This could be a nursing home or assisted living administrator's ongoing nightmare. On one hand, we want elders to have the best quality of life they can have, whether they live at home, in assisted living or a nursing home. Often – hopefully – that includes friends. And some of those friends may be of the opposite sex.
Many of these elders choose an assisted living center so they can be in comfortable surroundings with services provided and lots of social activity. The family thinks this is terrific. But when Grandpa announces that he and his friend Millie are in love and want to get married, the response is generally one of stunned silence. Can't you just be friends? You know – play cards and go to the movies together? What do you mean you want to get married?
A tougher situation is when there is uncertainty about the elder's mental stability. A friend of mine tells me his dad, who has Alzheimer's disease, used to go into a woman's room at the nursing home, and take off his clothes, clearly intending to get into bed with the woman. He's not sure that the man had any other intentions, but no one at the home wanted to find out. And what about the woman? Was she a willing participant? Did she want him there? And if she did, is she competent to decide?
The sticky question is this: When do people lose their right to chose what they do sexually? Yes, with dementia there are times when sexual "acting out" is evident in public and the person has to be distracted and sometimes removed from the situation. It can be self-stimulation or undressing in public. But what about love? What about consensual sex?
In November 2007, retired Supreme Court Justice Sandra Day O'Connor bravely, and with great love, gave her public blessing to a romance between her husband, whose Alzheimer's no longer allowed him to recognize her, and a woman in the nursing home where they both lived.
Of course, sex wasn't mentioned in the press coverage, and it's none of our business if this was part of the new romance. But what Justice O'Connor has gone through is not unusual with spouses who have mates with advanced dementia. If two consenting people, each with dementia, fall in love, where do staff step in and decide what is proper and what is not? When does the hospital administrator start to worry that one of the families will sue because they will claim their parent was an unwilling partner, or that the parent is not in safe surroundings?