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Few care centers have policies about sex among residents

Iowa case highlights balance between rights and protections for people with dementia

Henry Rayhons listens to closing arguments in Hancock County District Court on Monday, April 20, 2015. He was acquited of the charge of having sex with his wife, who suffered from dementia. (Molly Montag/Mason City Globe Gazette)
Henry Rayhons listens to closing arguments in Hancock County District Court on Monday, April 20, 2015. He was acquited of the charge of having sex with his wife, who suffered from dementia. (Molly Montag/Mason City Globe Gazette)

Did Henry Rayhons, a 78-year-old former state legislator, have sexual intercourse with his wife after staff at her Garner nursing home told him Alzheimer’s disease had robbed her of the ability to consent?

Would it have been acceptable if he had?

The Iowa sex-abuse case involving Henry and Donna Lou Rayhons brought national attention to the question of whether people with dementia can consent to sex — even with their spouses.

Henry Rayhons was acquitted on the charge last Wednesday. But the case highlights the challenge care centers face in honoring seniors’ desires for companionship or sex while working with families who may disagree about what is appropriate later in life, said Ann Christine Frankowski, associate director of the Center for Aging Studies at the University of Maryland Baltimore County.

“We’re more comfortable talking about death than we are about sexuality.” Frankowski said.

Donna Lou Rayhons, 78, died Aug. 8 after battling Alzheimer’s for several years. A week later, Henry Rayhons, a Republican state representative, was charged with third-degree sex abuse, a Class C felony punishable by up to 10 years in prison.

Donna Rayhons’s daughters from a previous marriage butted heads with Henry Rayhons about their mother’s care and worked with the Concord Care Center’s staff to develop the care plan that prohibited sex.

“The scenario is most disappointing to me because of the failure to have advanced discussions and decision-making about sexual intimacy, just like we do for other health-related questions,” said Marianne Smith, a University of Iowa associate professor of nursing who researches dementia.

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Most nursing homes and assisted-living facilities don’t have written policies about sexual contact, instead handling individual cases as they arise, Smith said.

Kara Merritts, Iowa City Rehabilitation and Health Care Center director of nursing, said her facility has never faced a situation in which residents wanted to be sexually active, but staff would talk with family about making it part of the resident’s care plan.

“Sometimes you have to broach those sensitive subjects,” she said.

ManorCare Health Services, which has facilities in Cedar Rapids, Dubuque and Waterloo, sent a statement about its position on intimacy for residents.

“Since every resident’s goals and situation are unique, we work with them individually to create a plan of care that meets their needs while being sensitive to protecting their rights,” ManorCare said. “These meetings may include family members, physicians, staff and other professionals.”

Hebrew Home in Riverdale, New York, encourages sex among elderly residents by giving them access to a privacy room and allowing magazines and movies with explicit content, BloombergBusiness reported in July 2013. The nursing home is one of few in the country with a policy on sexual expression among residents, Bloomberg wrote.

During the trial earlier this month, Henry Rayhons denied having sex with his wife on the date in question. But he said they had been intimate on other occasions at the care center when she showed interest in physical contact.

Non-verbal cues are commonly used by dementia caregivers to know when patients are hungry, tired or need to use the bathroom, Smith said.

“We use behavior as a form of communication when speech is no longer an option,” Smith said. “My experience with people who have dementia is that when they don’t want to do something, they make it known.”

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Frankowski, who is finishing up a five-year study of autonomy in assisted living centers and dementia units, said she’s talked with a lot of seniors frustrated by lack of choice with food, activities and companionship.

She’s also heard complaints about staff who threaten to tell the residents’ children if they see behavior the children may not like.

But as older baby boomers start entering nursing homes in the next five to 15 years, Frankowski sees this altering.

“I’m sure they won’t accept the privacy rules,” she said. “I can see a big change.”

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