Between the sheets: The Secret World of STDs in Assisted Living Facilities

Illustration by Ari Post

For what seems like forever, I’ve been working to raise awareness about the alarming increase in STDs in the over-50 population. The biggest semi-secret is the supposed safety of Assisted Living Facilities (ALFs). All too few are neither aware of, or want to openly acknowledge that our parents and grandparents are still having sex! It’s like when we were kids and we said “yuk” at the idea of our parents “doing it.” Even with Alzheimer’s and dementia, though recent factual memory fades and inhibitions wane, desire remains.

I recently met with an RN who works in an ALF in Florida who confirmed my fears. “People are shacking up all the time,” she said on condition of anonymity, “but nobody really talks about it. It’s often innocent…there are a lot of ‘lost husband/wife’ cases, people pretending to be married because they don’t know any better…They can’t help it. They forget who they are and where they’re supposed to be sometimes. It’s an issue that everyone has come to know, on some level or another, but nobody’s taking any action to discuss it, much less help prevent it.”

Education and acceptance are the keys to unlocking a safer future for our older population. Many people over the age of 50 have never been tested for STDs, much less feel the need to. The majority of safe-sex programs are for the younger generation and statistics show that they work. Our well-seasoned population didn’t grow up talking about STD’s, and they still don’t. They’re often unaware that they could get an STD and, more often than not, doctors don’t consider that these elders are having sex. As a result, they often misdiagnose STD infections.

To find out what is being done about it, I contacted the Executive Director of one of the most respected ALFs in the DC Metro area. In addition to providing leading health and residential support to their residents, she explained the main priority when addressing residents’ sexually active lifestyles is “to protect the residents that cannot make their own decisions.”

While facilities like this one maintain a high degree of resident care, the unfortunate reality is that many facilities don’t, or can’t because of budgetary and staffing circumstances. And though we can’t fight the staffing problem, we can increase the educational element.

Ideally, ALFs could incorporate safe-sex education programs into their activity schedules, similar to those taught in high schools. Also, a conversation about sexual activity and STDs should become a standard part of every ALF intake interview.

It would be easy to blame the health care industry, but the truth is that those actually doing the work are doing the best that they can with what they have, under the legal guidelines set for them. For now, the responsibility of protecting our grandmothers, grandfathers, brothers and sisters ultimately lies with us—as family members, as friends, as a community who cares—to talk to our loved ones and to have “the conversation” about STDs and safe sex.

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