Memory Care Community Standards

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1 Memry Care Cmmunity Standards SEXUAL / INTIMATE BEHAVIOR POLICY Staff shuld understand, recgnize and supprt the healthful expressin f sexuality and intimacy amng residents, and demnstrate an understanding f the prcedures fr staff respnse t and interactin with residents wh demnstrate sexual r intimate behavir. Staff will attempt t determine a resident s ability t cnsent t sexually intimate behavirs if residents are invlved in sexual activity. OVERVIEW The need fr intimacy is strng in human nature, as it prvides a sense f wrth, well-being, and cmmunity. Handhlding, handshakes, friendly hugs, hand massage and ther displays f affectin are cnsidered apprpriate in mst envirnments and are encuraged as utlets fr expressing intimacy. Staff shuld understand that a resident with dementia may make verbal r physical sexual advances tward thers, r exhibit behavirs nt generally accepted in sciety. The reasn is that the resident frgets the scial rules gverning sexual behavir. Expressins f sexualized behavir in residents with dementia can be the result f impairment in cgnitive functining. An expressin f sexualized behavirs in residents with dementia des nt indicate, and shuld nt be cnsidered, as a lapse in mrality. Staff shuld nt take such behavir persnally. A lss f cgnitive functining r cgnitive abilities ften causes a lss f understanding abut scial rules and can affect behavir s that a resident mistakenly uses inapprpriate bjects in a sexual manr, uses areas as a restrm, r takes ff clthes in public when becming t warm. Inapprpriate behavir can be a result f the fllwing: A resident might shw increased sexual behavir r activity nt recgnized in the past, if a lss f cgnitive functining r cgnitive abilities results in lss f inhibitin r apprpriate judgment. A resident mistakes persnal care as a sexual advance. A resident mistakes anther persn fr their spuse and make advances tward that persn. A resident s inapprpriate tuching r fndling f their private area culd be a result f infectin, need t tilet, and/r ill-fitting clthes. Staff shuld rule ut any physical prblems and/r medicatin side effects that might be causing inapprpriate behavir. Factrs that might trigger sexual behavir include Lack f meaningful stimulatin during the day These sample plicies are prvided fr infrmatinal purpses nly. Therefre, yu shuld nt use the sample plicies withut first reviewing them with yur clinical/peratinal team and, if necessary, btaining the advice f cmpetent regulatry cunsel.

2 Memry Care Cmmunity Standards Mental cnfusin Discmfrt, itching, infectin Lneliness r need fr affectin, tuch, cmpaninship Need t use the restrm Nn-sexual gestures and friendliness, such as teasing r cmfrting frm anther RESIDENT RELATIONSHIPS This Cmmunity acknwledges that residents have the right t interactin and relatinships with ne anther if bth have capacity t cnsent (fr an interactin r relatinship). Staff shuld recgnize that a resident with dementia is able t meet the human need fr intimacy in ways besides sexual cntact. If a resident with dementia exhibits behavir new r incnsistent with previus habits, the actin might represent lss f inhibitin, lw selfesteem, r a need fr tuch. The fllwing general steps are meant t supprt residents fr healthful expressin f sexuality and intimacy and t define fr staff hw t respnd and interact with residents. Prcedure 1. If residents enter int a relatinship, Cmmunity staff will assess each resident s capacity fr cnsenting t the relatinship. T assess resident capacity fr cnsent, staff shuld fllw directin in the attached sheet ( Evaluatin fr Resident Relatinship ). 2. The Cmmunity will make available health educatin t the cnsenting residents and/r respnsible parties t help them assess the risks and benefits f an intimate relatinship. 3. Staff will assist t develp a plan fr privacy when need is bserved, such as when a resident exhibits behavir nt cnsistent with previus habits r has difficulty finding an apprpriate time r place fr private time. 4. The Cmmunity reserves the right t define apprpriate/inapprpriate behavirs fr all Cmmunity public space and n the grunds. When residents are bserved at behavir nt apprpriate, staff will prvide neutral redirectin and, if needed, review by supervisr staff t design an apprpriate plan fr resident assistance. 5. Each resident must cnsent fr a relatinship; and the Cmmunity shall reprt any allegatin f sexual assaults/rape fr investigatin by the prper authrity, and shall prvide clse bservatin as necessary t supprt residents after any such reprt. EPISODE RESPONSES The Cmmunity recgnizes that residents with Alzheimer s disease r ther age-related dementia might demnstrate sexually inapprpriate behavir due t disease prcesses that result in memry lss, cnfusin, and reduced inhibitin. Staff shuld regard sexually These sample plicies are prvided fr infrmatinal purpses nly. Therefre, yu shuld nt use the sample plicies withut first reviewing them with yur clinical/peratinal team and, if necessary, btaining the advice f cmpetent regulatry cunsel.

3 Memry Care Cmmunity Standards inapprpriate behavir the same as any ther inapprpriate behavir, and shuld learn hw t identify it and hw t respnd. Residents When a resident disrbes, tilets in an inapprpriate area, r has intimate cntact with anther persn r themselves while in a Cmmunity public area, the resident exhibiting such behavir will be redirected apprpriately t either a private rm r the resident s apartment. Staff bserving that a resident r residents are engaged in intimate/sexual behavir shuld remain calm and unemtinal. A reactin f shck, disgust r laughter might cnfuse r upset the resident(s). Handle each situatin apprpriately, as fllws: One resident - Tw residents Sexual cntact D nt allw the resident t be sptlighted, laughed at, r receive any demeaning reactin frm thers. If in a public lcatin, quietly lead the resident t a private place. If the resident is underdressed r expsed, prvide smething as cver-up. Act as thugh nthing unusual happened. If in an inapprpriate area, intervene fr mving residents t a private area. If in an apprpriate area, appraise the situatin t determine if the actins are wanted by each resident (cnsensual). If the activity is deemed cnsensual, leave the residents in private. Cnsider invlving resident family members, while maintaining resident cnfidentiality as apprpriate. Cntact the residents physicians t ntify f the behavir. If needed, develp plans t assist with appraches r interventins and dcument apprpriately. A staff member wh discvers that sexual cntact ccurred between tw residents, and it was unknwn t staff, shuld ntify an apprpriate supervisr. Supervisry staff shuld: Review the residents legal rights, and evaluate (per attached directin). Cnsider invlving the family members, while maintaining resident cnfidentiality as apprpriate. Cntact the residents physicians t ntify f the behavir. If needed, develp plans t assist with appraches r interventins and dcument apprpriately. When develping a care plan, cnsider what might have led t the These sample plicies are prvided fr infrmatinal purpses nly. Therefre, yu shuld nt use the sample plicies withut first reviewing them with yur clinical/peratinal team and, if necessary, btaining the advice f cmpetent regulatry cunsel.

4 Caregivers Memry Care Cmmunity Standards behavir and whether circumstances shuld be changed t cntrl similar behavir in the future. Sexually inapprpriate behavir ften is expressin f a need fr human cntact, being lved r belnging, which might result in a resident inapprpriately tuching anther resident r a caregiver. Staff may acknwledge this expressin f need by teaching r demnstrating acceptable ways fr the resident t meet their needs, but in a manner such that the resident shuld nt interpret the acknwledgment actin as an advance by the caregiver. When a resident acts inapprpriately, the caregiver s immediate respnse shuld be as fllws: Dn t scld, but speak in a frmal manner. Stay calm and remind the resident that unwanted remarks/tuching are nt prper. If mistaken by the resident fr a lved ne, remind the resident in a manner such as, Oh, Mr. Smith, I am yur care prvider. Check t determine if a care/assistance actin might be misinterpreted as an advance; review, fr example, actins such as. Leaning dwn in frnt f the resident. Entering the resident s persnal space. Making gestures f an intimate nature hugging, kissing, etc. Further respnse t resident behavir expressing need fr cntact (e.g., tuching f anther, including a caregiver) can include the fllwing: Prvide neutral redirectin unless therwise specified in the resident s service plan. Indicate ther ways fr the resident t gain caregiver attentin, including the fllwing, which are acceptable:. handshakes. pats n the upper back. brief lateral hug. scial cnversatin. eye cntact. waving and cmpliments Redirectin Required The fllwing behavir tward a caregiver r anther resident is nt apprpriate, and staff shuld immediately redirect the resident wh is Staring inapprpriately These sample plicies are prvided fr infrmatinal purpses nly. Therefre, yu shuld nt use the sample plicies withut first reviewing them with yur clinical/peratinal team and, if necessary, btaining the advice f cmpetent regulatry cunsel.

5 Memry Care Cmmunity Standards Invading anther s persnal space Makings sexual prpsitins Giving a frntal hug Rubbing/strking/winking Fndling Grabbing anther s arm r clthing Expsing self (r public masturbatin) Tuching genital areas Verbally r physically threatening When redirecting in respnse t resident expressins f need fr tuch, intimacy r sexual respnse, it is very imprtant that a staff member remain neutral in bdy language, tne f vice, and spken respnse. Staff shuld cntact a supervisr r ther apprpriate advisr abut specific training and strategies fr remaining neutral in this type f situatin. Reprting Any reprt f a situatin related t resident sexual/intimate behavir, t the family, physician, supervisr, etc., shuld cnvey nly the facts, withut unnecessary details, and shuld be presented in a prfessinal manner. Staff wh reprt shuld evaluate each situatin n a case by case basis. Cmpletin f an incident reprt and cmmunicatin t supervisrs are required fr any incident abut a resident s sexual/intimate behavir, whether an episde invlves apprpriate r inapprpriate behavir. The apprpriate Cmmunity staff must investigate incidents as required, and shuld share with ther staff any pertinent utcmes and recmmendatins. Based n circumstances when discvered and Cmmunity evaluatin (per attached directin), if a resident relatinship is determined t be nn-cnsensual, the Cmmunity shall fllw regulatins and plicy t reprt apprpriately fr the situatin as resident abuse. These sample plicies are prvided fr infrmatinal purpses nly. Therefre, yu shuld nt use the sample plicies withut first reviewing them with yur clinical/peratinal team and, if necessary, btaining the advice f cmpetent regulatry cunsel.

6 EVALUATION FOR RESIDENT SEXUAL/INTIMATE RELATIONSHIP The prcedure and guidelines here shuld be the basis fr evaluating resident capacity fr cnsent t a sexual relatinship. T participate in the prcedure steps belw, staff shuld at a minimum be cmprised f the Administratr and the RCC/LN (r ther if apprpriate). Staff shuld seek input frm the resident s physician and, as applicable, invite the resident (if able) and the resident s, family, representative and/r respnsible party t participate fr an evaluatin meeting r t prvide input therwise, as applicable fr the situatin. NOTE: Staff must cnduct separate sessins when mre than ne resident in a relatinship will be evaluated fr capacity t cnsent. Prcedure The Administratr shuld facilitate fr evaluatin participatin/input and apprpriate dcumentatin. If necessary, cpy this attachment s secnd sheet as a recrd f evaluatin results fr a resident s recrd. In additin, use the resident s service plan t dcument details abut wh participates and hw evaluatin ccurs, and abut any interventins determined t be apprpriate as a result f evaluatin. Staff and the resident, if able, and/r thers with input shuld discuss the fllwing questins t determine whether cnditins might allw a sexual relatinship t cntinue. 1. Resident ability t avid explitatin - Is resident behavir cnsistent with frmerly held beliefs/values? Des the resident have the ability and/r capacity t say n t uninvited sexual cntact r make his/her wishes knwn? 2. Resident awareness f the relatinship Is the resident aware f wh is initiating sexual cntact? Des the resident knw the ther s identity? Fr example, if the resident believes that the ther persn is a nnexistent spuse, acquiescence is because f that mistaken belief, and therefre nt cnsensual. Can the resident state/describe a level f sexual intimacy he/she wuld be cmfrtable with? 3. Resident awareness f ptential risk Des the resident realize that this relatinship might be time limited? (Fr example, ne resident might lse interest, leave the Cmmunity, becme ill, etc.) Can the resident describe hw he/she will react if/when the relatinship ends? Des the resident exhibit an understanding f the pssible transmissin f STDs? Based n the questins abve, staff will use the guidelines table (see next page) t facilitate a determinatin (separately fr each resident) whenever a resident (r residents) suffering frm dementia r a lss f cgnitive functining r cgnitive abilities engage in sexualized behavirs. Prceed thrugh cnsideratin f indicatrs in the rder shwn, and refer t the general guideline clumn abut the answers, which prbably is the

7 Memry Care Cmmunity Standards determinatin mst apprpriate fr the resident. Recrd a decisin abut each indicatr and cmment if necessary. EVALUATION FOR RESIDENT SEXUAL/INTIMATE RELATIONSHIP Recrd f Decisin GUIDELINE INDICATOR GENERAL GUIDELINE DECISION A. Resident s Mini-Mental State scre greater than 14? Cnsider the resident s scre with ther factrs, but initiate the questins abve. B. Answers t #1 abve indicate that resident is able t avid explitatin? C. Answers t #2 abve indicate that resident is aware f the relatinship? D. Answers t #3 abve indicate that resident is aware f risk. YES : Cntinue questins abve. NO : Nt likely that resident is able t cnsent YES : Cntinue questins abve. NO : Nt likely that resident is able t cnsent YES : Cnsider resident cmpetent fr the relatinship. NO : Allw the relatinship but prvide frequent reminders f risk Cmments: Service plan, prgress ntes, ther resident recrd dcumentatin updated as required? Circle ne YES NO N/A Administratr signature Date evaluatin cmplete These sample plicies are prvided fr infrmatinal purpses nly. Therefre, yu shuld nt use the sample plicies withut first reviewing them with yur clinical/peratinal team and, if necessary, btaining the advice f cmpetent regulatry cunsel.

8 Memry Care Cmmunity Standards (File cmpleted frm in the resident s recrd.) These sample plicies are prvided fr infrmatinal purpses nly. Therefre, yu shuld nt use the sample plicies withut first reviewing them with yur clinical/peratinal team and, if necessary, btaining the advice f cmpetent regulatry cunsel.

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