people respond? They're shocked. If we get to that stage where we're bringing an ethicist in, there's a lot of pushback and they talk about their rights and their right to, often, not always, to be in control of the situation. And your response to that is what? This goes back to the idea, we keep using this word dignity,

and to centre the person in this conversation. Well, that's what we try to do, bring it back to their loved one and ensuring that we're meeting their needs and that this is really about meeting a need for comfort and engagement and belonging. And often through the ethicist discussion, they get there. It's rare once the ethicist comes in that they don't see the light. But one of the things we do, what we're talking about doing is so that it isn't such a shock that all of a sudden you're sitting in front of an ethicist, is as soon as someone is admitted into long-term care, is saying to them, and there's many different ways to ask it, is there anything we

can do to support you to continue your intimacy as a couple? Or we ask families about things like, you know, about masturbation. Is this something that your loved one does at home? We look for ways to facilitate it so that the discussion about this isn't a shock. And that's where I was going to go, Jill, is are there ways to have these sorts of conversations when somebody is moving into long-term care, rather than at a moment of crisis, when you can imagine the tenor and the tone of the conversation might be different?

Yeah, so I agree. It is so important to get the right expectations in place right at admission. In long-term care, the way that I approach these situations is I ask under what circumstances does the long-term care home have either the right or the duty to intervene in what the long-term care resident or residents want to be doing. And so, I think discussing the resident bill of rights and the role of the home, when they will intervene, when they won't intervene, and under sort of what authority can really help, because it can seem really unfair to people when all of a sudden they're treated in a way that they had not

been expecting or they had not been led to believe would be the way that they would be treated. I mean, it goes back to what Mary was saying in that course that somebody asked us our responsibility to talk with the residents about sex. And she says, absolutely it is. Yes, for sure. And to make sure that the residents know what the home's role will be in facilitating, monitoring, and perhaps intervening in activities related to sexual behavior. Because I think probably also many residents don't expect that the home will have a role. And so I think that that discussion should probably

be part of the informed consent process when somebody is admitted to the long-term care home. That you know that the ground rules, if I can put it that way, that you know what may unfold in certain circumstances. Yes, absolutely. Can we, Mary, just, I mean, in some ways we started by talking about what we don't talk about and perhaps what people don't want to talk about when it comes to older people and sex.

What do we need to understand more generally about this, about sex and sexuality as we get older? That that doesn't change, that they are the people that they were before, that they're exactly like us. So again, it's that developing empathy and getting them to see them as humans. Very often in long-term care, and I'm not suggesting they don't always see them as humans, but they get very caught up in tasks and being concerned about legislation and will they get in trouble. We need to put that in the background. That will just happen anyway. We need to focus on what's best

for the human being in front of us. And that you being uncomfortable and talking about this doesn't mean that it isn't happening. It doesn't mean, I mean, as long as it's not about you. It's not about you. I mean, I know that it's happening in all of the long-term care homes.

All of the long-term care homes. All of the long-term care homes. So, there's going to be someone, at least one person in every home area, I would say, you know, not all day, every day, but consistently that has this issue. So, there's a lot of people whose human rights and needs are not being met. And that we need to get over our uncomfortability, our hangups by talking about this to actually deal with it. Get over it. Mary, thank you very much.

Thank you. And Jill, thank you so much for being here. Thanks very much. Mary Connell is an educator specializing in seniors and sexual health. Jill Oliver is an ethicist with the William Osler Healthcare System. Sometimes you have conversations in this program

that you're not entirely sure where they're going to go. You go into them thinking this is what the thing is going to be about, and then you are completely surprised at where the conversation turns. That was one of those discussions. So interesting.