I can tell you this is something to think about: http://www.bloomberg.com/news/2013-0...sing-home.html


At 8:30 p.m. on Christmas Day 2009, nurse Tiffany Gourley was called to a room at the Windmill Manor nursing home in Coralville, Iowa. She found a 78-year-old male resident who had just had intercourse with an 87-year-old woman. The man, a former college professor, was divorced. The woman, a retired secretary, was married. Both had dementia.

What followed illustrates one of the most complex and unexamined issues facing elderly care facilities as the Baby Boom generation enters old age: How to determine if residents with dementia have the mental capacity to consent to sex.

The Windmill Manor incident and its lengthy aftermath also show that nursing homes, regulators and families are not prepared to deal with that question.

“It ruined my life,” the director of nursing at the time, Karen Etter, said in an interview.

She was fired.

“It’s the most difficult thing I’ve ever had to live through,” said Steve Drobot, the former Windmill Manor administrator.

He was fired, too.

Sex among the elderly, especially those with Alzheimer’s or other types of dementia, is a subject that many of the nation’s 16,000 elderly care facilities have largely been able to ignore. The aging of the Baby Boomers, many of whom grew up in the 1960s sexual revolution, will force more facilities and families to confront the sorts of legal, ethical and moral questions that arose at Windmill Manor.

More than 40 million people are 65 and over in the U.S., according to the Census Bureau. Baby Boomers, those born from 1946 to 1964, began moving into that group in 2011. That shift will help the $120.6 billion U.S. nursing home industry grow by an annual average of 3.6 percent to about $144 billion by 2018, according to industry research firm IBISWorld. The growth might be stronger if not for reductions in Medicare and Medicaid reimbursements and increased use of in-home services.

More than 5 million in the U.S. have Alzheimer’s, the most common form of dementia, the Alzheimer’s Association says. Barring medical breakthroughs, the association expects the number of those 65 and over with Alzheimer’s to grow to 7.1 million by 2025.

The craving for human touch doesn’t vanish with age. A 2007 study published in the New England Journal of Medicine said 53 percent of people 65 to 74 years old and 26 percent of those 75 to 85 reported being sexually active -- that is, having sexual contact such as kissing, fondling or intercourse with another person. Half of those active in the older group reported having sex two to three times a month.

These proportions are likely to grow with the aging of a generation that is sexually freer, living longer and has access to drugs such as Viagra. For those with dementia, intimacy and sex can be a comfort as they gradually lose comprehension of family and friends, research has found.

In Alzheimer’s patients, touch is often the last sense to deteriorate.

“You can get responses from people in the final stages of the disease by giving them a massage or a pedicure,” said Beth Kallmyer, vice president of constituent services for the Alzheimer’s Association.

Elderly care facilities already face changes related to sex as Boomers retire. Rates of chlamydia and gonorrhea among people age 55 and older -- while small -- rose from 2010 to 2011, according to the Centers for Disease Control and Prevention. The number of elderly living with HIV or AIDS is likely to grow as the younger population ages.

Nursing homes have long struggled with episodes of rape in which victims clearly didn’t consent. Sex between the demented raises more-nuanced questions that make it difficult for facility staff to know whether they should report cases of potential abuse to authorities. In cases that are reported, facilities and residents often are anonymous because of state and federal privacy measures.

The story of what happened at Windmill Manor was assembled from hundreds of pages of documents filed with Iowa regulators and courts, as well as interviews. Bloomberg News is withholding the names of the man and woman involved out of respect for their privacy and that of their families.

Windmill Manor is a one-story, red-brick building set on a rise overlooking Interstate 80 in Coralville, a suburb of Iowa City. The 120-bed home is owned by Residential Alternatives of Iowa, part of RFMS Inc. of Galesburg, Illinois, which also runs nursing homes in Illinois and Nevada. Stacey Cremeens, Windmill Manor’s current administrator, declined to comment for this story. RFMS officials didn’t respond to interview requests.

In November 2009, Steve Drobot had been administrator of Windmill Manor for almost a year. Drobot, 51 years old, is a slight, plain-spoken man with a neatly trimmed beard and thinning gray hair. He began working in institutions that care for the elderly in 1993.

“I can honestly say that I loved every day working with the elderly,” he said in a brief interview in Iowa in May. “They have great stories to tell.”

In testimony to the Iowa Board of Nursing Home Administrators, a regulatory body, three staffers who worked with Drobot at Windmill Manor praised him as a caring, hard-working boss who helped out in the dining room and personally responded to resident call lights.

“He was wonderful,” Etter, the former director of nursing, said in an interview.

Etter became a registered nurse in 1991 in a career shift prompted by the end of her first marriage. She later moved to Iowa from Illinois to care for her father, who had Alzheimer’s, and joined Windmill Manor as nursing director in July 2008.

She quickly gained a reputation as a no-nonsense boss. Several nurses told state regulators that Etter warned them they could be fired if they reported any resident incidents to state officials before first speaking with her or Drobot. Etter told Bloomberg News she was enforcing the nursing home’s chain of command.

At about 3:30 a.m. on Nov. 17, 2009, nurse Starla Wheelock checked a woman’s bedroom in Windmill Manor’s unit for residents with dementia. The woman and a man from a room across the hall were in bed talking, naked from the waist down, according to documents filed with state regulators. The woman became upset when the nurse asked the man to dress and return to his room.

The situation wasn’t entirely a surprise. The two had been friendly, holding hands and telling stories, since the man was admitted the week before. The dementia unit coordinator told regulators that the two “gravitated toward” each other, and that the woman called the man by her husband’s name and was calmed by his presence.