Breaking taboos: Supporting care home staff to deal with a sensitive subject

For the past year, the Society’s Innovation team has been asking the question, ‘How can we better support care home staff when it comes to the sex and intimacy needs of residents living with dementia?’

‘Sex and intimacy is a taboo subject in general, but when we add age, dementia and care homes to the picture it becomes further shrouded,’ says Beverley Page-Banks, Programme Development Manager.

Beverley says that, although care home staff have the best of intentions, a resident’s needs or rights might be ignored or denied.

‘Sex and intimacy is a taboo subject in general, but when we add age, dementia and care homes to the picture it becomes further shrouded,’ says Beverley.

‘They may still want to hold hands or cuddle with a loved one, to share a bed and maintain a sex life with a partner, or to seek a new partner,’ she says.

‘There are stories where this has been enabled. However, more often than not, care home staff get stuck in a cycle of concern about mental capacity and wanting to avoid any risk at all.

‘This is completely understandable, but it can restrict privacy, rights and choice for people with dementia.’

Workshop in a box

Beverley’s team visited care homes to speak with many staff and people affected by dementia, Over 70 ideas were drawn together to help staff approach this issue in a way that supports residents’ dignity and rights.
 
These ideas were whittled down, and prototypes of two of them were tested with care home staff. This convinced the team to combine them into one solution – a ‘workshop in a box’ called Lift the Lid that enables care homes to run sessions themselves.

Up to 10 staff at a time can take part in a session. This can last for two to three hours or be broken down into 45-minute sections.

Although it’s mainly designed for care home staff, aspects could be adapted for residents and their families too.

Lift the Lid includes a True or False game, with 10 question and answer cards that challenge perceptions and provoke discussion. A second activity, Follow the Heart, uses scenarios and guidance to support important conversations with residents, partners and families. Another, Plan for Change, helps staff to pin down what will make a practical difference in their particular care home.

Sensitive subject

Joanne Howcroft is a Bupa manager who has taken a lead on how her organisation meets the needs of care home residents who have dementia. She has been involved in the project for the past year.

‘It has been an interesting journey and a fantastic experience that has encouraged me to reflect on my own perceptions,’ she says.

‘The final product will help staff realise that relationships do not stop at a certain age or when somebody moves into a care home, and will support building a culture of person-centred care.’

Apple Trees Care and Reablement Centre in Grantham, Lincolnshire, has also taken part in the development process.

‘The sex and intimacy of people living with dementia is an important part of their wellbeing that continues even when living in a care home,’ says manager Denise Booth.

‘The activities give staff the understanding, ability and confidence to respond in an appropriate and respectful manner,’ says Jessica.

‘Lift the Lid helps open up a subject that we don’t talk about very often, so it’s absolutely amazing for us.

‘Employees said that it started conversations around a subject that might at times be quite sensitive to talk about. It also made the topic relaxed, and people felt able to share their own thoughts.’

Jessica, a Unit Manager for Bupa, says that Lift the Lid ‘normalises a conversation that is needed but kept hidden’.

‘The activities give staff the understanding, ability and confidence to respond in an appropriate and respectful manner, and to not react out of embarrassment and fear,’ she says. ‘It will help us to provide dignified care.’

Cultural shift

Staff at some Four Seasons Health Care homes have already made practical changes as a result of Lift the Lid. Residents’ care plans have been reviewed to make sure their emotional and psychological wellbeing is being included.

Discussions about sex and intimacy have been added to staff, resident and relatives meetings. ‘Do not disturb’ signs have also been introduced for some residents’ rooms.

‘Lift the Lid has created the foundation for a cultural shift that has enhanced residents’ experience of their care,’ said Roberta Rocella at Four Seasons. ‘We simply couldn’t praise this initiative more.’

‘Lift the Lid has created the foundation for a cultural shift that has enhanced residents’ experience of their care,’ says Roberta.

Beverley hopes that Lift the Lid will lead to real and positive change across care homes. 

‘We started a conversation about something that we were told is just not talked about, but we and many others have been talking about it ever since,’ she says.

'We would never encourage care homes to adopt blanket tactics or to do anything that could put residents or staff at risk. Instead Lift the Lid helps care home staff to create their own policies based on individual need and consent.'

‘We hope that sex, intimacy and relationships will no longer be seen only as a problem or a behaviour that needs to be “managed”, but as a human right to be respected and supported.’