Navigating Tensions About Resident Sexual Expression in Alberta’s Continuing Care Homes: a Qualitative Study of Leaders’ Experiences

Introduction In continuing care homes, resident sexual expression is complicated by interpersonal, physical, and social features that are part of congregate living. Little is known about how managers navigate the complexities of these features. Methods We undertook a descriptive, exploratory study to pursue this line of inquiry. We conducted in-depth interviews with 28 participants from a network of managers, clinical ethicists, geriatric specialists, and social workers in Alberta, Canada. Results We present our findings as three dynamic tensions: 1) the tension between how sexual expression should be supported and how it is addressed in care homes; 2) the tension between private and public space in the care home; and 3) the tension between a medical model of care and a conceptualization of sexual expression as an activity of daily living. Conclusions These tensions are connected with sexual rights – specifically, with the rights to equality and non-discrimination, privacy, and autonomy and bodily integrity. Sexual expression can also have physical, social, and emotional benefits for continuing care residents. Thus, the tensions surrounding resident sexual expression ought to be navigated with an approach that acknowledges sexual rights and best upholds them. Policy Implications We suggest that in order to realize the benefits and prevent the harms associated with resident sexual expression, there is both need and opportunity for a coordinated, multi-level approach.