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Q. I have been a friend of a woman for 30 years who now resides in an assisted living facility.  She has a mild form of Alzheimer’s. She has expressed a desire to resume what was once a sexual relationship. While I find her very attractive, I am unwilling to have sex unless I can be sure she is capable of giving informed consent. I have asked the officials at her facility if I could speak with her social worker only be told they do not have one. I believe her daughter has power of attorney for her, but I think asking the daughter for her opinion would be very embarrassing for my friend and probably the daughter as well. We had dinner a couple of weeks ago for her birthday, and she did not indicate any interest (or disinterest) in having sex on that occasion, and I did not suggest it. What do you suggest?

Peggy Brick says:  You are wise to be cautious about resuming your relationship without an opportunity to check your friend’s cognitive ability to give consent. Ideally, the facility would have a sexuality policy to help you. Alas! Not even a social worker to give you advice. And unfortunately, children of residents often disapprove of a parent’s relationship. Below are some suggested ways to determine consent. Perhaps you could contact the agency’s ombudsperson. If you’d like to discuss this further, contact me using the links below this answer.

Assessing Competency to Engage in an Intimate Relationship
A resident’s capacity to decide to have an intimate relationship should not be based on a one-size-fits-all concept.The following criteria are suggested for inferring sexual capacity:

1. Voluntariness. A person must be able to voluntarily decide with whom he or she wants have an intimate relationship. There should be no coercion.
2. Safety. Both participants should be reasonably protected from harm, such as transmission of a sexually transmitted infection or psychological harm (e.g., undesired separation.
3. No exploitation. A person should not be taken advantage of by a person with more power or status.
4. No abuse. There should be no abuse of psychological or physical nature.
5. Ability to say “no.”  A person should be able to say “no” either verbally or non-verbally and to extricate him- or herself from an unwanted situation.
6. Socially appropriate time and place.

Ideally, a staff team – possibly nurse, social worker, activities director, and administrator – might meet and be charged with the responsibility of determining if the resident is aware of the relationship and/or behavior and is capable of making a decision to engage in sexual behaviors. The following would be discussed:

a)  Is the resident comfortable with the person who is initiating the contact?
b)  Is the resident comfortable with the activities?
c)  Is the resident safe when engaged in these activities?
d)  Are the thoughts and feelings about the activity clear, ambivalent, negative, confused?
e)  Is the resident able to say no to unwanted behaviors?
f)   What is the impact on staff and other residents of any public displays of affection?
g)  How should the family be involved in this situation?
h)  Are there other questions that are raised by the situation that need to be addressed?

If answers to these questions are unclear, establish a plan to attempt to answer the questions before engaging in sexual activity.

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