Understanding sexual misconduct in aged care

Most sexual harassment of older Australians occurs in nursing homes. And most often, such misconduct is perpetrated by other elderly residents.

In this three-part series, we explain why the majority of such incidents are not matters for the police, outline what responses are available to nursing home operators and residents’ families, and explore how the issue of sexual assault in nursing homes is driving change in the aged care sector.

Under the Aged Care Act 1997, residential aged care providers are required to report indecent and sexual assaults to the police within twenty-four hours of either an allegation being made or suspicions first arising that such an assault has occurred.

There is, however, one important exemption from the Act’s mandatory reporting requirements: providers do not need to lodge a report when an alleged or suspected assault has been perpetrated by a resident with an assessed cognitive or mental impairment.

Elderly residents with dementia, or with frontal lobe damage resulting from senility or a stroke, commonly demonstrate some degree of altered personality. A common change is a significantly diminished interest in sexual activity. As this can extend to an aversion to basic forms of physical affection such as holding hands and kissing, this can be confusing and distressing for the person’s partner and close family.

Even more challenging is when the alterations to a patient’s personality give rise to negative changes in sexual attitude and activity. Around one in five dementia sufferers develop recurring inappropriate sexual behaviours due to cognitive deterioration and impaired judgment. In women, this typically manifests verbally, with patients using foul language or discussing taboo sexual fantasies.

In men, however, it can become overtly physical. Inappropriate sexual behaviours in men can range from indecent acts of self-exposure and masturbation, to non-consensual touching and grabbing of nursing staff, other residents, and visitors. It can run the gamut from unwanted sexual harassment to aggressive sexual assault.

Being subjected to harassment or assault, or merely witnessing such behaviour, is painful and confronting. But when perpetrated by someone with impaired inhibitions and diminished judgment, Australian authorities consider such acts of inappropriate sexual behaviour as medical and psychosocial problems rather than matters for the criminal justice system.

It is important to understand that while sexual activity often decreases in elderly people, sexual interest may not. And in those with dementia, natural sexual urges can give rise to behaviours that the patient cannot recognise as inappropriate or as unwanted by those around them. The challenge is to balance the right of individual patients to express themselves sexually with the right of other patients and staff to be protected from inappropriate and aggressive sexual behaviour.

Striking this balance does not mean inappropriate sexual behaviour is tacitly accepted or simply ignored. Under the Aged Care Act 1997 nursing home operators are responsible for the protection of residents and staff — and also for the welfare of the perpetrators.

The onus is on aged care providers to manage inappropriate sexual behaviour by residents in their care. The law requires that within twenty-four hours of receiving an allegation of sexual misconduct by a resident with an already-assessed cognitive or mental impairment, aged care providers must put in place a strategy for the management of the resident’s behaviour.

Such management strategies, however, ought not be punitive nor overtly restrictive. In close consultation with the families of dementia patients exhibiting inappropriate sexual behaviour, nursing home managers have a range of responses available to them.

In the next instalment of this series, we will canvass the managerial, therapeutic, and pharmacological options available for the management of inappropriate sexual behaviour in nursing homes. Read part two.

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