‘Sexuality is a basic need — it doesn’t stop when a person requires care’
Thinking about others’ sexual desires can be uncomfortable. But when it comes to the elderly and those with physical/intellectual disabilities who need additional care, ignoring sexuality could deprive them of a basic human need, writes Suzanne Harrington
This is a topic that many of us may find both icky and tricky — perhaps until we ourselves reach the age where we become the topic. It’s about the sexual needs of elderly people. As the population ages and longevity increases, are older people expected to live out the rest of their lives as sexless beings? What about those with physical or intellectual disabilities — does the same apply to them? How can the sexual needs of people who cannot access the usual means of meeting sexual partners, through age or disability, be met? These were questions asked by Dutch futures anthropologist Roanne van Voorst when she was researching the future of sex work for her latest book, Six in a Bed: The Future of Love — from Sex Dolls and Avatars to Polyamory.
While interviewing around one hundred Dutch sex workers, she found that a new genre was becoming increasingly prevalent: sex care. This, she says, is “sex provided by professionals to people who are so elderly, ill, physically disabled or intellectually impaired that they cannot use the common route towards having sex with another person.”
Sex care
Van Voorst suggests that even as traditional sex work becomes increasingly criminalised under the Swedish model — which criminalises clients as well as sex workers, thereby pushing the trade underground — “sex care is regarded as one of the possible future directions for sex work to take, a form that will remain legal, while traditional sex work will be further criminalised.” She adds that this criminalisation has not led to a reduction in paid sex, it has just made sex work more dangerous for the workers, rather than the clients. “In Ireland, sex work activists claim that violence has increased 61pc,” she writes.
Sex care, however, is a different dynamic — more humane and compassionate than strictly transactional. Van Voorst mentions a recent Dutch survey which showed that 75pc of carclient’s ers in nursing homes said they had known clients who indicated they had sexual desires.
Van Voorst describes how in several northern European countries, the sexual needs of those long-presumed not to have any are being increasingly recognised.
“In the Netherlands, we now have bureaus that facilitate sex care between potential clients and the sex care workers,” she says. “They work not just in the Netherlands but also in Belgium and Germany. Different bureaus use different terminology — some don’t even use the word sexuality, but will call it ‘cuddle care’ or ‘intimacy care’ ... they spread cuddles, or orgasms, or whatever. But they mainly spread the idea that sexuality is a basic need, like food or water. And the more people understand that it’s there, the more it will continue to grow.
“We have more and more initiatives. There’s an apparatus with sexual images matching the sexual memories of the people in care homes — this is a product being used in quite a lot of nursing homes in the Netherlands. But we need more lobbyists. ”
The apparatus she mentions is an innovation called the Qwiek.up — a mobile machine conceived by Dutch care company Qwiek, which can project images onto the wall of a room, including porn/erotica in a vintage style. Half of all Dutch care homes now have one.
Paul Voncken, the managing director of Qwiek, told Van Voorst how the sexual needs of elderly people remain “A real blind spot… most care organisations are still looking at how to make it mentionable for all concerned.”
Van Voorst is optimistic that change is happening, albeit glacially.
“If you compare the way we now speak about sexuality with how we spoke about it in, say, the 1950s, you do see so much more openness,” she says. “We talk about what is not working too. For those who find it physically hard to do it themselves, a lot of us will readily understand that these people need and deserve help. I don’t think many of us realise that it’s a problem — I certainly wasn’t aware of it myself — and that elderly people remain sexual beings.”
‘The generations I care for would be those in their 80s and 90s, the majority of whom would be full of Catholic sexual repression’
Normalising sexuality
However, when it comes to sexual culture, is the Netherlands a million light years from Ireland? While the normalisation and presence of sex care professionals in Irish care settings, alongside physiotherapists, occupational therapists, art therapists etc is still some considerable way off, what is the current situation regarding those residential clients who still have
sexual needs but can’t log onto dating apps or meet people independently for sexual contact?
I speak to two senior care professionals working in Irish care sites — one in a gerontological setting, the other with those living with intellectual disabilities. For reasons of client confidentiality, both asked to remain anonymous.
“The generations I care for would be those in their 80s and 90s, the majority of whom would be full of Catholic sexual repression,” says the assistant director of gerontological nursing. “Occasionally, there might be a more liberated person with sexual needs but mostly not.
“I have never encountered sex between residents, but definitely romance. A widow and a widower may establish a relationship, and sometimes their families can be appalled but they have no right to be. It’s the right of the two people involved. Equally, we have seen what we call the ‘care home divorce’, where a married couple initially arrive together, but one has higher care needs and the other is experiencing carer’s burden, so they may stop sharing a room.
“Sexualisation is considered an ADL — an activity of daily living — which means we facilitate sexual needs the same as any other need. With people who have cognitive impairments like dementia, it’s all about consent and safeguarding. Capacity can be established in the moment, even if the person will have forgotten it soon after. So we can ask questions to establish consent: ‘Do you want him/her to sit next to you, do you want to hold his/her hand’ — that kind of thing. It is always about consent.
“If someone is masturbating in private and a staff member inadvertently disturbs them, we apologise and excuse ourselves. It’s the person’s private space. We would try to facilitate meeting people’s needs — if a woman wants a sex aid, or a man wants to watch porn, then we would want to facilitate that. It’s about facilitating their quality of life. You can’t ignore that part of people — we need to meet all unmet needs, not just the ones we approve of.”
The other senior professional works within the intellectual disability services, supporting clients whose ages range from 18 to end of life, and who are both residential and living independently.
“It’s a difficult dynamic to navigate,” they say. “The sexual needs of our clients are not formally acknowledged or supported, and it’s difficult for them to meet other people for sexual relationships.
“In our sector, consent would be a huge issue. How we approach client sexuality and their sexual needs would be tied into consent and safeguarding. It’s different for those who live independently, and who may be independently sexually active but for residential clients, this is not the case. There’s a huge part of their lives missing — sex is a basic human need but in Ireland, we are still a long way away from sex care. Lots more work needs to be done.”
Roanne van Voorst remains hopeful that this topic will become more talked about and in time, care and compassion will override our squeamishness as we recognise that active sexuality does not just belong to the physically and intellectually unimpaired, under pension age.
“I think it will become more normalised, depending on the country — although countries can always get inspired by each other,” she says. “It’s a slow process. But we have a greying population, and human sexuality doesn’t stop after 50 or 60 but remains a drive for many people who will need an outlet.
“It can be alienating for people if they are not allowed to express that side of themselves.
“Families express embarrassment if an elderly relative makes sexually inappropriate remarks, which suggests there is a necessity to address this. It is a humane way of helping people to deal with what would otherwise become a frustration. We are slowly starting to understand more about this but for many people, it is still a painful topic. So unfortunately, I think it will be a slow process.”
‘If a woman wants a sex aid, or a man wants to watch porn, we would want to facilitate that. It’s about quality of life — we need to meet all unmet needs, not just the ones we approve of ’