Sally-Marie Bamford, July 2011
The last taboo: A guide to dementia, sexuality, intimacy and sexual
behaviour in care homes, provides care home workers and managers with
information and practical advice on this complex, controversial and
The need for affection, intimacy and relationships for people with
dementia in care homes has too often been ignored and side-lined in
policy and practice. The onset of old age or a cognitive impairment does
not erase the need for affection, intimacy and/or relationships. While
the issues involved can be complex, controversial and sensitive and may
challenge our own beliefs and value system, it is essential that we
understand more about them to foster a more person-centred approach to
dementia care. Care home residents with dementia often have complex care
needs and trying to understand and respond to the more intimate and
sexual aspects of a resident’s personality can be challenging.
Aimed at care home workers and managers, the guide not only provides
essential information on this aspect of dementia care but offers
practical advice to support current work-based practices. Set out in an
accessible and easy-to-read format, this guide includes case studies,
questions, suggestions and a self assessment quiz to promote easy
learning. It also provides a possible pathway for care home managers to
develop a guiding policy on sexual expression in dementia.
The guide for care staff is summarised in 10 key points:
1. Some residents with dementia will have sexual or sensual needs.
2. Affection and intimacy contribute to overall health and wellbeing for residents.
3. Some residents with dementia will have the capacity to make decisions about their needs.
4. If an individual in care is not competent to decide, the home has a
duty of care towards the individual to ensure they are protected from
5. There are no hard and fast rules. Assess each situation on an individual basis
6. Remember not everyone with dementia is heterosexual.
7. Inappropriate sexual behaviour is not particularly common in dementia.
8. Confront your own attitudes and behaviour towards older people and sex generally.
9. Communicate – look at how you can improve communication with your colleagues, managers, residents and carers on this subject
10. Look after yourself and remember your own needs as a care professional