Love, Romance May Still Flourish in the Nursing Home, But Can An Advance Directive Give Residents the Right to a Sex Life?

August 9, 2008 by  
Filed under Anne Holmes, Blog, Health & Fitness

I just read a thought-provoking article which begins, “She was 82. He was 95. They had dementia. They fell in love. And then they started having sex…”

Written by Slate’s Melinda Henneberger, it’s a modern day Romeo and Juliet tragedy titled “An Affair to Remember,” which is somewhat of an ironic title, since it deals with Alzheimer’s and loss. In the article, we read that perhaps a document which doesn’t yet exist — a sexual power of attorney — might have eased the pain all around.

I agree, and I’m all for it. But as it doesn’t yet exist, I’m suggesting that at minimum, Dororthy and Bob could have been protected by an Advance Directive, especially if when issuing it, each had had a frank discussion about their wishes with their Power of Attorney-designee. But that would have involved having some REALLY frank discussions…something few of us might be up to talking about with our parents — or our children.

When Dorothy Met Bob…

This is the true story of Dorothy and Bob (not their real names) who met in their assisted living community. As backstory we learn that:

  • Dorothy, a widow of sixteen years, had married her childhood sweetheart upon his return from WWII, and together they’d raised four children, built a business and traveled the world. She lapsed into dementia following his death.
  • Meanwhile, Bob had been married three times, and prior to meeting Dorothy, had been quite a player within the nursing home, inviting different ladies to dinner nightly.

But once the two met, it’d clearly been love, and according to Henneberger, their relationship had been beneficial for both of them.

“Whenever Bob caught sight of Dorothy, he lit up “like a young stud seeing his lady for the first time.” Even at 95, he’d pop out of his chair and straighten his clothes when she walked into the room. She would sit, and then he would sit. And both of them began taking far greater pride in their appearance.

Dorothy went from wearing the same ratty yellow dress all the time to appearing for breakfast every morning in a different outfit, accessorized with pearls and hair combs.”

The two often spent time at the piano, Dorothy playing while Bob sang. Never mind that he always sang the same song, no matter what Dorothy played, it was clear to all observers that they were happy together.

Bob’s Son Puts a Stop to the Relationship

However, Bob’s son, who had been appointed Bob’s guardian, decided to put a stop to the relationship after walking in on his father and his new girlfriend having sex in Bob’s room.

After getting over his initial sputtering shock, he asked the facility’s staff to ensure that they were never left alone together, then a month later, moved Bob to another nursing home without first notifying either Bob or Dorothy.

We read that Bob was hustled out in greatly confused distress, while Dorothy looked on, perplexed.

Now here’s where the story really began horrifying me:

  • Once Bob was gone, Dorothy stopped eating.
  • She lost 21 pounds, was treated for depression, and hospitalized for dehydration.
  • She sat in the window for weeks waiting for Bob’s return.
  • She doesn’t do that anymore, though: “Her Alzheimer’s is protecting her at this point,” says her doctor, who thinks the loss might have killed her if its memory hadn’t faded so mercifully fast.

Sexual Power of Attorney

In the article, Dorothy’s daughter, who is an attorney, comments (maybe facetiously) that a Sexual Power of Attorney might allow the elderly to control their own sexual experiences when they reach a point of dementia.

I’m not sure how this sort of power of attorney would work or how anyone might go about designating a person to oversee his or her sexual future. The concept however, is very interesting.

Shouldn’t someone have protected the couple’s right to privacy—their right to have a sex life? As the facility manager reminds us in the article, “We were in uncharted territory.”

Certainly there are many questions:

  • Can someone with dementia give informed consent?
  • How do we protect against what might actually be “date rape?”
  • How do caregivers balance safety and privacy concerns?
  • When families object to a demented person being sexually active, are nursing homes responsible for chaperoning?

Manager Say It Was Her “Worst Professional Experience”

  • In all of her years of working with elderly people, this was not only her worst professional experience but was the only one that left her feeling she had failed her patients.
  • She had a particularly hard time staying neutral and detached, she said, because she kept thinking that “if that was my mom or dad, I’d be grateful they’d found somebody to spend the rest of their lives with.”
  • In fact, as a result of the whole experience, the manager, who is 50, had a different version of “the talk” with her 25-year-old daughter, instructing her never, ever to let such a thing happen to her or her husband:
  • “I hope I get another shot at it when I’m 90 years old.”

Dorothy’s doctor also took this experience personally.

  • “Can you imagine as a clinician, treating a woman who’s finally found happiness and then suddenly she’s not eating because she couldn’t see her loved one? This was a 21st-century Romeo and Juliet.
  • And let’s be honest, because this man was very elderly, I got intrigued; my respects to the gentleman.” His patient was happier than he could ever remember; she was playing the piano again, and even her memory had improved.
  • But after the trauma of losing Bob, Dorothy’s doctor came close to losing his patient, he said, adding that most people her age would not have survived the simultaneous resulting insults of depression, malnutrition, and dehydration.
  • “We can’t afford the luxury of treating people like this. … But we don’t want to know what our parents do in bed.”

Henneberger notes the conflicted feelings, writing:“We’re squeamish about the sex lives of the elderly—and even more so when those elderly are senile and are our parents. But as the baby boom generation ages, there are going to be many more Dorothys and Bobs—who may no longer quite recall the Summer of Love but are unlikely to accept parietal rules in the nursing home. Gerontologists highly recommend sex for the elderly because it improves mood and even overall physical function, but the legal issues are enormously complicated, as Daniel Engber explored in his 2007 article “Naughty Nursing Homes.”

At Minimum, WE ALL NEED a Signed Advance Directive

  • I believe that we all need to designate someone to whom we would trust our life to be our attorney-in-fact or proxy.
  • We need to trust this person to not only keep us alive should we find ourselves in a vegetative state or to pay our health care bills when we’re incapacitated
  • We also need to know that this person’s values and beliefs are in line with our own – including our beliefs on sexuality and sexual behavior
  • We need to be able to trust this person to make the same decisions we would make, or at least follow our intent and look out for our best interest

In the case of Bob and Dorothy, I don’t feel that Bob’s son was truly looking out for his father’s best interest. I have the feeling he might have been trying to safe-guard his inheritance or to keep his father “alive-but-lifeless” to satisfy his own need to keep his father around.

Which Leads Me to My Closing Thoughts:

  • First, perhaps immediate family members are not always the best people to designate for such important roles. Certainly this sadly botched love affair shows the incredible intensity and human cost of an issue that, as Dorothy’s doctor says, “We can’t afford to go on ignoring.”
  • And finally, as much as I know that my two adult children don’t want to think their parents or grandparents actually have sex lives, I’m going to send this post to them, and suggest that it’s time we have “the new talk.”
  • And finally, what do you think about this? I hope you’ll make time to talk about this within your families, too.


  • As Baby Boomers we need to recognize that Advance Directives are not just for our parents in the nursing home, they’re for all adults.
  • They’re designed to spell out what kind of treatment we would want if we were to experience a stroke, a heart attack, an auto accident, or some other situation which leaves us suddenly incapacitated, and can protect us at any age.
  • If you or your parents don’t already have a signed advance directive – preferably both a living will and a healthcare power of attorney – in force, you need to take care of this immediately.

Send for my free report on these crucial topics. Just fill in your name and email address in the box below, and click the button that says, “Send me information on protecting myself and my family with an Advance Directive.” Please do it now! None of usknow what tomorrow will bring…


5 Responses to “Love, Romance May Still Flourish in the Nursing Home, But Can An Advance Directive Give Residents the Right to a Sex Life?”

  1. Wondering How You’ll Keep Family Peace While Liquidating Your Parents’ Estate? Author of “The Boomer Burden” Offers Tips to Reduce the Stress : Boomer Lifestyle on August 27th, 2008 1:33 pm

    […] woman with advanced Alzheimer’s (husband in back bedroom dying of Parkinson’s) is completely taken advantage of when […]

  2. C. Shawn Oak, MSSW on October 24th, 2008 4:55 pm

    Self-determination, intimacy, and sexual expression for residents of long-term care facilities is an emerging issue. In a society that historically represses sexual behavior and reeled at the sexual revolution are about to experience a second sexual revolution when the boomers begin entering long-term care and discover the barriers in place to discourage them from being sexual. Moreover, the mantra from the 60s may change from, “Make Love, Not War” to a “Making War on the polices and practices of long-term care, to make love”!

    Add these barriers to the medicalization of a natural behavior such as sexual expression within the context of dementia and Alzheimer’s and the need for a sexual advanced directive becomes more attractive–at least in my opinion.

    I’m working on it.

  3. rent a pod on December 22nd, 2009 1:35 pm

    That’s certainly a said story for both Dorothy and Bob (or whatever their real names might be). It seems no matter what the situation, a preplanned, well thought out discussion when it comes to age and health issues is the only good way at the moment to resolve such conflicts.

  4. Jill on January 29th, 2010 12:11 pm

    I don’t think they should act like wardens. let them live what is left of their lives.

  5. dana@ power of attorney on August 3rd, 2011 12:34 pm

    Thank you for shedding light on an important issue that is often not discussed. In many cases, it’s a situation where a child is fearful the partner is gold digger, or have other dislikes about the companion, and are trying to control their parent’s choice of a partner. It is possible to include statements in an advance health care directive which limit the authority the health care agent has to make decisions in regard to visitors and companions. However, the suggestion to discuss your wishes first and choose an agent with compatible values and beliefs is a valuable one.