Knowing me, knowing you… Reflecting on intimacy and sexuality at the end of life

A blog post written by Nigel McGothigan, Director of Aged Care and Health Care Education, Australian Capital College

In 1976 ABBA sang to the world “…knowing me, knowing you…”. The sentiment of this phrase, I believe, is the crucible of the Aged Care Diversity Framework (2017).  [1] In knowing myself truly and fully, I can know you and accept and respect you as a unique individual person with your own unique diverse needs. In this actioning of the Diversity Framework, we form the basis for providing aged care services that are evidenced-based, safe and reliable, and able to respond effectively to the level, diversity and complexity of people’s need, particularly at the end of life.

No matter their diverse characteristics, life experiences, cultural background, gender, sexuality, sexual orientation or financial situation, every Australian has the right to have to their individual needs and expectations met without discrimination.

For many, there remains a difficulty in accepting that older adults or those who are at end of life have sexual needs and the right to express them. Simpson et al. (2016) maintains there is no evidence to suggest that the need for intimacy and sexuality immediately stops when a person turns seventy years of age or enters a nursing home. [2]

Because a person is old or dying, does not preclude them from feeling and needing the touch, the love and the presence of another. Sexuality is a fundamental part of the human existence, and sex is an important way of sharing  closeness and expressing love. Sexuality is the feeling of sexual desire expressed through sexual activity. Like intimacy, sexuality is a natural expression of human need. However, for many people sexuality goes beyond the narrow concept of sexual intercourse and is bound up with many of the broader expressions of self such as dress, grooming, speech, attitudes, physical closeness, kissing and hugging.

Perceptions and experiences of quality aged care are linked to positive interactions with aged care workers. Aged care workers have a significant role in encouraging and enhancing the dignity and independence of older people in their care. A competent and quality aged care workforce will understand and be agile in addressing expectations and the complex and diverse care needs of the older person. It is about me knowing you; but how?

One tool is the Aged Care Quality Standards (2019) Standard 1 – Consumer Dignity and Choice which reflects the importance of the individual’s sense of self and having choice. [3] Choice and control are basic human rights that promote an older person’s autonomy and dignity. Supporting older people to have choice and control over care and quality of life decisions ensures that older people continue to be valued members of society and maintain a purposeful life regardless of the care setting in which they may find themselves.

Another tool is the Aged Care Diversity Framework Action Plans (2019). [4] The action plans provide practical assistance in addressing specific barriers and challenges faced by older people with diverse characteristics and life experiences. The action plans were written to address the common general and specific needs for three distinct groups of older Australians who identify as (a) Aboriginal and Torres Strait Islander or (b) Lesbian, Bisexual, Gay, Transgender and Intersex (LGBTI) and gender diverse elders or (c) from a Culturally and Linguistically Diverse (CALD) background. Welcoming, honouring, implementing, and living the plans ensures that we support the needs of older people in a person-centred approach including the period at the end of their life.

It is useful to remember, we have a heart, so be compassionate. We have ears, so listen. We have a mouth, so use our words carefully. We have arms, so lend a hand to others. We have legs, so walk in the steps of other great people before you. We have wisdom and knowledge, so use it to better the world for others. Never forget that what we do or say or what you don’t do or say will impact so many people both positively and negatively. Be true to your vocation, as aged care workers, to be present and active for others in their greatest need. Learn and be mentored by our older Australians. Remember they are the experts of their own body.

References