Sexual needs and rights do not disappear just because older people live in long-term care facilities (for convenience, henceforth L-TCF). For instance, Bauer et al (2013) showed that most residents see themselves as sexual beings. In addition, most staff working in L-TCFs commonly report diverse sexual situations involving residents (Villar et al, 2019a). Despite the reported continuation of sexuality, the prevalence of sexual behaviours among older people living in L-TCFs is likely to be lower than for their counterparts living independently in their own homes. Probably for some older people living in L-TCFs, sex does not hold (or not any more) an important place in their life, and they simply do not miss it at all (Villar at al, 2014a). Unquestionably, individuals have the right not to be sexually active in later life, which should be equally supported as the right to continue with sexual relations. However, research in this field has also identified specific barriers that discourage or even prevent older people living in L-TCFs from expressing openly their sexual needs and maintaining their rights to a sexual/erotic life.

In this chapter, we discuss such barriers, paying special attention to the difficulties faced by specific social groups, such as people living with dementia (PLWD) and those identifying as lesbian, gay, bisexual or trans (for convenience, henceforth we will use the abbreviation LGBT). The chapter will also consider further research in this field of knowledge that could help improve sexual expression and help secure the sexual rights of older people living in L-TCFs.

Barriers to sexual expression in L-TCFs

Studies have found L-TCFs are not particularly sex-friendly places to live in, regardless of the country in question (see, for instance, Mahieu and Gastmans, 2012, in Belgium; Bauer et al, 2013, in Australia; Villar et al, 2014a, in Spain; or Simpson et al, 2018b, in England). The reasons given are diverse and interrelated. Some of them are concerned with resident demographics, in light of the high prevalence of chronic conditions (including cognitive impairment), dependency (including some difficulties related to mobility, communication) and polypharmacy (for instance, sleeping pills or anxiolytics) that could potentially impair sexual desire and the ability to engage in sexual activities. However, as well as health-related issues, other barriers may impede even these forms of sexual expression.