“Sex. Sex. Sex.” Why in this oh-so-modern day and age and in my ever so pervasive hipness, as well as with years in the health care profession behind me, would a little three letter word, repeated three little times, instill my heart with a cold “Oh, dear me no!” ?
Well, because instead of it being a punch line to a joke, or a friend and I having a personal conversation, or an ad on a movie billboard, it happened to be in my office where I was working as a Social Services Director. The repeated word was from one of the residents I visited with regularly in the nursing home. Ok, I thought. Here is an opportunity to really show how culturally transformed I am!
Oh, yeah, right. Here I am, talking with a 24 year-old gentleman who is raging at the losses he is faced with due to a severe head and spinal trauma. I got to live through my 20s being young, wild, foolish, and at that time thinking I knew it all. I got to live, mostly intact, and certainly by his standards – absolutely intact – to grow old enough now to realize I don’t know nothin’. And how could I possibly know the depth of the sorrow he is sharing by those three little letters – spelling out a word that speaks volumes in regard to what it represents to someone? This can represent the loss of many things--the loss of spiritual, emotional and physical intimacy and the loss of love, fun, closeness, hope, children, power, communication, hunger. There are infinite possibilities for what it represents to this individual – this young person. And goodness knows; it morphs as we age, with what our moods are, and as our relationships change. It is expressed for a myriad of reasons, and then throw in physical and physiological changes and environmental constraints – talk about bringing life to a community!
As we work with a growing generation of younger people in long term care; as the baby boomers come into our communities, as Viagra is a common prescription, we are going to have to become comfortable with sex. Yep, I said it. That word that shakes every nursing home administrator to the core, the un-discussed and mostly un-care planned challenge that residents who are still feeling the sexual feelings and the emotional feelings that they physically want to express – deal with and are embarrassed to discuss. The thing that staff don’t want to have to confront, despite handling death, disease, illness, anger, sorrow, “behaviors,” and having the training and education – sex remains no man’s land. Bedrooms aren’t private when you move into a nursing home. Attitudes about sex are displayed like a peacock in all his glory when sex is brought up in a community.
No one wants to take it on – so welcome, tah – dah – the Social Services Director. Sex is more than a “behavior,” more than an “activity,” more than something to dissect and attempt to “control.” It is as personal and as private as something can be. Here is the perfect example for cultural transformation in a community.
As a Social Services Director I was really fortunate to build relationships with a widely diverse group of individuals. Because of that I was allowed the difficult gift of having to get out of my own way – and remove any pre-conceived ideas I might have had.
Same sex, sex between people who are ill or have physical challenges, safe sex education, “appropriate” sexual encounters (privacy challenges, sex between consenting adults, etc.) – and I discovered that discussing the most intimate details with another human being is humbling. Social Services is more than handling Medicaid/Medicare/Insurance issues, doing MDSs, or doing care plans or assessments. The individuals in this department are more than a resident liaison. They in fact are modeling behavior, modeling culture change – walking the walk, if you will. Because it is all about individuals. All about people as people – not as their diagnosis, not as residents, or patients, or “disabled.”
It is being an advocate at all times for residents and speaking for and educating staff, residents, and families at a highly charged time in health care. I found that this transitional period of health care enjoys more possibility and more potential than I ever thought possible.
With the financial impact related to the cuts in monies allotted to long term care – now we can focus on the thing that we should be all about: people. How to integrate culture change into staff team building, relationships, choices, etc., can be our focus now. Value-based health care can now be created in our communities. This will create the communities that provide home – not merely “homelike.” Indeed, this shift will also generate revenue by creating culturally transformed systems and processes.
Sex is here to stay folks. It’s just one piece of life. How we choose to provide for these special relationships is going to be indicative of how we are going to promote growth for the future for our residents in the larger sense. Supporting and promoting the ability to discuss “uncomfortable” topics, and create an atmosphere based on choice, relationships, dignity and respect is really the simple thing that it boils down to. Sex isn’t the issue – just the example.
