Experts from the Widener University-based Sexuality and Aging Consortium say a groundbreaking Iowa court case illustrates why consumers and long-term care facilities should do more thinking about sex — before they get into trouble.
Whether their parents still want sex probably isn’t at the top of the minds of most people choosing a nursing home for their loved ones.
But experts from the Widener University-based Sexuality and Aging Consortium say a groundbreaking Iowa court case illustrates why consumers and long-term-care facilities should do more thinking about sex — before they get into trouble.
In the Iowa case, Henry Rayhons, 78, a former member of the Iowa House of Representatives, is charged with sexual abuse for having sex with his wife of seven years in her nursing home. She had been diagnosed with Alzheimer’s disease. A doctor at the Garner, Iowa, facility where Donna Rayhons lived, and her two daughters from a previous marriage, concluded she was too impaired to consent to sex.
The case raises complex questions about what constitutes consent for a person with dementia and how nursing homes should prepare for the inevitable: People of all ages want and need sexual contact.
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“Our need for touch is universal, from birth to death,” said Robin Goldberg-Glen, a social-work professor at Widener who is co-president of the consortium.
The group, which includes about 40 experts on sexuality and aging from around the country, educates professionals and students in an attempt to reduce discrimination and advocate “for the rights of people in long-term care to have their sexuality respected and their choices respected,” said co-president Melanie Davis, a sexuality educator in Somerville, N.J.
The consortium is not taking a position on the Rayhons case. It and the family dynamic behind it are complicated. Witnesses say Rayhons was told his wife was not capable of consenting to sex. It’s unclear what kind of contact occurred between them while a curtain was pulled between her side of the room and her roommate’s last May. Semen that matched his genetic profile was found on her quilt and sheet. The roommate complained about noises but did not describe sounds of a struggle.
Henry Rayhons testified Friday that he and his wife held hands, prayed and kissed at her nursing home the day in question, but that they had no sexual contact.
He said any sounds his wife’s roommate heard were him situating his wife in her bed. His wife died in August.
“She was my queen,” he testified. “I miss her every day. I will never take her ring off.”
Rayhons is charged with third-degree sexual abuse, and if convicted could face up to 10 years in prison.
The crux of the case is the question of Donna Rayhons’ ability to consent. Iowa law defines an act as sexual abuse in the third degree if the two parties are not living together as husband and wife, and if one person “is suffering from a mental defect or incapacity, which precludes giving consent.”
Dr. Robert Bender, a geriatrician with Broadlawns Medical Center in Des Moines, testified for the defense Friday, saying a cognitive test in which patients are asked basic questions doesn’t measure parts of the brain that enable people to feel sexual desire. Bender never treated Donna Rayhons, but said he has treated several other Alzheimer’s patients.
Donna Rayhons’ doctors previously testified that her score of zero on that test indicated severe impairment.
Prosecutors played a recorded interview with an investigator that showed Rayhons initially said he and his wife never had sex at the nursing home but later said they had a few times, and possibly briefly on the day in question.
Rayhons, who served nine terms in the Iowa House, testified that he didn’t have sex with his wife that day, adding: “She was not in any mood to have anything at all.”
The defense rested its case Friday. Closing arguments are scheduled for Monday
Davis and Goldberg-Glen think a clear policy and better communication might have headed off the legal confrontation. “There are much more humane ways and caring ways to deal with a case rather than taking legal action,” Goldberg-Glen said.
Figuring out what consent means for someone with dementia is tricky. Responding positively to touch is different from deciding whether you want to buy a new car or would rather have chicken than fish for lunch.
Gayle Doll, director of Kansas State University’s Center on Aging and an adviser to the consortium, said nursing-home leaders often try to guess what residents would have wanted before getting sick.
The current thinking, she said, is that “we become new persons” when we get dementia, and decisions should be based on how we are now. She advocates for assigning the same staff members consistently to residents so that the staff understands unspoken cues.
“People with dementia, we make every decision for them,” she said. “We’ve got to start hearing their voices.”