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Sexuality in SNFs: Balancing resident rights and resident safety

April 24, 2014
by Alan C. Horowitz, RN, JD
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"There’s too much sex and craziness that’s going on. Now they’re bringing it to the nursing home, and it don’t [sic] belong there," according to the son of a nursing home resident who recently filed a suit against a New York facility.1 The lawsuit stems from the nursing home’s decision to allow a male stripper to visit the facility and perform as if he were a Chippendale.2

Apart from the merits of the case, this recent incident forces us to consider a growing concern among nursing home administrators—how to handle residents’ sexuality. Is there, as the plaintiff states, "too much sex" going on in nursing homes? The answer: it depends.

The need for love, intimacy, and companionship is a basic human need that people share, regardless of age. But prejudicial and stereotypical views are not uncommon regarding sexuality among nursing home residents. Until fairly recently, the sexual needs—and rights—of nursing home residents have not really garnered the attention they deserve.


Federal regulations provide that married couples in nursing facilities may share a room when both spouses consent to the arrangement [42 C.F.R. § 483.12(m)]. Further, on June 28, 2013, the Centers for Medicare and Medicaid Services (CMS) issued a directive stating that residents have a right to visitors on a 24-hour basis, including same-sex spouses and domestic partners.3

The applicable regulations require facilities to accommodate residents’ "individual needs and preferences" so long as other residents are not endangered [42 C.F.R. § 483.15(e)]. If two residents, legally married or not, want to be together, they have that right. Whatever those residents choose to do, as long as both have the capacity to consent and there is no risk of harm to either resident or a violation of a regulation, it is their right to be together and to have privacy.

The exact number of residents in nursing homes who are sexually active is unknown. What is known is that approximately 1.6 million residents live in nursing facilities. While studies reveal that the prevalence of sexual activity generally declines with age, the elderly population has certainly not abandoned normal sexual intimacy. Sexuality is a basic human need that normal people carry throughout their lives. The sexual needs of the elderly population are similar to the needs that they had when younger, although the frequency, intensity and manner of expression may vary with aging.4

According to a recent study in the New England Journal of Medicine, the following percentages of age groups engaged in sexual activity: 57-64 years of age 73 percent; 65-74 years of age, 53 percent; and for the group aged 75-85 years old, 26 percent.Clearly, a significant proportion of nursing home residents remain sexually active.  



Alan C. Horowitz

Partner at Arnall Golden Gregory

Alan C. Horowitz

Alan C. Horowitz, Esq., is a partner at...