WEBVTT

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Our views of intimacy and
sexuality are really guided I

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think by our culture sometimes by
our religion and our upbringing.

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But we tend to think about
young vibrant people we

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tend to shy away from thinking
about older disabled people just

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to lighten things up a little
bit I thought I\'d show you this

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cartoon Showing off I know
what you\'re walking stick.

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Older people would like to be
intimately involved with somebody

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else if they have an
opportunity but the reality

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is they lose opportunities because their
partner passes away their partner becomes ill

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or maybe their partner can
no longer function sexually

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because of medications and other
complications related to aging.

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If you like that cartoon I think you\'ll like
this one no no I said I\'ve got acute angina.

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So I like to bring a little levity
to it because you know this

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is a serious topic but I
believe we need to have

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an open discussion and

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a real mature adult conversation about
this instead of Hiding it away.

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So when I talk about intimacy I went to delineate
that from sensuality intimacy refers to

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talking kissing hugging holding hands
and culling without overt sex.

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So this is flirtatious kind of stuff

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right sexual acts on the other
hand are really aimed at arousal.

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This includes finaling disrobed
being oral and genital sex in

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that case we\'re looking at

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a heightened level of activity and
engagement between two people.

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So let\'s talk about dimension now I think of
dementia primarily as failure of the brain.

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You\'re familiar with terms like
kidney failure and heart failure

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And dementia is brain failure it\'s
the brain is not doing what it

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was designed to do and it
results in a number of

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symptoms primarily memory loss begins with
short-term memory loss and ultimately it rose

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even the long-term memories
for reasons that are really

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not clear a well-understood and that\'s why

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scientists had been stymied in
their efforts to come up with

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effective treatments and ultimately a cure
for various types of dementia But you\'re

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well familiar with all these
different symptoms associated with

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dementia orientation to time and place
problems with thinking problems performing

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ADLs decrease reaction
time poor coordination use

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of hands and feet diminishes
visual-spatial impairment also

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diminished awareness when you and
I are forgetful or usually aware

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that we have forgotten something but many
people with dementia forget they are forgetful.

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And they have no insight into the nature of

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their disability and they\'re very
difficult to care for because they

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don\'t think they need any help this is a
process that unfolds over a course of

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many many years anywhere
from three to 20 years

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this process can unfold And I divide
it up into four different stages.

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So the symptoms gradually worsen over

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time and the rate of progression
really varies from person to person

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Some people can remain
in the early stages for

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three or five years whereas others
can decline rapidly to the n stages

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by year three or four there are a
number of different symptoms but

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the one I want to focus in on particularly
is what we call disinhibition.

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This is the loss of manners.

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We use our manners to talk
to one another we use

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our manners at the table there also
sexual manners that we learn over

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the course of time and people
with dementia lose all kinds

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of manners in the course of dementia
Apart from all those symptoms

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I just share with you I think we have to look
at the emotional as psychological impact of

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dementia and I think many people suffer

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from fear and a loss of
competence and insecurity.

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These are people who are
perhaps seeking you

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out they liked your attention
because they feel lost and alone on

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their own loneliness so they
don\'t feel connected to

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other people they feel a loss of

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control of their surroundings
and they may be Board also.

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Maybe they\'ve lost their sense of
initiative maybe they\'ve got a lot of

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energy but they can\'t direct themselves the

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way they once did And lastly I think

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because of their inability to manage
their own activities of daily living.

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They may develop a sense
of helplessness because of

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their reliance on other people they feel
an acute loss of their independence.

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So let\'s talk about some of
the changes in intimacy and

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sexuality over time for some couples

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they can still retain their sense
of intimacy and sexuality.

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They might still share their
interest and their capacity for

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intimate and sexual behaviors on the
other hand some of them May also

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experience a loss of interest
a loss of interests by one

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or both partners So for example
the spouse who\'s becoming

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a caregiver may now feel put upon
by all the work he or she is

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having to do and that sense
of romantic involvement may

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diminish as a result of that
kind of hard work that they\'re

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doing Thirdly there may
be a loss of capacity I\'m

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talking about sexual functioning
now the inability for example of

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men to both have an
erection and to maintain

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an erection This may be a result

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of dementia itself or some of
the medications that they\'re

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taking and then lastly there may be increased
interests by the partner with dementia.

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Now I want to show you a couple
of clips Of a couple who over

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the course of time experience some changes
in their own intimate in sexual behavior.

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This is a married couple living at
home together they\'re relatively young

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by the standards of most care facilities

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he\'s in his late fifties
she\'s in her early sixties.

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But listen to what they have to say about the
impact of dementia. On their relationship.

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Every shows much concern
And good support for ugly.

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Certainly our love for each other

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as Betty indicated I think is
stronger now that has ever been.

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Simply because from my vantage point
I realize how much I need her.

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How much I depended on or in the past.

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How much I loved her now in I
want to do everything I can to

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make life meaningful for her
and so for us every day

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is a very special day in our law
for each others better than ever

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before and that\'s a physical
love as well as respecting love

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right Some couples facing Alzheimer\'s
disease have told me about

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a diminished sexual desire because of

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some of the daily frustrations they
face they just don\'t feel like they\'re

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interested in that anymore and there\'s

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a different focus in

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their relationship I\'m wondering what
that experience has been for you

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either a diminished desire some people
report to me an increased desire

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I that\'s what I feel about
it I think I don\'t know

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maybe it made him

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read I keep on

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being green and remember that.

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Can you talk about that somebody

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you feel a greater closeness
in a desire forever it before.

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Yeah well I\'ve always liked
him pretty much yeah.

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Why do you think she might have felt an
increased desire or closeness with average

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at this point in time Any thoughts about

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that says you want to feel loved
she wanted to feel loved.

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Yes. She might have felt some of
those feelings that I referred to.

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Earlier fearfulness the loneliness the
helplessness and maybe by becoming

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physically involved with her husband he was

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reassuring to her that she was
still loved just the way she is.

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Despite her problems but I want to show you
another clip that illustrates I believe.

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Some of the natural changes that
occur in the course of dementia.

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So this is ever being interviewed.
Just a year later.

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She\'s now in her sixth year Alzheimer\'s but
are all began I just felt like she was

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my wife I was her husband and
she had some problems and

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and we could live with those
problems but in the last.

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Eight to ten months things have
really started to change a lot.

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And now I really see myself
as a caregiver and I\'m

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recognizing the differences in attitude and

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relationship that evolves around that
she\'s still my wife and I love her

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and she still loves me but
because of the caregiver role.

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Things began to change in terms of the
relationship and I may get a little emotional when

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I talk about this Picked I
know I\'ll get emotional.

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Talking about this it\'s
almost like you\'re carrying

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for an adult child and
she doesn\'t have to wear

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diapers or anything like that yet
but she does have a problem with

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the I\'m not wiping herself and so
she\'s developed some older wetness.

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A few time she\'s not realized she had

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to go to the bathroom till it was too
late and associates water itself.

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So it\'s like you\'re carrying for an
adult baby or an adult that little

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child and when you do that
day in and day out it\'s

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it\'s this husband wife relationship begins to
change And when it comes to our sexuality.

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She\'s not as responsive as before when
we talk about it she still wants to have

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sex he still wants to have

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an intimate relationship but it\'s
like she doesn\'t know what to do

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and there are times when it\'s almost
like i get the feeling that there\'s

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this shy little girl who\'s
embarrassed by the fact that she

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doesn\'t have any clothes on or
that I don\'t have any clothes on

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And she\'s embarrassed by the whole thing and
sometimes there\'s just shy little laugh.

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That really gets to be a
bother to me after awhile.

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Because I\'m wondering if
she\'s laughing at my body

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or I just don\'t know why she\'s laughing and
sometimes she can\'t even tell you why.

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Except that she says well I\'m shy.

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So how many we have five grown children.

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We\'ve been married over 30 years now and

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we ought to be getting over the
shine that\'s part you know.

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But it does change things after a while.

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So you can see that the advance
in her Alzheimer\'s disease hits

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really presented a challenge
for both of them and for.

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Particularly for him as he is
Taking an increasing role and

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responsibilities for his wife and its
really put him off quite frankly.

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But he said it quite beautifully
you know he would love to have

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that but because of all the
changes he\'s finding it

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difficult to appreciate that aspect
of their marriage Now I also want to

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point out we\'re not just talking
about heterosexual couples

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here in our society where there\'s
a renewed appreciation for

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the diversity of people including gay
lesbian transgendered individuals and

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so there are people who are
attracted to the same sex but they

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have typically experience a lot of
discrimination and prejudice rather lifetime.

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Okay so I just wanted to bring that
up Because it does come into play in

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long-term care settings where they should enjoy
the same rights as heterosexual couples.

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I think for the most part people really want
to be intimates they want to be close to

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other people this may diminish

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their fear and their loneliness and
their helplessness and their boredom.

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Okay. And that closest
will come primarily from

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you and that might be very satisfying
the relationship that they enjoy.

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With individual caregivers here but
this is what it really means to

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deliver person-centered care that
this individual really feel special.

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This person feels connected to you on

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a deep level and it comes next so
much with words which are important

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Through touch you know when we were

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born we didn\'t have the ability to
communicate with words we couldn\'t

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speak words we couldn\'t
understand words but we

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knew we were cared for
primarily through touch.

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So this is a great vehicle
especially for those people in

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advanced dementia Who no longer
have the facility for words they

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don\'t understand they\'d speaking very
little or not at all and when we touch

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them we let them know that they\'re cared
for but some people for reasons that are.

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Maybe not clear it\'s usually due to
some kind of history of maybe abuse.

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They don\'t like being touched
and after all they might not

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recognize who you are even
though you are with them

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let\'s say three days four days five days a

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week they still don\'t remember each
and every time you are a new person

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to them and so I think you have to go over

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the top in your approach with these
folks who are quite fearful of being

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touched It may bring trigger some
old memories about being hurt in

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the past by a caregiver maybe your parents
and so they are apprehensive about any.

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Anybody being.

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Physical with them and so you\'ve
gotta use extra amounts of TLC in

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those cases and I would suggest spinning a
lot more time in a preliminary kinda way.

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Letting them know that you care
to hockey with them talking

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about some favorite subjects of
there\'s maybe singing a song.

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Getting them in the mood I think that
you are there as a friend and not to be

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feared These are some of

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the behaviors that are sometimes
directed towards you as staff members

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or other resonance or even oneself
masturbation sometimes people with dementia.

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Will do this in private or in

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public and of course if it happens in
a public area this is not good for

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the other residents or
visitors or staff how can we

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accommodate this because
there\'s a tendency to be

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dismissive and saying get your
hands out of your pockets.

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Get your hands out of your pants and
to be disgusted by this behavior

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because it is it becomes
a public scene and it\'s

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embarrassing for them if if
only they Could understand what

00:15:41.330 --> 00:15:45.078
they\'re doing and the actual
location they would be horrified

00:15:45.079 --> 00:15:53.023
themselves and so the proper way to deal
with this is to preserve someone\'s dignity.

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I showed them into their
own private space and let

00:15:57.589 --> 00:16:02.644
them masturbate alone we don\'t
want this to be a public display

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because clearly this is
alarming for other people

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okay there\'s also the issue that
sometimes in rare cases that arise that

00:16:11.270 --> 00:16:17.869
we call hypersexuality this has to do
with a very rare symptom of dementia is

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most prominent in people who have

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frontal temporal dementia But it also can

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occur in Alzheimer\'s disease
and other types of dementia.

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This refers to uninhibited and compulsive
talk and or behavior directed towards staff.

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Towards oneself or other people.

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So this is inhibitions out of control.

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Alright. And if you ever
encounter someone like

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this I just asked you not to take it
personally to treat it like a symptom.

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Quite naturally it feels offensives.

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It\'s disturbing.

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But the person has really little or no
control over this kind of behavior.

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So clearly this kind of persistent
need to act out sexually requires

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some medical attention okay And there are

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some medications that are available
to curb this kind of behavior.

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Most often we use estrogen with

00:17:12.574 --> 00:17:16.968
men who are exhibiting this kind of
behavior with women with women who

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exhibit this behavior we might
try some antidepressants are

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anti-anxiety drugs the tendency is to
treat these kinds of behaviors with

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anti-psychotics because they
have sedating qualities

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but some research shows that
instead of snowing people

00:17:33.604 --> 00:17:37.218
under sedating them we\'re better off
using some of those other drugs that I

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mentioned so let\'s talk about your
relationship with people with dementia.

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They spend all of their
time here You go home after

00:17:47.119 --> 00:17:51.723
your shift but they stay here
and this is likely to be.

00:17:51.724 --> 00:17:55.774
Their final home in most cases right.

00:17:55.775 --> 00:18:01.158
And more than just your workplace
this is where they live all the

00:18:01.159 --> 00:18:05.479
time but think about it you are nice to

00:18:05.480 --> 00:18:10.818
them you care about them they become
like extended family members.

00:18:10.819 --> 00:18:15.589
My right. And so sometimes they may confuse

00:18:15.590 --> 00:18:21.109
your friendship and your
care and concern for romance

00:18:21.110 --> 00:18:24.828
and I can fully understand
this because many people

00:18:24.829 --> 00:18:28.364
dementia don\'t appreciate the
fact that there are older people

00:18:28.365 --> 00:18:32.229
Maybe they\'re doing some time traveling
as a result of their dementia they think

00:18:32.230 --> 00:18:35.528
they\'re younger people
and you are very nice to

00:18:35.529 --> 00:18:38.528
them and you\'re smiling and
you\'re carrying and you\'re

00:18:38.529 --> 00:18:42.053
touching them sometimes in
intimate ways and they may get

00:18:42.054 --> 00:18:46.763
the wrong idea and yet from their
perspective it\'s the right thing to do

00:18:46.764 --> 00:18:51.834
because they want to have a romance with you
and also they may forget their spouses.

00:18:51.835 --> 00:18:55.208
By the late stages this
is pretty normal for them

00:18:55.209 --> 00:19:00.953
to have a loss of long-term
memory a marriage of 50-60 years.

00:19:00.954 --> 00:19:04.163
Those brain cells responsible
for those memories.

00:19:04.164 --> 00:19:08.199
May be destroyed as so people
may be living in the here and

00:19:08.200 --> 00:19:11.899
now And again they might think they\'re

00:19:11.900 --> 00:19:16.668
younger people they might think they
are even younger than you are okay.

00:19:16.669 --> 00:19:19.504
And so they may begin to flirt.

00:19:19.505 --> 00:19:24.664
They may use suggestive talk in
their minds this seems completely

00:19:24.665 --> 00:19:30.139
appropriate And then again they

00:19:30.140 --> 00:19:32.959
might go into this sexual realm they might

00:19:32.960 --> 00:19:36.409
grope They might find all
they might try to kiss you.

00:19:36.410 --> 00:19:39.769
These are uncommon x but
when they do occur.

00:19:39.770 --> 00:19:42.079
They\'re always kind of shocking.

00:19:42.080 --> 00:19:46.189
So I\'m wondering if any of you have
had experiences of either this flirt

00:19:46.190 --> 00:19:52.068
flirtatious talks suggestive
talk or outright sexual acts

00:19:52.069 --> 00:19:55.219
directed towards you because
it is it happens now

00:19:55.220 --> 00:19:58.548
and then and we want to be able
to give you a chance to talk

00:19:58.549 --> 00:20:01.608
about it when you\'re helping
somebody you have to get really

00:20:01.609 --> 00:20:05.418
close sometimes and so sometimes
it\'s just inevitable.

00:20:05.419 --> 00:20:10.129
If you don\'t know what\'s
common and There was

00:20:10.130 --> 00:20:15.109
this one time when I was helping a
larger man so I had to get really

00:20:15.110 --> 00:20:19.998
close to him to help him sit
up and he did like kissed

00:20:19.999 --> 00:20:27.999
my chest and it was it was
just I redirected him.

00:20:29.209 --> 00:20:32.749
How did you feel when these incidents first

00:20:32.750 --> 00:20:37.939
occurred in the beginning I was very
surprised and then bother me too

00:20:37.940 --> 00:20:40.488
much but then kind of
as time goes on and it

00:20:40.489 --> 00:20:43.518
keeps on happening when you
least expect it it gets a

00:20:43.519 --> 00:20:46.669
little frustrating sometimes
but you gotta remember

00:20:46.670 --> 00:20:50.509
that again they don\'t know what
they\'re doing a lot of times and

00:20:50.510 --> 00:20:54.018
it\'s Their disease what they have

00:20:54.019 --> 00:20:57.409
that very much attributes to

00:20:57.410 --> 00:21:03.378
their actions and how were you able to
redirect successfully yes very good.

00:21:03.379 --> 00:21:07.203
Sounds like you handled it very well
you didn\'t take them personally.

00:21:07.204 --> 00:21:10.759
Right. And you did set limits you are very

00:21:10.760 --> 00:21:14.928
respectful and I think the
proper thing to do is

00:21:14.929 --> 00:21:18.619
to redirect or to say something as direct

00:21:18.620 --> 00:21:23.298
as well I\'m a spoken for I\'m
married I\'m interrelationship.

00:21:23.299 --> 00:21:25.429
I do value our friendship.

00:21:25.430 --> 00:21:28.129
But we have limits to this relationship.

00:21:28.130 --> 00:21:32.223
Now of course saying that is one
thing but then remember them

00:21:32.224 --> 00:21:36.123
remembering it it\'s a different
Altogether because of their dementia.

00:21:36.124 --> 00:21:38.704
So this may have to be repeated.

00:21:38.705 --> 00:21:42.169
Time and time again it\'s
also important to say

00:21:42.170 --> 00:21:45.589
you know what triggered this
behavior as you pointed out

00:21:45.590 --> 00:21:50.239
you\'re engaged in some very
personal intimate kinds of tasks

00:21:50.240 --> 00:21:55.684
right dressing and bathing
someone doesn\'t isn\'t natural.

00:21:55.685 --> 00:21:58.804
Unless you\'re doing that to
a young child in this case

00:21:58.805 --> 00:22:02.434
they\'re full grown adults and so they may.

00:22:02.435 --> 00:22:05.838
They may distort this situation
instead of thinking of it

00:22:05.839 --> 00:22:09.978
as a task that they need
help with they might think

00:22:09.979 --> 00:22:14.719
about this as an opportunity
for little sexual play or

00:22:14.720 --> 00:22:19.849
flirtatious behavior OK so it\'s
always important to think about what

00:22:19.850 --> 00:22:22.264
is their perspective on the situation

00:22:22.265 --> 00:22:26.389
right there they\'re seeing an opportunity
for romance and you\'re saying well

00:22:26.390 --> 00:22:29.538
no I\'m your caregiver and I do appreciate

00:22:29.539 --> 00:22:33.544
you I can be your friend but there\'s
going to be limits to this relationship.

00:22:33.545 --> 00:22:37.908
Ok now some people feel hounded

00:22:37.909 --> 00:22:42.258
by particular resonance and there might be
something about your appearance or your voice

00:22:42.259 --> 00:22:48.304
that reminds them of a former spouse
or lover and you might feel put upon

00:22:48.305 --> 00:22:51.048
on a regular basis In that case

00:22:51.049 --> 00:22:54.934
all the redirection and sweet talk
in the world may do you no good.

00:22:54.935 --> 00:22:58.249
So in those cases and those are rare.

00:22:58.250 --> 00:23:02.178
I think it\'s important to talk
about maybe being reassigned to

00:23:02.179 --> 00:23:06.769
someone else because for some reason
that we can\'t quite understand.

00:23:06.770 --> 00:23:10.098
They target you and nothing you can do

00:23:10.099 --> 00:23:13.983
about it to dissuade them
from this kind of behavior.

00:23:13.984 --> 00:23:19.249
I would suggest if something like this
occurs to report it to your supervisor

00:23:19.250 --> 00:23:25.293
because it might occur with another staff
member on your day off or another shift.

00:23:25.294 --> 00:23:30.409
Okay. So to take away the element of surprise
for another staff member I think it\'s

00:23:30.410 --> 00:23:33.048
important to to tell someone It also

00:23:33.049 --> 00:23:36.318
made me just to talk it through
because maybe you do feel offended.

00:23:36.319 --> 00:23:41.193
Maybe you are upset by it maybe you weren\'t
successful in redirecting someone.

00:23:41.194 --> 00:23:44.329
So I think to brainstorm
with your supervisor or

00:23:44.330 --> 00:23:48.559
your co-workers and to document it document

00:23:48.560 --> 00:23:52.038
the facts not your feelings but
just to inform others what\'s going

00:23:52.039 --> 00:23:56.088
on I started here as a
senior in high school.

00:23:56.089 --> 00:23:58.713
Very young very naive.

00:23:58.714 --> 00:24:03.139
Long ago and it was my second day on

00:24:03.140 --> 00:24:09.018
the job and I worked in activities and I
was asked to do quality of life interviews

00:24:09.019 --> 00:24:13.849
and I approached a gentlemen\'s
room his door was

00:24:13.850 --> 00:24:16.848
closed So I did the appropriate thing and I

00:24:16.849 --> 00:24:20.734
knocked and he happily
invited me in the room.

00:24:20.735 --> 00:24:24.109
So you have to remember
that I was 17 years old.

00:24:24.110 --> 00:24:30.919
So I walked into the room and
at that moment in time I had

00:24:30.920 --> 00:24:38.449
absolutely no idea that he was
masturbating so I approached the bedside.

00:24:38.450 --> 00:24:42.588
And I started talking to him
about this Quality of Life

00:24:42.589 --> 00:24:47.568
interview as it was supposed
to do as he continued

00:24:47.569 --> 00:24:50.629
to masturbate And then I\'m

00:24:50.630 --> 00:24:54.109
starting to kinda realize and I\'m
starting to feel a little bit

00:24:54.110 --> 00:24:58.039
uncomfortable and before I could do

00:24:58.040 --> 00:25:03.963
anything he physically grabbed me and
pulled me on top of him in the bed.

00:25:03.964 --> 00:25:07.939
So again I\'m not a nurse.

00:25:07.940 --> 00:25:15.940
I\'m not a CNA it scared me and I guess
what was really frustrating for me

00:25:16.895 --> 00:25:24.895
was that lack of communication from everybody
who knew what this gentleman did and yet.

00:25:27.559 --> 00:25:35.559
Sorry. Nobody shared
that information Great.

00:25:36.750 --> 00:25:42.339
Well thanks for sharing that story
you know what\'s remarkable is that

00:25:42.340 --> 00:25:47.289
you stayed on the job and here
you are after all these years

00:25:47.290 --> 00:25:49.389
I think a lesser person
would have run out of here

00:25:49.390 --> 00:25:53.093
screaming and would have said
this is not the place for me

00:25:53.094 --> 00:26:00.338
you know so you hung in there I was very
shaken up that day I actually left early.

00:26:00.339 --> 00:26:05.379
I went home I said to my boyfriend
who\'s still my husband as of

00:26:05.380 --> 00:26:10.809
today 20-30 years later and he said well

00:26:10.810 --> 00:26:13.778
you need to leave that place and I said

00:26:13.779 --> 00:26:20.574
no I need to make a difference
in that place and so

00:26:20.575 --> 00:26:25.614
it just gave me that initiative and
you spoke about it earlier about

00:26:25.615 --> 00:26:28.944
great communication and about

00:26:28.945 --> 00:26:33.008
knowing your residence and what\'s
going on with them that\'s right.

00:26:33.009 --> 00:26:37.628
Thank you yeah I\'m sure this
is not the first experience of

00:26:37.629 --> 00:26:42.338
someone walking in on this guy and you
didn\'t have the benefit of anybody.

00:26:42.339 --> 00:26:45.549
Preparing you Well how do you
know unless someone says.

00:26:45.550 --> 00:26:47.709
Let\'s have a huddle at 17 meeting.

00:26:47.710 --> 00:26:50.348
Let\'s tell you about each
of your residents that

00:26:50.349 --> 00:26:53.810
you\'re carrying for today
thanks for sharing that

00:27:07.500 --> 00:27:12.549
And we\'re going to delve into the
topic of consent and how to assess if

00:27:12.550 --> 00:27:17.513
somewhat is consensual to participate
in either intimate or sexual behaviors.

00:27:17.514 --> 00:27:21.639
So let\'s talk about resident
to resonant relationships

00:27:21.640 --> 00:27:26.333
of course this is their home and they
live in a co-ed living situation.

00:27:26.334 --> 00:27:30.818
Men and women living
together 247 every day of

00:27:30.819 --> 00:27:36.248
the year so a friendships between races
really should not be surprising right.

00:27:36.249 --> 00:27:40.419
But sometimes these friendships
may become physical in

00:27:40.420 --> 00:27:45.768
nature So let\'s talk about those
special relationships there are

00:27:45.769 --> 00:27:48.619
uncommon but when they do
happen I think we need

00:27:48.620 --> 00:27:52.129
to respect them in fact I
would go so far as to say we

00:27:52.130 --> 00:27:55.834
should celebrate them because
sometimes people will

00:27:55.835 --> 00:28:01.219
find romance here and this will
be a happy occasion for them this

00:28:01.220 --> 00:28:05.778
may sustain them during the course of their
their stay here do you think people with

00:28:05.779 --> 00:28:11.103
dementia can actually consent to
participate in sexual relations.

00:28:11.104 --> 00:28:17.928
Okay. So okay so it\'s going to depend upon

00:28:17.929 --> 00:28:24.424
the severity of their dementia Okay would you
agree that somebody in the early stages.

00:28:24.425 --> 00:28:29.449
Perhaps. Can\'t consent to
participate in sexual relations.

00:28:29.450 --> 00:28:33.619
So you might draw the line at the
severity of the dementia that would be

00:28:33.620 --> 00:28:39.709
the telling thing for you so I like
to show this rather provocative photo

00:28:39.710 --> 00:28:44.268
I want you to take a good look at
that this was actually a photo from

00:28:44.269 --> 00:28:49.279
Newsweek magazine a few years
ago and the the headline is

00:28:49.280 --> 00:28:53.568
rather provocative it says sex love and
nursing homes and the byline at the bottom

00:28:53.569 --> 00:28:58.639
says forget Bingo for some risky senior
citizens Romance is the name of the game.

00:28:58.640 --> 00:29:05.928
Why intimacy matters to the Medicare set
To me it\'s rather ages kind of view of

00:29:05.929 --> 00:29:09.619
things but as you take a
look at those two people oh

00:29:09.620 --> 00:29:11.449
what what are your thoughts and

00:29:11.450 --> 00:29:14.569
feelings and if we could just take
a few moments with the microphone.

00:29:14.570 --> 00:29:19.758
If you would just share how
you perceive this picture.

00:29:19.759 --> 00:29:22.879
Go ahead brett Do you have an idea
what\'s your thought you want to share

00:29:22.880 --> 00:29:26.193
the microphone was someone
go ahead it\'s nice.

00:29:26.194 --> 00:29:28.788
It\'s a nice picture why
do you say it\'s nice.

00:29:28.789 --> 00:29:31.893
Getting talking enjoying.

00:29:31.894 --> 00:29:35.569
Okay. So it\'s very sweet.

00:29:35.570 --> 00:29:39.588
Very sweet Okay anybody else Want to add to

00:29:39.589 --> 00:29:46.984
that say again they\'re
not lonely anymore okay.

00:29:46.985 --> 00:29:49.999
So maybe they were alone and now they have

00:29:50.000 --> 00:29:54.809
a special friend and some
of that pain of loneliness.

00:29:54.810 --> 00:29:59.778
Maybe diminished or gone altogether
as a result of finding each other

00:29:59.779 --> 00:30:07.779
ok so am I correct in saying everybody has
a very positive view of this picture okay.

00:30:09.230 --> 00:30:16.398
However let me ask you if that
gentleman was your father

00:30:16.399 --> 00:30:20.179
and your mother was living at home in

00:30:20.180 --> 00:30:25.128
the community In other words after
many years of care at home.

00:30:25.129 --> 00:30:31.489
Your father developed dementia and your mother
sent him to a place and he found himself

00:30:31.490 --> 00:30:34.609
with this other woman would
you feel any different

00:30:34.610 --> 00:30:38.374
now about this picture would it be a sweet.

00:30:38.375 --> 00:30:41.193
Well hola boy.

00:30:41.194 --> 00:30:44.329
But he can\'t help it and that
is dementia it\'s dimension

00:30:44.330 --> 00:30:47.359
you can\'t change it I mean it would

00:30:47.360 --> 00:30:54.499
be the feelings where me and medianal he
got mentioned that\'s my 0s there okay.

00:30:54.500 --> 00:31:02.500
So you would try to understand his perspective
on things they do And then second.

00:31:04.534 --> 00:31:09.709
What\'s that you wanted to see them
happy you want to see him happy

00:31:09.710 --> 00:31:16.543
okay no it\'s not your mom I
mean he\'s happy you want long.

00:31:16.544 --> 00:31:20.358
Very good. Yes. Here\'s my example but let

00:31:20.359 --> 00:31:24.048
me ask you how would your mother
feel about this other woman

00:31:24.049 --> 00:31:32.049
Well I\'m waiting time all very well
and she would be somewhere out. Ok

00:31:33.844 --> 00:31:36.558
so you would guarantee that they could have

00:31:36.559 --> 00:31:39.408
this special relationship as long as

00:31:39.409 --> 00:31:43.383
your mother was not bothered by it or
did not see it until she wouldn\'t know.

00:31:43.384 --> 00:31:47.014
She wouldn\'t necessarily know There okay.

00:31:47.015 --> 00:31:49.018
So you\'re not going to tell your mother.

00:31:49.019 --> 00:31:53.269
Any other thoughts about that hole that go

00:31:53.270 --> 00:31:58.278
ahead what happens when that relationship
goes to the next level what happens

00:31:58.279 --> 00:32:00.468
when that relationship goes
to the next level so we

00:32:00.469 --> 00:32:02.748
take it from the intimacy the holding hands

00:32:02.749 --> 00:32:07.953
and the talking and flirtatious
to the level of sex.

00:32:07.954 --> 00:32:12.708
I don\'t know you tell me what happens.

00:32:12.709 --> 00:32:16.608
Oh so you\'re thinking
about the wife now and

00:32:16.609 --> 00:32:21.918
her feelings she might feel
betrayed she might feel this is

00:32:21.919 --> 00:32:29.919
inappropriate and let\'s just presume also For
the sake of argument that this woman that

00:32:31.549 --> 00:32:39.394
this woman is less impaired than the
man and she has become quite assertive

00:32:39.395 --> 00:32:43.159
and aggressive with him
he\'s more impaired that she

00:32:43.160 --> 00:32:48.479
is would this make any
difference with this picture.

00:32:49.180 --> 00:32:57.018
Tell us tell us why would make a difference
to you well so much in pair in it he\'s

00:32:57.019 --> 00:33:04.503
not or vice a versa when would I
want that for my mom or my dad.

00:33:04.504 --> 00:33:09.109
No. Okay because it\'s just

00:33:09.110 --> 00:33:15.108
not OK in my eyes okay but in
their eyes they could be right.

00:33:15.109 --> 00:33:16.699
And their eyes it could be right.

00:33:16.700 --> 00:33:19.144
Okay. So this is the rub.

00:33:19.145 --> 00:33:21.859
Isn\'t it you\'ve got
different perspectives on

00:33:21.860 --> 00:33:25.953
this you have one perspective
if you are the resident.

00:33:25.954 --> 00:33:28.849
You\'ve got another
perspective if your spouse.

00:33:28.850 --> 00:33:33.334
You have yet another perspective
if you\'re an adult child right.

00:33:33.335 --> 00:33:37.559
And who\'s to say which
perspect perspective is right.

00:33:37.990 --> 00:33:43.233
So I\'m going to argue however
just for the sake of argument

00:33:43.234 --> 00:33:48.814
that we need to really put an emphasis
on the perspective of the resident.

00:33:48.815 --> 00:33:54.679
Even though they might Irrationally
consider each other to be

00:33:54.680 --> 00:34:01.188
spouses and they might not have any
knowledge that they\'re still married.

00:34:01.189 --> 00:34:06.798
That it would be terrible if we disrupted
this relationship because they seem to

00:34:06.799 --> 00:34:09.559
derive so much enjoyment from it and to

00:34:09.560 --> 00:34:12.874
get in the middle of it might
actually cause some harm.

00:34:12.875 --> 00:34:15.409
How about any other kinds of expressions

00:34:15.410 --> 00:34:18.213
of intimacy or sexuality
that we haven\'t covered.

00:34:18.214 --> 00:34:22.249
Is there any situation that
you\'ve been involved in that you

00:34:22.250 --> 00:34:26.659
found disturbing at first and that you\'d

00:34:26.660 --> 00:34:34.660
like to share we have a couple who
both are widowed And they like

00:34:36.620 --> 00:34:41.509
to as our staff our team
would call it make out in

00:34:41.510 --> 00:34:48.798
the main dining room and this does cause
some people to feel very uncomfortable.

00:34:48.799 --> 00:34:54.349
So really for us it\'s just
about educating the staff.

00:34:54.350 --> 00:34:59.419
It is consensual although
we would like to them to

00:34:59.420 --> 00:35:04.414
do it maybe in a more private
place we offer that but

00:35:04.415 --> 00:35:12.199
ultimately if they would like to
Makeout it\'s their right to do

00:35:12.200 --> 00:35:17.089
so and we just tried to help
them feel as comfortable as

00:35:17.090 --> 00:35:23.343
possible and again provide them place
to be private if they\'d like to be.

00:35:23.344 --> 00:35:27.078
Well I\'m glad to hear that
romance can flourish here

00:35:27.079 --> 00:35:32.029
because in some places people
are uncomfortable with

00:35:32.030 --> 00:35:35.688
that and I\'ve heard cases in which

00:35:35.689 --> 00:35:40.173
staff are are put up by that and
actually prohibit that kind of behavior

00:35:40.174 --> 00:35:44.568
but as you pointed out in this
case it was consensual i it was

00:35:44.569 --> 00:35:48.708
very obvious now some of
their public behavior might

00:35:48.709 --> 00:35:51.609
be off putting To you and others who

00:35:51.610 --> 00:35:54.969
work here who live here and
I think you\'re well within

00:35:54.970 --> 00:36:02.784
your role to try to tell them to reserve
that for maybe a more private space okay.

00:36:02.785 --> 00:36:05.019
But I love the fact that you honored

00:36:05.020 --> 00:36:08.738
their their their desires and

00:36:08.739 --> 00:36:13.088
their their interest in each other
because again I think we\'re

00:36:13.089 --> 00:36:17.349
moving to a place like this it can it

00:36:17.350 --> 00:36:22.299
can disempower people they they
can feel cutoff and lonely and

00:36:22.300 --> 00:36:27.309
40 people to find each other I think it\'s very
calming and they\'ll you\'ll probably never

00:36:27.310 --> 00:36:30.428
experience any kind of
depression or anxiety

00:36:30.429 --> 00:36:34.219
coming from those two As a
result of their togetherness.

00:36:34.220 --> 00:36:37.098
Let\'s delve into some of these issues
because I think it really gets

00:36:37.099 --> 00:36:40.158
into is someone really
able to consent do they

00:36:40.159 --> 00:36:43.328
really know what they\'re getting into all

00:36:43.329 --> 00:36:46.759
right because clearly someone
who\'s lacking consent.

00:36:46.760 --> 00:36:51.034
We have to protect them from harm
they may be used poor judgment

00:36:51.035 --> 00:36:52.968
in a lot of different ways
they might want to wander

00:36:52.969 --> 00:36:56.018
outside the front door
in the middle of winter.

00:36:56.019 --> 00:36:58.024
You have safety issues.

00:36:58.025 --> 00:37:03.784
You\'ve got people who perhaps use poor judgment
with respect to eating that non foods and

00:37:03.785 --> 00:37:06.618
things like that so we clearly people with

00:37:06.619 --> 00:37:10.264
dementia may need some protection
from their own poor judgment.

00:37:10.265 --> 00:37:14.958
So this is where we get into what
I call levels of behavior Level

00:37:14.959 --> 00:37:19.504
one would be consensual
intimacy that means without

00:37:19.505 --> 00:37:24.018
overt sex and I believe that
what is required here as

00:37:24.019 --> 00:37:30.634
a low level of mental capacity
in order to demonstrate consent.

00:37:30.635 --> 00:37:33.214
The stakes don\'t seem terribly high.

00:37:33.215 --> 00:37:37.309
There\'s not a lot of inherent
harm in these kinds of behaviors.

00:37:37.310 --> 00:37:41.494
Except it may harm the sensibilities
of family members who are visiting.

00:37:41.495 --> 00:37:49.495
Okay. And we might be able to educate and
and sort of help families understand

00:37:49.624 --> 00:37:53.899
the nature of these relationships
then it seems to be monogamous it

00:37:53.900 --> 00:37:59.208
seems to be wholesome and Doesn\'t
seem to be causing any harm.

00:37:59.209 --> 00:38:02.268
Level two. However has to do with

00:38:02.269 --> 00:38:06.198
consensual sex acts I think
we\'d all agree that just takes

00:38:06.199 --> 00:38:12.993
it to a new level and then lastly there
is non-conceptual intimacy and sex.

00:38:12.994 --> 00:38:15.573
These are cases where people clearly have

00:38:15.574 --> 00:38:20.209
no idea about the nature of this
relationship and they\'re lacking the ability

00:38:20.210 --> 00:38:23.779
to to fend off someone they they can\'t

00:38:23.780 --> 00:38:28.429
voluntarily participate maybe because they are
too severely impaired with their dementia.

00:38:28.430 --> 00:38:33.213
So consent quite simply refers
to one\'s mental ability to make

00:38:33.214 --> 00:38:35.328
a good decision and to act in

00:38:35.329 --> 00:38:38.763
one\'s own self-interest that\'s
sort of a dictionary definition

00:38:38.764 --> 00:38:42.649
Consent and clearly people
with dementia may not be

00:38:42.650 --> 00:38:46.458
able to safely do complex things
they can\'t drive a car after

00:38:46.459 --> 00:38:50.629
a certain point in time they can
no longer managed money or or live

00:38:50.630 --> 00:38:53.508
alone but of course as we know

00:38:53.509 --> 00:38:56.913
people dimension make simple choices
for themselves all the time right.

00:38:56.914 --> 00:39:00.408
They make a simple choice to get
up out of bed in the morning

00:39:00.409 --> 00:39:04.654
they make a choice to accept a
bath or not to accept a bath.

00:39:04.655 --> 00:39:08.628
So they\'re really capable of
making simple choices for

00:39:08.629 --> 00:39:14.448
themselves but when it comes to
the complex matters about such as

00:39:14.449 --> 00:39:17.148
whether or not to participate
in a sexual relationship that

00:39:17.149 --> 00:39:20.299
might be this gray area that concerns

00:39:20.300 --> 00:39:26.933
all of us But for families sometimes the role
of the so-called surrogate decision-maker.

00:39:26.934 --> 00:39:29.214
These might be the powers of attorney.

00:39:29.215 --> 00:39:32.934
Or that family member who is
the legal representative.

00:39:32.935 --> 00:39:36.443
When it comes to consent to take part in

00:39:36.444 --> 00:39:42.249
either intimate or sexual relationship
that power is not all that clear with

00:39:42.250 --> 00:39:47.079
these legal documents or with
any kind of designated role as

00:39:47.080 --> 00:39:52.588
a surrogate so who then decides
it gets kinda sticky doesn\'t it

00:39:52.589 --> 00:39:56.904
so I\'m going to show you a video now a clip

00:39:56.905 --> 00:40:00.069
of two people who have found each other in

00:40:00.070 --> 00:40:02.708
an assisted living facility
there named Woody and

00:40:02.709 --> 00:40:06.094
Cathy And what do you is had

00:40:06.095 --> 00:40:12.154
Alzheimer\'s disease for about a dozen
years after many years of home-care

00:40:12.155 --> 00:40:15.318
his wife and his daughter
decided that he should go to

00:40:15.319 --> 00:40:18.799
this place that\'s where
you will see Woody and

00:40:18.800 --> 00:40:23.898
eventually he will be paired
off with Kathy and ultimately

00:40:23.899 --> 00:40:30.570
they will walk into his room and they will
take a nap together in his private room

00:40:45.220 --> 00:40:53.220
Place what\'s go somebody
doesn\'t needs I had spent

00:40:55.669 --> 00:41:03.669
my funded both this beautiful
museum but lucky for us we

00:41:04.960 --> 00:41:11.958
felt bad about where I should

00:41:11.959 --> 00:41:19.959
go in with a high volume.

00:41:24.730 --> 00:41:30.349
So we don\'t have So anybody in

00:41:30.350 --> 00:41:36.900
here I don\'t think so let\'s see No.

00:41:40.390 --> 00:41:48.390
You\'re gonna sit down as
nice I\'m glad you\'re here

00:42:00.010 --> 00:42:02.479
do you want to write down.

00:42:02.480 --> 00:42:09.809
Yeah like a gold rush

00:42:32.680 --> 00:42:39.768
They believe that there are
married to each other right Kathy

00:42:39.769 --> 00:42:46.593
says he\'s my husband and how did he
respond you remember he says we\'re lucky.

00:42:46.594 --> 00:42:51.378
We\'re lucky. Okay. And I think
they are lucky to have each

00:42:51.379 --> 00:42:58.834
other But do you think this is a
case of an extra marital affair.

00:42:58.835 --> 00:43:04.728
Or infidelity it wouldn\'t agree
with that maybe he is thinking of

00:43:04.729 --> 00:43:12.168
his wife really in you know in
his mind\'s mind we\'re you know.

00:43:12.169 --> 00:43:18.573
But even though it\'s Cathy but it\'s not
really his real life you know right.

00:43:18.574 --> 00:43:23.959
So in his dementia he might be confuse
yeah But he might be pleasantly confused.

00:43:23.960 --> 00:43:29.613
Over the nature of this relationship die
they certainly don\'t appear distressed.

00:43:29.614 --> 00:43:31.939
Not by any stretch.

00:43:31.940 --> 00:43:38.329
Would you agree that this appears
consensual this relationship between.

00:43:38.330 --> 00:43:42.120
Yeah I would agree too.

00:43:43.000 --> 00:43:51.000
So I believe that we need to perhaps documents
that if we think it\'s consensual why it\'s

00:43:52.250 --> 00:43:57.214
consensual and unfortunately we don\'t
have a lot of really good tools

00:43:57.215 --> 00:44:03.184
available to make definitive
judgments about capacity or consent.

00:44:03.185 --> 00:44:07.029
Right We have these rather
crude tools like the beams

00:44:07.030 --> 00:44:11.259
the brief inventory of mental status and
we have the Mini-Mental State Exam.

00:44:11.260 --> 00:44:14.918
This just tells you about the
severity of their dementia.

00:44:14.919 --> 00:44:19.143
I think if there\'s any question
It\'s important to employ

00:44:19.144 --> 00:44:24.579
mental health professional to involve the
primary care physician to use several tests not

00:44:24.580 --> 00:44:29.289
only of cognition but to interview
the affected parties to find out

00:44:29.290 --> 00:44:34.223
from them and to interview the
key staff because you might

00:44:34.224 --> 00:44:37.223
hold a lot of information that

00:44:37.224 --> 00:44:40.328
will be able to interpret this
is indeed consensual or it\'s

00:44:40.329 --> 00:44:47.419
not so I think we really want to support
those who are consensual Right.

00:44:47.420 --> 00:44:50.549
But you have to probably
put this in a care plan

00:44:50.560 --> 00:44:55.638
we work in highly regulated
environments and if there\'s

00:44:55.639 --> 00:44:59.868
any kind of lack of
clarity I think it might

00:44:59.869 --> 00:45:05.190
come back to haunt you because
family members may be upset.

00:45:05.410 --> 00:45:09.649
There have even been lawsuits
over this kind of thing

00:45:09.650 --> 00:45:14.419
where we\'re all worried about state
regulators federal regulators

00:45:14.420 --> 00:45:18.348
who might come in surveyors
and unless something is

00:45:18.349 --> 00:45:23.969
written down we are opening
ourselves up to scrutiny

00:46:11.530 --> 00:46:17.314
That\'s wonderful aw I\'m roundwood hair.

00:46:17.315 --> 00:46:25.315
Here on the right panel you can
do with you and make you come and

00:46:25.370 --> 00:46:28.669
sit there and sit right there it\'s brushes

00:46:28.670 --> 00:46:33.720
hair shirt right there he want
you to sit right down Cathy.

00:46:34.390 --> 00:46:37.459
Very pretty pretty colored

00:46:37.460 --> 00:46:40.908
three years you know what we\'re gonna do
tonight or by going to the Corinthians we\'re

00:46:40.909 --> 00:46:43.638
going to see all the grains and we\'re
going to be singing where they go

00:46:43.639 --> 00:46:47.629
see whether you can you can sing it I

00:46:47.630 --> 00:46:52.009
don\'t know if I can can you know
sort of you know but I\'m glad I can

00:46:52.010 --> 00:46:57.063
view it as we go Okay good or I can\'t.

00:46:57.064 --> 00:47:05.064
There we go. Good to see you back later
will be where actually there she lander.

00:47:12.130 --> 00:47:15.349
What do you have an
interesting life he walked

00:47:15.350 --> 00:47:18.079
into the room with his girlfriend
and he left with his wife.

00:47:18.080 --> 00:47:26.080
So tell me his wife three action
what do you pay with understanding.

00:47:26.315 --> 00:47:30.619
She appears understanding
she\'s okay with it she

00:47:30.620 --> 00:47:34.879
went right 2M is she\'s like sitting
on his lap she\'s got her arm around

00:47:34.880 --> 00:47:39.904
him this is mine Here now so I mean

00:47:39.905 --> 00:47:42.468
there\'s just has the feelings
inside but she\'s not gonna say

00:47:42.469 --> 00:47:45.213
anything she knows the circumstance.

00:47:45.214 --> 00:47:50.839
She knows that they don\'t get it
and actually this is not unusual.

00:47:50.840 --> 00:47:55.099
I have found that many
spouses reach a point of

00:47:55.100 --> 00:47:59.989
acceptance about these relationships
there was a time in which I

00:47:59.990 --> 00:48:03.694
had a gentleman call me
and his wife was found

00:48:03.695 --> 00:48:06.739
with another man they were
just holding hands but

00:48:06.740 --> 00:48:09.334
they have become very
affectionate and a couple.

00:48:09.335 --> 00:48:13.999
In relatively short time and the staff
had asked the gentleman what should

00:48:14.000 --> 00:48:18.618
we do about this relationship
and he said wait

00:48:18.619 --> 00:48:21.799
a minute She\'s she\'s living there now

00:48:21.800 --> 00:48:26.359
she doesn\'t consider me to be her
husband and she has found someone

00:48:26.360 --> 00:48:30.063
who\'s making her happy I\'m all for it

00:48:30.064 --> 00:48:35.493
because her happiness means everything to be
Now I cannot do anything about or dementia.

00:48:35.494 --> 00:48:37.683
I couldn\'t care for her at home.

00:48:37.684 --> 00:48:41.959
Any longer and if it\'s giving
her joy and meaning and

00:48:41.960 --> 00:48:48.228
a purpose I have to step aside
and let her have her life

00:48:48.229 --> 00:48:53.448
To me that was really touching it
was I think Such an expression of

00:48:53.449 --> 00:48:58.099
love that someone could be so unselfish and

00:48:58.100 --> 00:49:00.349
I believe that\'s what she had done with

00:49:00.350 --> 00:49:04.518
him that she couldn\'t be
there all the time obviously

00:49:04.519 --> 00:49:12.519
and so whatever gave him joy seemed
to be the utmost priority. Yeah.

00:49:13.030 --> 00:49:18.604
But I bet she did the first time it
happened she wasn\'t so accepting.

00:49:18.605 --> 00:49:22.489
I think the first time it must
have been a bit of a shock to

00:49:22.490 --> 00:49:27.454
see that she was replaced by someone else
and that\'s certainly understandable.

00:49:27.455 --> 00:49:32.014
I\'ll tell you another quick story
in that regard I met a woman who

00:49:32.015 --> 00:49:36.619
had cared for her husband at home for
a long long time like this case.

00:49:36.620 --> 00:49:41.659
And she said the hardest day of her life
was the day she had her husband go to

00:49:41.660 --> 00:49:47.254
a nursing home but she said then the
next day was almost the worst day

00:49:47.255 --> 00:49:51.079
but disaster was averted she said
when I went to the nursing home

00:49:51.080 --> 00:49:56.689
the next day I found that there was
already another woman in his life

00:49:56.690 --> 00:50:01.248
within 24 hours he had
found someone and he was

00:50:01.249 --> 00:50:06.724
walking hand in hand down the
hall as she entered the floor

00:50:06.725 --> 00:50:11.239
and she burst into tears
now fortunately there was

00:50:11.240 --> 00:50:16.929
a kindly LPN Who saw this scene
unfold and took her aside and let

00:50:16.930 --> 00:50:22.448
her have a good cry and talk about her story
of caring for him all these years and how

00:50:22.449 --> 00:50:24.924
difficult it was to do that and how

00:50:24.925 --> 00:50:28.673
devastating it was to have him
come here and now to be replaced.

00:50:28.674 --> 00:50:36.143
So quickly by another woman
and she then told me the LPN.

00:50:36.144 --> 00:50:38.679
Said something that I\'ll never forget.

00:50:38.680 --> 00:50:42.428
Maybe there was something maybe there\'s
something about this other woman

00:50:42.429 --> 00:50:46.478
that reminds him of you
and the woman says I

00:50:46.479 --> 00:50:51.129
don\'t know if that was true but
I bought it I had to believe

00:50:51.130 --> 00:50:56.418
it I had to believe he he
desired that connection That

00:50:56.419 --> 00:50:59.808
there was still a bit of
our own relationship still

00:50:59.809 --> 00:51:03.618
there and that he needed a woman in
his life after all we had shared

00:51:03.619 --> 00:51:06.019
the same home the same bed for

00:51:06.020 --> 00:51:11.194
decades and he must have been so
profoundly lonely without me in his life

00:51:11.195 --> 00:51:15.798
and he needed a woman to
take care of him to be with

00:51:15.799 --> 00:51:21.424
him and that set in motion a wonderful.

00:51:21.425 --> 00:51:25.248
Some might say odd relationship that
every time she visited and that woman

00:51:25.249 --> 00:51:29.868
who was with him she enjoyed visits

00:51:29.869 --> 00:51:33.019
with both of them the staff
didn\'t have separate

00:51:33.020 --> 00:51:36.469
them when she went on
outings she took both of

00:51:36.470 --> 00:51:39.169
them So to me that was

00:51:39.170 --> 00:51:44.043
another example of a great love that
that few of us can even imagine.

00:51:44.044 --> 00:51:46.518
But she was able to do it because again in

00:51:46.519 --> 00:51:49.099
very short order she had to
decide am I going to be against

00:51:49.100 --> 00:51:54.783
this are my gotta go with the flow and in the
course of dementia many family caregivers

00:51:54.784 --> 00:51:57.304
decide it\'s best to go with the flow.

00:51:57.305 --> 00:52:01.459
Rather than fights what\'s
going on here so I

00:52:01.460 --> 00:52:05.993
think it says showed me that sometimes
people are quite resilient.

00:52:05.994 --> 00:52:07.849
That they can adapt to some of

00:52:07.850 --> 00:52:10.548
these very difficult situations and

00:52:10.549 --> 00:52:13.729
surprises sometimes I think
we do have an obligation to

00:52:13.730 --> 00:52:17.149
keep families and formed after all
you are the eyes and ears they have

00:52:17.150 --> 00:52:21.258
entrusted the care of a
loved one to you And it\'s

00:52:21.259 --> 00:52:24.124
a very important job that you have to

00:52:24.125 --> 00:52:27.829
protect their loved one and to support
their loved one but they want to be in

00:52:27.830 --> 00:52:30.558
the know they hate surprises
don\'t they they hate

00:52:30.559 --> 00:52:34.879
surprises and so to maybe say in advance.

00:52:34.880 --> 00:52:36.169
Here\'s what we\'re seeing.

00:52:36.170 --> 00:52:41.538
Not to say you won\'t believe what your husband\'s
doing you know just to be very factual.

00:52:41.539 --> 00:52:44.778
You know he\'s found a friend this friend

00:52:44.779 --> 00:52:48.363
happens to be female they seem
to be getting along quite well

00:52:48.364 --> 00:52:51.648
they\'re holding hands it seems to be

00:52:51.649 --> 00:52:56.988
consensual I think it\'s all of
the way you present it Alright.

00:52:56.989 --> 00:53:02.329
So we\'ve got to use our own
judgment here I think we can

00:53:02.330 --> 00:53:07.249
sometimes get hung up on oh
my God this is infidelity or

00:53:07.250 --> 00:53:09.919
extra marital or what would
the wife think we actually

00:53:09.920 --> 00:53:12.649
don\'t know what husbands
and wives might think of

00:53:12.650 --> 00:53:14.868
these things we have to give them

00:53:14.869 --> 00:53:18.468
the opportunity to decide for themselves
and other story I\'ll share with

00:53:18.469 --> 00:53:24.679
you a woman I know called me surely after
her mother went to a nursing home.

00:53:24.680 --> 00:53:29.358
Her mother had been widowed for ten years
and hadn\'t dated during that entire time

00:53:29.359 --> 00:53:34.203
her her mother was now in
her early 80s and had had

00:53:34.204 --> 00:53:38.028
Alzheimer disease probably
seven or eight years And

00:53:38.029 --> 00:53:42.798
upon entering the nursing home within
48 hours she was found in bed with a

00:53:42.799 --> 00:53:47.133
male resident half naked and a staff called

00:53:47.134 --> 00:53:52.609
this woman the adult daughter who
was the power of attorney and

00:53:52.610 --> 00:53:56.478
the legal representative and the
daughter quickly called me the

00:53:56.479 --> 00:54:00.858
social worker for some advice
she says What am I supposed

00:54:00.859 --> 00:54:04.369
to do she says I can\'t even
get my head around the fact

00:54:04.370 --> 00:54:07.909
that my mother is a sexual person
I think we all would agree

00:54:07.910 --> 00:54:10.923
it\'s hard to envision our
parents sexual people right

00:54:10.924 --> 00:54:14.148
it\'s like I don\'t want
to think about that and

00:54:14.149 --> 00:54:17.328
she said I was kind of
horrified at first hearing

00:54:17.329 --> 00:54:21.529
this story but then the staff
told me It appeared to be.

00:54:21.530 --> 00:54:25.098
My mother taking the lead
that she loved this guy into

00:54:25.099 --> 00:54:28.473
the room and this was a
very comfortable kind of

00:54:28.474 --> 00:54:32.029
thing they had found each other
as soon as the daughter had

00:54:32.030 --> 00:54:36.618
left 48 hours earlier and they
have become fast friends.

00:54:36.619 --> 00:54:41.069
So my friend said this woman said to me.

00:54:42.280 --> 00:54:45.679
What should I do and I said what
are your concerns she says well

00:54:45.680 --> 00:54:48.873
I guess I don\'t have to worry
about pregnancy thank goodness.

00:54:48.874 --> 00:54:53.809
She\'s sort of lightened the mood she
says But I was told that this gentleman.

00:54:53.810 --> 00:54:55.563
Had had a girlfriend.

00:54:55.564 --> 00:54:59.794
While living in the community
prior to his admission And I\'m

00:54:59.795 --> 00:55:05.179
kinda worried that she might
get gonorrhea she whispered.

00:55:05.180 --> 00:55:11.359
I can\'t believe I\'m talking about STDs
and my mother at the same time and I

00:55:11.360 --> 00:55:13.908
said well you know that is
a legitimate concern and

00:55:13.909 --> 00:55:17.059
it probably is not something that
your mother has thought of either.

00:55:17.060 --> 00:55:19.759
She says I don\'t even know if
they could figure out how to have

00:55:19.760 --> 00:55:22.368
sex you know my my mother\'s kind of advance

00:55:22.369 --> 00:55:30.369
but nonetheless this is a worry to me and I
said well maybe you could talk to his family.

00:55:30.425 --> 00:55:34.398
So sure enough they raise
this with his family and

00:55:34.399 --> 00:55:39.093
he and they had the gentleman tested
and he was clean as a whistle.

00:55:39.094 --> 00:55:46.624
No STDs And so what ensued
was a great romance.

00:55:46.625 --> 00:55:51.094
Both the son of the gentleman
and the daughter of the woman

00:55:51.095 --> 00:55:55.998
realized that this was indeed
a special relationship they

00:55:55.999 --> 00:56:00.498
treated each other like husband and wife
until this gentleman died two years later of

00:56:00.499 --> 00:56:06.228
a stroke and during that time
they were indeed inseparable.

00:56:06.229 --> 00:56:09.454
And by that I mean they slept together.

00:56:09.455 --> 00:56:12.049
No one even cared about
whether they were having

00:56:12.050 --> 00:56:15.949
sex it seemed to be such a
beautiful relationship together.

00:56:15.950 --> 00:56:20.683
No one concern themselves
about doing is sexual act.

00:56:20.684 --> 00:56:27.498
Alright. And Indeed the woman
with Alzheimer\'s Disease.

00:56:27.499 --> 00:56:32.044
She had a private room but her bed
wasn\'t big enough for the gentleman.

00:56:32.045 --> 00:56:37.414
So what was the solution do you
think they get a bigger bed.

00:56:37.415 --> 00:56:39.289
Both families chipped in and get

00:56:39.290 --> 00:56:47.290
a queen size bed and it eliminated
that the risk of falling out of

00:56:47.570 --> 00:56:53.148
a little bit and quite honestly
the daughter after her mother

00:56:53.149 --> 00:57:00.424
died was so grateful that her mother had
had this Last opportunity at romance.

00:57:00.425 --> 00:57:04.773
She said without her Alzheimer\'s Disease
she wouldn\'t have met this guy and she was

00:57:04.774 --> 00:57:09.408
happy as a lark and she\'ll
she lost him like a spouse.

00:57:09.409 --> 00:57:17.269
So to think about taking away that
possibility you know taking away

00:57:17.270 --> 00:57:20.899
that kind of of romance late in

00:57:20.900 --> 00:57:25.264
her life and even in a nursing home
you know it would have been sad.

00:57:25.265 --> 00:57:28.519
She denied her that opportunity so
I just share with you that story

00:57:28.520 --> 00:57:32.509
because it shows you how families can get

00:57:32.510 --> 00:57:37.219
their heads around this they can they can
struggle a bit to understand the perspective of

00:57:37.220 --> 00:57:40.098
their loved one and reach some kind of

00:57:40.099 --> 00:57:44.419
And the excepted that maybe
it\'s hard for us to fathom.

00:57:44.420 --> 00:57:50.449
So what if the family does say no
I\'m glad you brought that up okay.

00:57:50.450 --> 00:57:54.559
Again I would go back to
the rights of residence.

00:57:54.560 --> 00:57:56.389
The rights to dignity

00:57:56.390 --> 00:58:02.148
free association privacy we really
need to be the voice sometimes of

00:58:02.149 --> 00:58:05.779
the person with dementia
and interpret as best we

00:58:05.780 --> 00:58:10.128
can what this relationship means
to the person with dementia.

00:58:10.129 --> 00:58:18.129
Now I wouldn\'t expect all spouses and children
and others to hop on board immediately.

00:58:18.335 --> 00:58:22.668
Okay for many people
there are denial They\'re

00:58:22.669 --> 00:58:27.453
angry they\'re grieving and perhaps they
will never accept this relationship.

00:58:27.454 --> 00:58:34.623
Ok. But I think we should have a conversation
we should tell them what we\'re seeing.

00:58:34.624 --> 00:58:38.269
Without any judgment and also

00:58:38.270 --> 00:58:42.528
point out what appears to be the
benefits of these relationships to

00:58:42.529 --> 00:58:45.678
the two parties you know people who were

00:58:45.679 --> 00:58:53.679
formerly wanting to get out who were
upset and angry or depressed lonely.

00:58:53.705 --> 00:58:57.108
They now seem to be having
a very meaningful life

00:58:57.109 --> 00:59:02.839
together these kinds of arguments
may sway family members towards

00:59:02.840 --> 00:59:08.238
this acceptance Then again some
others will never accept it so I

00:59:08.239 --> 00:59:11.028
have heard of staff who have
resorted to separating couples

00:59:11.029 --> 00:59:14.149
when they know Mrs. So-and-so
is coming from the outside.

00:59:14.150 --> 00:59:16.069
He\'s coming from a visit.

00:59:16.070 --> 00:59:21.918
It\'s kinda sneaky maybe under handed but I
think this is a way that staff have tried to

00:59:21.919 --> 00:59:24.709
respect the rights of
the residents and also

00:59:24.710 --> 00:59:28.339
tried to respect the
sensitivity of the family.

00:59:28.340 --> 00:59:36.319
So I think that\'s one way of managing
this Also I think we have to be

00:59:36.320 --> 00:59:39.844
careful about who we\'re talking to because

00:59:39.845 --> 00:59:44.119
sometimes people are not the
designated legal representative.

00:59:44.120 --> 00:59:49.849
You have people sometimes for chiming in who
don\'t have the actual authority to speak

00:59:49.850 --> 00:59:52.489
in behalf of somebody with
dementia so you always

00:59:52.490 --> 00:59:55.608
gotta identify who is that
surrogate decision-maker.

00:59:55.609 --> 00:59:59.539
Alright. The spouse might be on
board but the adult child might

00:59:59.540 --> 01:00:03.318
not so you got to really figure out who

01:00:03.319 --> 01:00:06.799
should weigh in on these
matters Debian said

01:00:06.800 --> 01:00:11.313
so if the spouse or is against
it so what happens then.

01:00:11.314 --> 01:00:16.038
So if the spouse is against it and yet
these two people are attracted to each

01:00:16.039 --> 01:00:21.753
other Like bees to honey and you
have found they are inseparable.

01:00:21.754 --> 01:00:25.548
I mean they may cling to each other
desperately like husband wife.

01:00:25.549 --> 01:00:31.248
Okay. Again I would suggest
that we need to figure

01:00:31.249 --> 01:00:33.978
out ways to respect that relationship to

01:00:33.979 --> 01:00:37.368
keep them together except
when others are visiting.

01:00:37.369 --> 01:00:42.424
But there are some spouses and we
have to be realistic. With families.

01:00:42.425 --> 01:00:48.348
When they say well if the family\'s insist
we have to separate these two what is

01:00:48.349 --> 01:00:56.349
the answer we can\'t do that if
we find this impossible right.

01:00:56.434 --> 01:01:00.049
We would have to have one
person Assigned to them

01:01:00.050 --> 01:01:06.109
247 this is not realistic and I have
known some family members who have said

01:01:06.110 --> 01:01:08.778
If you can\'t assure me that
they\'re gonna be separated at

01:01:08.779 --> 01:01:12.424
all times I\'m going to have
my loved one go elsewhere

01:01:12.425 --> 01:01:17.748
and in a few rare cases I\'ve heard of that
happening but I\'ll guarantee you and I never

01:01:17.749 --> 01:01:22.504
heard the follow-up story I will
guarantee you that in facility be.

01:01:22.505 --> 01:01:23.808
You\'ll end up like facility

01:01:23.809 --> 01:01:31.158
a right that people have this desire
to be with someone that they will find

01:01:31.159 --> 01:01:35.629
a partner because they\'re trying to fill
some kind of emotional need their need for

01:01:35.630 --> 01:01:41.520
safety security companionship
must be met one way or the other

01:01:52.620 --> 01:01:58.493
In this part we\'re gonna talk
about these particular topics.

01:01:58.494 --> 01:02:03.909
How do identify non-consensually
intimacy or sexual behaviors.

01:02:03.910 --> 01:02:07.598
Bad is when people are
unwilling or unable to give

01:02:07.599 --> 01:02:12.144
consent to participate in either
intimate or sexual behaviors.

01:02:12.145 --> 01:02:15.519
Secondly we\'re going to talk about
how to respond to these behaviors

01:02:15.520 --> 01:02:19.839
personally and as an organization
because I believe you

01:02:19.840 --> 01:02:24.228
should not be alone responding to these
issues they\'re very sensitive And they\'re

01:02:24.229 --> 01:02:29.614
tough calls and so you need the benefit of
working with a team and entire organization.

01:02:29.615 --> 01:02:34.624
I\'m going to show you a
clip of a video this is

01:02:34.625 --> 01:02:39.588
a continuation of a video
that was done regarding ever

01:02:39.589 --> 01:02:42.124
written Betty in the first
segment that I showed

01:02:42.125 --> 01:02:47.553
earlier Betty was in the early
stages of her Alzheimer\'s disease

01:02:47.554 --> 01:02:52.054
and after that first segment
we filmed effort a year later

01:02:52.055 --> 01:02:56.793
and he was talking about the fact
that now that she was developing.

01:02:56.794 --> 01:03:01.128
Physical care needs he no longer
felt that she was capable of

01:03:01.129 --> 01:03:04.489
participating consensually in in

01:03:04.490 --> 01:03:08.374
a sexual relationship There were times
when she did not recognize him.

01:03:08.375 --> 01:03:12.618
So after all those years he
made that very hard choice of

01:03:12.619 --> 01:03:17.089
having her go into a care facility
I remember once or twice well I

01:03:17.090 --> 01:03:19.309
would just and it\'s a single bed she\'s in

01:03:19.310 --> 01:03:24.409
a regular hospital bed but I would just lay
down beside her and snuggle up next tour and

01:03:24.410 --> 01:03:28.068
just holder and that was
gratifying for me just

01:03:28.069 --> 01:03:32.103
to be able to hold her and to let
her know that I was there for her.

01:03:32.104 --> 01:03:37.039
Now even at the present time in
her really debilitated state are

01:03:37.040 --> 01:03:42.953
there opportunities to either give
affection or receive affection from her.

01:03:42.954 --> 01:03:47.659
I even as she\'s sitting in her Geri
chair I still put my arm around

01:03:47.660 --> 01:03:54.229
her And all the fluff the pillows
for if I cry a little bit.

01:03:54.230 --> 01:03:59.209
I still love her. So much
I wish I could just hold

01:03:59.210 --> 01:04:04.518
her and feel her arms around me
but there\'s no response anymore

01:04:04.519 --> 01:04:08.899
she\'s just there and so we just

01:04:08.900 --> 01:04:13.699
deal with that but I hold her hand all the
time I\'m there I\'m holding her hand and I

01:04:13.700 --> 01:04:16.069
kissed her on the forehead or
what\'s allowing it to kiss her on

01:04:16.070 --> 01:04:20.404
the lips and just tell
her that I love her and

01:04:20.405 --> 01:04:22.848
who I am is constantly reminder that I\'m

01:04:22.849 --> 01:04:26.658
Ev and I\'m the old guy that she
married a lot of years ago it was

01:04:26.659 --> 01:04:32.268
still lesser Very much so
Imagine though if you have

01:04:32.269 --> 01:04:38.314
somebody who is so impaired like
Betty and you see a visitor.

01:04:38.315 --> 01:04:41.584
It might be a spouse it might
be a boyfriend or girlfriend.

01:04:41.585 --> 01:04:45.559
As the case may be who is trying

01:04:45.560 --> 01:04:51.213
to have a sexual relationship with
somebody who was so profoundly impaired.

01:04:51.214 --> 01:04:57.079
Okay. So I want to talk about that you
know how to respond appropriately to

01:04:57.080 --> 01:05:03.379
this I think any incidence of
either real harm or perceived term.

01:05:03.380 --> 01:05:08.508
So maybe you\'ve interrupted and incident
and stop this from from occurring.

01:05:08.509 --> 01:05:13.054
Those kinds of situations need to be
reported immediately In other words

01:05:13.055 --> 01:05:17.778
you just can\'t keep this to yourself
because the chances are this may reoccur.

01:05:17.779 --> 01:05:22.789
And you want the organization to
know about it and deal with it

01:05:22.790 --> 01:05:26.149
properly and in this case
I would make the argument

01:05:26.150 --> 01:05:30.483
that you need to invoke the
organizations abuse policy.

01:05:30.484 --> 01:05:34.938
Now there are several kinds of abuse right
there there\'s physical abuse but there\'s

01:05:34.939 --> 01:05:39.229
also sexual abuse and even if abuses has

01:05:39.230 --> 01:05:43.038
not happened but the
potential is there is still

01:05:43.039 --> 01:05:47.763
constitutes an occasion where the
abuse policy comes into play.

01:05:47.764 --> 01:05:50.869
So abuses for potential abuse or

01:05:50.870 --> 01:05:58.068
actual abuse in which case Every
organization has their own abuse policy

01:05:58.069 --> 01:06:01.324
but what they do share is
that all of them require

01:06:01.325 --> 01:06:04.488
a response that means that there will be

01:06:04.489 --> 01:06:10.819
an investigation and the state regulators
and even law enforcement may be notified.

01:06:10.820 --> 01:06:15.408
For further investigation because
in this case that the rights of

01:06:15.409 --> 01:06:20.468
the resident to be safe and to be
free from coercion has been violated.

01:06:20.469 --> 01:06:22.939
I believe we have a moral as well as

01:06:22.940 --> 01:06:27.289
a legal responsibility to intervene
in these cases immediately.

01:06:27.290 --> 01:06:31.129
Well now I want to talk about
a real case involving two

01:06:31.130 --> 01:06:35.103
people named Henry and data and this
is actually a picture of Henry.

01:06:35.104 --> 01:06:39.904
In a courtroom So I\'ll
tell you a few facts.

01:06:39.905 --> 01:06:46.698
She meaning Donna had late stage dementia
and lived in an Iowa nursing home.

01:06:46.699 --> 01:06:51.514
Her husband visited often by the
way this is a second marriage.

01:06:51.515 --> 01:06:55.534
We know that she had adult
children by her first marriage.

01:06:55.535 --> 01:06:59.659
We don\'t know about his family
situation they apparently continued

01:06:59.660 --> 01:07:04.563
sexual relations in the nursing
home and he was told to stop.

01:07:04.564 --> 01:07:08.088
Due to her inability to consent
This was a judgment made

01:07:08.089 --> 01:07:12.018
by staff at a team meeting and he

01:07:12.019 --> 01:07:15.079
allegedly continued there
was one incident in

01:07:15.080 --> 01:07:20.674
particular and he was later arrested
for sexual assault after her death.

01:07:20.675 --> 01:07:25.158
Between the time of the
incident and the arrest it

01:07:25.159 --> 01:07:30.213
was at relatively short amount of time she
died shortly after this incident occurred.

01:07:30.214 --> 01:07:35.374
Now it\'s not quite clear why the
timing occurred the way it did.

01:07:35.375 --> 01:07:40.488
Alright. But within ten days of
her burial He was arrested for

01:07:40.489 --> 01:07:46.188
sexual assault and ultimately a jury trial

01:07:46.189 --> 01:07:54.189
determined his fate So first of all
just by my description of the story

01:07:56.259 --> 01:08:01.418
what what is what are some red flags
for you what are some concerns that

01:08:01.419 --> 01:08:06.218
you have that what\'s passed the mic around

01:08:06.219 --> 01:08:09.158
again I\'m going to tell you

01:08:09.159 --> 01:08:12.654
the rest of the story but I want
it to noodle this over because

01:08:12.655 --> 01:08:19.734
this is a real case that really ended in a
in a tragedy I think for all concerned.

01:08:19.735 --> 01:08:27.623
Well it you know it concerned me that
she was not she wasn\'t able to consent.

01:08:27.624 --> 01:08:32.129
So I feel that

01:08:32.130 --> 01:08:38.269
That would have been the right thing for
them not to have them arrested but to

01:08:38.270 --> 01:08:44.253
press charges against them
but you know just have

01:08:44.254 --> 01:08:52.254
authorized visits or however you would
do that I mean he was told not to write.

01:08:52.400 --> 01:08:57.274
He was told not to do it and
he\'s still keep doing it

01:08:57.275 --> 01:09:02.509
right right now let me add to the story he

01:09:02.510 --> 01:09:06.709
claimed that when he was with her

01:09:06.710 --> 01:09:12.439
that she could recognize him that there
was still some glimmer of connection

01:09:12.440 --> 01:09:17.808
between them And he was
using mad as his point for

01:09:17.809 --> 01:09:24.479
saying that he should be able to
participate in sexual relations with her

01:09:56.130 --> 01:10:00.489
This was indeed a tragedy
he resigned his post as

01:10:00.490 --> 01:10:05.859
a lawmaker this was devastating
to him it was devastating to

01:10:05.860 --> 01:10:11.888
her family I believe that it probably
could have been prevented as you suggest

01:10:11.889 --> 01:10:15.068
that if they had clearly documented

01:10:15.069 --> 01:10:20.034
things and they\'d come up with a plan
of action to supervise his visits.

01:10:20.035 --> 01:10:24.069
It seems that most people would have

01:10:24.070 --> 01:10:27.878
agreed that she lacked capacity
or consensual ability.

01:10:27.879 --> 01:10:31.708
Due to her severe impairment but
he sought or another way you

01:10:31.709 --> 01:10:35.889
alluded to earlier that
consent is more than

01:10:35.890 --> 01:10:39.888
verbal and that sometimes especially And an

01:10:39.889 --> 01:10:44.328
act of intimacy how do you really
determine what is consent.

01:10:44.329 --> 01:10:49.008
I mean if she clearly wasn\'t saying
No like this other woman her I saw.

01:10:49.009 --> 01:10:51.858
Could it be interpreted as this is

01:10:51.859 --> 01:10:55.623
pleasurable even though I didn\'t know
this person right I\'m okay with this.

01:10:55.624 --> 01:11:00.438
He apparently felt this great
connection to his wife that

01:11:00.439 --> 01:11:05.539
he felt that when he was with her
she could connect with him in

01:11:05.540 --> 01:11:08.358
ways that she can not
connect with anybody else

01:11:08.359 --> 01:11:12.169
and by virtue of that connection
he felt comfortable having

01:11:12.170 --> 01:11:15.709
a sexual relationship
because he previously did

01:11:15.710 --> 01:11:19.728
admit to a sexual relationship with her in the
nursing home at which point they said well

01:11:19.729 --> 01:11:23.508
you can\'t do that anymore So they clearly

01:11:23.509 --> 01:11:27.349
had a difference of opinion here
because the staff didn\'t feel that

01:11:27.350 --> 01:11:31.038
she had the capacity to give
consent and that he was

01:11:31.039 --> 01:11:34.909
exercising perhaps wishful
thinking or he was

01:11:34.910 --> 01:11:38.809
delusional in his thinking
and they felt the need to

01:11:38.810 --> 01:11:43.773
protect her from herself she
could not resist coercion.

01:11:43.774 --> 01:11:48.484
So on that basis I think they felt
like they needed to intervene

01:11:48.485 --> 01:11:53.583
and from what I can gather they
didn\'t document this thoroughly.

01:11:53.584 --> 01:11:56.538
They did not give him a letter
they did not tell him about

01:11:56.539 --> 01:12:01.669
supervised visits to enforce
their worry and this was

01:12:01.670 --> 01:12:07.753
the sad outcome And
furthermore they did not have

01:12:07.754 --> 01:12:10.939
a policy in place nor did
they have a assessment

01:12:10.940 --> 01:12:14.913
that could actually help distinguish
between appropriate and inappropriate.

01:12:14.914 --> 01:12:18.499
I guess I have a question
as to whether or not

01:12:18.500 --> 01:12:22.758
the staff is educated in
the circumstances and what

01:12:22.759 --> 01:12:26.779
their comfort level is with
sexual relations within

01:12:26.780 --> 01:12:31.579
the nursing home because I think
that can play a big role in

01:12:31.580 --> 01:12:36.588
was he doing something beyond
his partners scope or was

01:12:36.589 --> 01:12:42.169
it definitely an intimate relationship that
they had and the staff were uncomfortable.

01:12:42.170 --> 01:12:49.158
This is why I feel very strongly that You
need to document you need to be very

01:12:49.159 --> 01:12:52.159
explicit especially in
cases where he evidently

01:12:52.160 --> 01:12:56.734
thought things were going along quite
well and they made maybe staffer wrong.

01:12:56.735 --> 01:12:59.869
Who knows what was really
in his mind but it led to

01:12:59.870 --> 01:13:03.648
the series of events that ended
up him being arrested and then

01:13:03.649 --> 01:13:10.848
put on tryout I believe was a four-day trial
the jury apparently had two questions to

01:13:10.849 --> 01:13:18.849
answer number one did an assault take place
And they decided that the facts for vague.

01:13:20.734 --> 01:13:24.769
In fact she was living in a
semi-private room and there was

01:13:24.770 --> 01:13:30.798
a roommate who testify that
she could not say for sure if

01:13:30.799 --> 01:13:33.329
they were indeed having sex

01:13:33.670 --> 01:13:40.309
the second question about donnas ability
to consent was never addressed by

01:13:40.310 --> 01:13:44.928
the courts because they didn\'t have to but
they couldn\'t prove that incident actually

01:13:44.929 --> 01:13:50.148
occurred and so they found him
not guilty of sexual assault.

01:13:50.149 --> 01:13:55.248
So it was just a terrible mess I think ultimately
could\'ve been avoided if everybody had

01:13:55.249 --> 01:14:01.279
been onboard from the beginning And
that means management at means.

01:14:01.280 --> 01:14:02.673
Direct line staff.

01:14:02.674 --> 01:14:06.288
Everybody had an awareness
of how to deal with

01:14:06.289 --> 01:14:09.079
this particular situation
and because they\'re

01:14:09.080 --> 01:14:12.318
so rare I think people just say
well we\'ll deal with the situation.

01:14:12.319 --> 01:14:20.319
Best we can but you see what can happen
this could also lead to a civil lawsuit.

01:14:20.690 --> 01:14:24.228
What if for example her
daughters were not satisfied by

01:14:24.229 --> 01:14:27.619
the verdict in this case
and decided they were

01:14:27.620 --> 01:14:30.889
seeking punitive damages from
him as well as the nursing

01:14:30.890 --> 01:14:35.088
home there have been cases where
nursing homes had been fined.

01:14:35.089 --> 01:14:39.889
By the state have also been
sued by families because

01:14:39.890 --> 01:14:45.948
Staff didn\'t work together and
document consent or lack of consent.

01:14:45.949 --> 01:14:48.949
So this gets into very dangerous waters.

01:14:48.950 --> 01:14:52.984
It can be very expensive very
trying emotionally for everybody.

01:14:52.985 --> 01:14:57.438
So we really need to have an open conversation
that\'s really the reason we want to have

01:14:57.439 --> 01:15:02.298
this adult conversation about
all the possibilities.

01:15:02.299 --> 01:15:03.919
So that nobody is selling.

01:15:03.920 --> 01:15:08.089
Like I\'ve gotta solve
this problem on my own

01:15:08.090 --> 01:15:12.499
this is a collective problem that we
need to dissolve together could you say

01:15:12.500 --> 01:15:16.803
something about the intersection
here of the need for staff

01:15:16.804 --> 01:15:21.979
and home and administration to
make a judgment call between

01:15:21.980 --> 01:15:26.989
Autonomy and safety and personally I\'m

01:15:26.990 --> 01:15:32.359
wondering whether our discomfort
with sexuality in older people

01:15:32.360 --> 01:15:34.879
might have led the staff to make

01:15:34.880 --> 01:15:39.933
this decision even though the
wife was perfectly maybe not

01:15:39.934 --> 01:15:44.718
in Normal terms consensual was still

01:15:44.719 --> 01:15:50.628
fine in a sexual relationship and
they came down on the side of safety.

01:15:50.629 --> 01:15:53.988
Yeah well I think this is
always a raging debate in

01:15:53.989 --> 01:15:57.678
any kind of care setting because of all
the liability issues right so there

01:15:57.679 --> 01:16:00.858
could be civil penalties or
criminal penalties and so

01:16:00.859 --> 01:16:04.278
we\'re always erring on the side
of safety and that\'s why I

01:16:04.279 --> 01:16:07.129
think we do have a rights enshrined in

01:16:07.130 --> 01:16:11.193
law to protect individuals
with the right of autonomy

01:16:11.194 --> 01:16:14.778
the right to dignity free association
so somehow we\'ve got to balance this

01:16:14.779 --> 01:16:19.263
out if we\'re really going to deliver
what we call person-centered care.

01:16:19.264 --> 01:16:22.848
We\'re always gonna see life through
the eyes of the person who\'s in

01:16:22.849 --> 01:16:25.038
our care And we\'re going to try to

01:16:25.039 --> 01:16:28.469
balance that out with our
organizational needs for safety.

01:16:28.630 --> 01:16:32.809
It\'s not easy it\'s messy and sometimes

01:16:32.810 --> 01:16:36.408
mistakes are made I think it is
moving in that direction they\'ll

01:16:36.409 --> 01:16:41.029
because you\'re seeing states surveyors
looking at that and wanting to

01:16:41.030 --> 01:16:46.099
find person-centered care and
that\'s a far cry from ten years ago

01:16:46.100 --> 01:16:48.859
so they\'re wanting to see what are you

01:16:48.860 --> 01:16:51.948
doing to meet this individual
not the whole group of

01:16:51.949 --> 01:16:54.769
individuals but this
particular individual\'s

01:16:54.770 --> 01:16:59.373
needs and I think that if
surveyors are on board.

01:16:59.374 --> 01:17:04.353
Some of that fear and I think a lot of
our problem with everything that we do

01:17:04.354 --> 01:17:09.828
is based on fear And really
what it what it says to me.

01:17:09.829 --> 01:17:13.578
Although we want some guidelines
to kind of assist us through

01:17:13.579 --> 01:17:17.208
the entire process I think we\'re

01:17:17.209 --> 01:17:20.868
right in when you look at
person-centered care because

01:17:20.869 --> 01:17:25.068
each case is going to be
very individualized Wilson.

01:17:25.069 --> 01:17:27.690
Right. Very good