Introduction

This chapter deals with how sexual issues are dealt with, both by residents and professionals, in long-term facilities for older people. Sexuality is a valuable dimension of humanity that may be maintained until a very advanced age (Lindau et al., 2007), and even in the presence of severe illness and dependency at least some older adults continue to be interested and involved in sexual behaviours (Benbow and Beeston, 2012).

A particularly challenging situation in this regard is when a person enters a long-term care (LTC) facility, an event marking a turning point in the older person's life. Although it is true that for some older people living in LTC facilities sex does not hold (or no longer holds) an important place in their life, and they simply do not miss it at all (Villar et al., 2014a), other residents see themselves as sexual beings who still experience sexual needs (Bauer et al., 2013), and consequently issues regarding sexual activities can occur in this setting (Lester et al., 2016).

In this chapter, we outline the study in Box 1. We then first identify the barriers that institutionalised older people might face with regard to the expression of sexual interests. We will explore barriers related to the profile of older people living in those contexts, to the attitudes of residents and staff, to the culture of care held in LTC facilities. Second, we will examine how sexual expression might be especially challenging among specific populations of older adults living in institutions, with particular attention being paid to people with dementia and LGBT (lesbian, gay, bisexual, transgender) residents. Finally, some practical implications as regards sexual expression and sexual rights of older people living in LTC settings will be considered.

In the exposition, the intersection between those topics and ageing, gender and sexual diversity issues will be emphasised. These factors are by themselves systems of inequalities, as they have material consequences and influence life chances (Veenstra, 2011; Calasanti and King, 2015). In our view, their effect in a closed context such as a LTC facility, in which living options are limited and deeply influenced by staff and institutional practices, might intensify inequalities and increase the risk to curtail sexual rights of certain collectives.