Policies Regarding Sexual Expression in Spanish Long-Term Care Facilities for Older People

Abstract

In the last few years, there has been increasing interest in the sexual rights and sexual expression of older people living in long-term care facilities (LTCFs).1-4 Although many of these studies conclude that institutions should implement explicit policies designed to deal with residents' sexual rights,5 little is known about the frequency with which these policies are implemented and what kinds of policies are the most popular.

The few studies published to date, all coming from Anglo-Saxon countries, suggest that these policies are rarely implemented, which may represent a barrier to residents' sexual expression. For instance, one study found that, although most facilities claimed to have a general policy regarding dignity and respect for residents' rights, just 10% of the 198 participant nursing homes specifically mentioned sexuality within these rights.6 Similarly, another study found that two-thirds of 366 nursing homes surveyed did not have a policy regarding residents' sexual expression, even though most of them recognized that there had been problems regarding residents' sexual expression in their facilities.7

We conducted a study to explore the presence and nature of sexual expression policies at LTCFs in Spain. We contacted directors of nursing (DONs) at LTCFs in different Spanish autonomous communities to explain the objectives of the study and to outline the procedure for data collection. Of the 245 who agreed to participate, 152 returned the completed questionnaire (62% response rate). The University of Barcelona ethics committee approved and supervised the entire process.

Participants completed a self-administrated 26-item inventory, each item addressing a sex-related policy and selected from the SexAT questionnaire.8 Specifically, 4 experts (1 DON, 1 psychologist working at a LTCF for older people, 1 head of a regional social service agency in charge of supervising LTCFs, 1 member of the research team) rated each SexAT item in terms of its importance for protecting residents' sexual rights and its relevance in the Spanish context. The 26 items (of the original 69) that consistently presented the highest scores were included in the final version of the inventory. These items were grouped into 4 areas (explicit rights guaranteed, staff practices and behavior, facilitating resources and materials, training and information) according to their content, and their order was randomized. For each item, participants were asked to indicate whether the policy was implemented at their LTCF.

We calculated the percentage of institutions at which each policy was included in the inventory, as well as the mean percentage of policies implemented, for each content dimension and in total. We found greater diversity between policies (Table 1). Although at least 8 of 10 LTCFs implemented some (particularly those related to the explicit recognition of sexual rights and sexual diversity), others were hardly present at all in 40% of centers, such as availability of sexual aids or policies related to training and information. There were important differences in the frequency of items included under each dimension. So, although the presence of sexual behavior policies at Spanish LTCFs seems to be higher than reported in previous studies, it is an area in which institutions need to improve.

Any interpretation of the results of the present study should take into account its limitations. First, our sample was obtained using a nonprobability procedure and from a single country, which limits the generalizability of the results. Second, the presence or absence of policies was derived from DONs' reports and not from objective measures; the potential influence of social desirability, which may have caused respondents to overestimate the implementation of policies, should be taken into account.

Our findings suggest that, although formal recognition of sexual rights and diversity seems to be the norm, specific policies are still not generalized in Spanish LTCFs, so there is still much room for improvement in this field, particularly in areas such as training and availability of resources and materials. The inventory used in this study could be useful for management and staff to establish which policies are implemented and how practices in this area might be improved.