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Sexual Intimacy and Dementia: Fulfilling a Basic Need or Resident Abuse?

June 8, 2015
by Alan C. Horowitz, JD, RN
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Not guilty. After about 13 hours of deliberation, an Iowa jury arrived at a not guilty verdict in the sexual abuse case involving a nursing home resident and her husband. As the national and international media reported, Henry Rayhons, a 78-year-old former state legislator, was charged with sexually abusing his wife, who had dementia, while she was a resident at an Iowa nursing home.(Donna Rayhons was 79 at the time and has subsequently passed away.)

Although Henry Rayhons was exonerated, many skilled nursing facilities (SNFs) are just beginning to grapple with concerns over sexuality and dementia. The issue of balancing the rights of a resident in a nursing home with his/her safety is at the heart of what SNFs must deal with.

The case against Henry Rayhons may be the first time that a husband was charged and prosecuted with sexually abusing his wife while she was a resident living with dementia in a nursing home. This case also illustrates the complexity of sexual intimacy when one or both partners may have a cognitive impairment. Can a person with dementia validly consent to being sexually intimate with another? The answer: It depends.

In the State of Iowa v. Henry Rayhons case, the nursing facility determined that Donna Rayhons lacked the capacity to consent to sexual contact with her husband. On May 15, 2014, during a care plan meeting, the facility informed Henry Rayhons that his wife “did not have the cognitive ability to give consent to any sexual activity,” according to the official complaint. The following week, a roommate of Donna Rayhons reported that she heard noises indicating that the couple was engaging in sexual activity. A surveillance video revealed Henry Rayhons depositing his wife’s discarded undergarments as he left her room the night in question. The facility contacted the local police and Rayhons admitted to having sexual contact with his wife. He also acknowledged that the facility advised him that his wife could not consent to sexual relations because of her incapacity. He was charged and prosecuted for felony sexual abuse in the third degree. Although the jury found Rayhons not guilty, this troubling case raises a host of questions that all SNFs need to answer.

The consent conundrum

Clearly, nursing facilities have an obligation under both federal and state law to protect their residents. They also have an obligation to respect autonomy and resident rights. Unfortunately, capacity is not an all-or-nothing proposition. Residents with Alzheimer’s disease or other forms of dementia may have intact decision-making capacity in the morning but lack that ability in the evening, as is common with sundowning. Decision-making capacity often waxes and wanes. And, a court may rule that a person lacks the ability to make medical decisions but is capable of handling financial matters, or vice versa. How then, can a facility know what the correct path is in a given situation?



Alan C. Horowitz

Partner at Arnall Golden Gregory

Alan C. Horowitz

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