Does an Elderly Couple Have a Right to a Sex Life?

By Melinda Henneberger, National Post

June 14, 2008

Illustration By Mike Faille, National Post

Bob's family was horrified at the idea that his relationship with Dorothy might have become sexual. At his age, they wouldn't have thought it possible. But when Bob's son walked in and saw his dad's 82-year-old girlfriend performing oral sex on his 95-year-old father last December, incredulity turned into panic. "I didn't know where this was going to end," said the manager of the assisted-living facility where Bob and Dorothy lived. "It was pretty volatile."

Because both Bob and Dorothy suffer from dementia, the son assumed that his father didn't fully understand what was going on. And his cellphone call reporting the scene he'd happened upon would have been funny, the manager said, if the consequences hadn't been so serious. "He was going, 'She had her mouth on my dad's penis! And it's not even clean!'" Bob's son became determined to keep the two apart and asked the facility's staff to ensure that they were never left alone together.

After that, Dorothy stopped eating. She lost 21 pounds, was treated for depression and was hospitalized for dehydration. When Bob was finally moved out of the facility in January, she sat in the window waiting for him. She doesn't do that anymore, though: "Her Alzheimer's is protecting her at this point," says her doctor.

But should someone have protected the couple's right to have a sex life?
"We were in uncharted territory," the facility manager said. We're squeamish about the sex lives of the elderly. But as the Baby Boom generation ages, there are going to be many more Dorothys and Bobs. Gerontologists recommend sex for the elderly because it improves mood and overall physical function, but the legal issues are complicated: Can someone with dementia give informed consent? How do caregivers balance safety and privacy concerns? When families object to a demented person being sexually active, are nursing homes responsible for chaperoning? This one botched love affair shows the incredible intensity of an issue that we can't afford to go on ignoring.

Dorothy's daughter said that her mother asked her to publicize her predicament. "We're all going to get old, if we're lucky," said the daughter. And if we get lucky when we're old, then we need to have drawn up a sexual power of attorney before it's too late. Who controls the intimate lives of people with dementia? Unless specific provision has been made, their families do. And for Dorothy and Bob, that became a problem.

"Who do you love?" Dorothy asked me, right after her daughter introduced us. She'd married her first sweetheart. Together they had four children, built a business and travelled all over the world, right up until she lost him to a heart attack 16 years ago. But she never mentions him now and doesn't like it when anyone else does, either, because how could she not remember her own husband? Her daughter visits every evening, and because Dorothy loves kids, her daughter pays the housekeeper to bring hers over every afternoon.
But even showing me around her well-appointed, little apartment in the nice-smelling assisted-living facility was an exercise in frustration for Dorothy: She joked and covered, but all around were tokens from her past that have lost their meaning for her. "These are all my favourites," she said, pointing to shelves of novels by the Brontes and books about Leonardo da Vinci and Franklin and Eleanor Roosevelt. But her expression said that she couldn't recall why she liked these volumes best, and what I think she wanted me to know is that she once was a person who could have told me. When her daughter mentioned Bob's name, it wasn't clear how much she remembered: "He came and he went, and there's nothing more to say."

So it was left to her daughter, her doctor and the woman who runs the assisted-living facility to explain how this grown woman wound up being treated like a child. "Come back anytime," Dorothy told me sweetly.

Downstairs, I met the woman who runs the facility. In 30 years of taking care of the elderly, she's seen plenty of couples, but none as "inspiring" as Dorothy and Bob. Which is why she keeps a photo of the two of them on her desk. In the picture, Dorothy is sitting at the piano in the lobby, where she used to play, and he used to sing along. She is all dolled up, and they are holding hands and beaming.

Before Dorothy came along, the manager said, Bob was a player and had all the women vying to sit with him on the porch. But with Dorothy, she said, "it was love." One day, the staff noticed that they were sitting together, then before long they were taking all their meals together, and over a matter of weeks, it became constant. Whenever Bob caught sight of Dorothy, he lit up. Even at 95, he'd pop out of his chair and straighten his clothes when she walked into the room. And both of them began taking greater pride in their appearance; Dorothy went from wearing the same dress all the time to appearing for breakfast every morning in a different outfit.

Soon the relationship became sexual. At first, Dorothy's daughter and the facility manager doubted Dorothy's accounts of having intercourse with Bob. But aides noticed that Bob became visibly aroused when he kissed Dorothy good night. His overnight nurse was an obstacle to sleep-overs, but the couple started spending time alone in their apartments during the day. When Bob's son became aware of these trysts, he tried to put a stop to them. When I called Bob's son and told him I was writing about the situation, he passed on the opportunity to explain his perspective. "I don't choose to discuss anything that involves my father," he said.

But according to the facility manager, the son was convinced that Dorothy was the aggressor in the relationship, and he worried that her advances might be hard on his father's weak heart. The private-duty nurse who had been tending Bob also had strong feelings about the matter, said the manager: "At first, she thought it was cute they were together, but when it became sexual, she lost her senses" for religious reasons and asked staff members to help keep the two of them apart.

Employees wound up choosing sides. And because the couple now had to sneak around to be together, their intimacy became more and more open and problematic. At one point, the manager had to make Bob stop "pleasuring her" right in the lobby, where Dorothy sat with a pillow placed strategically over her lap. In all of her years of working with elderly people, the manager said, this was not only her worst professional experience but was the only one that left her feeling she had failed her patients. She had a particularly hard time staying neutral, she said.

One day when Dorothy's daughter arrived to visit, she found Bob sitting in the lobby, surrounded by a wheelchair brigade of dozing people who had been posted around him by the private-duty nurse to block Dorothy from approaching him. That's when Dorothy's daughter got the state involved and started throwing around the word lawsuit, which only made things worse, the manager said. "Once she started talking legal, that pushed things over the edge." The state did send someone in to try to mediate the situation -- but then the mediator was diagnosed with cancer and died. Though the mediator's replacement tried to pick up where he had left off, she was never able to establish a rapport with Bob's son.

Finally, Bob's family decided to move him and insisted that neither he nor Dorothy be told in advance. No one in either family was there the morning Bob's nurse hustled him out the door. Later, the manager called his son and asked if there was any way Dorothy might come and visit just briefly. The son thought about it for a few days and then said no, his father was already settled into his new home and was not thinking about her anymore. The lawyers told Dorothy's family that there was no way they could make the legal case that Bob's rights were being violated by his family, because you couldn't put people with dementia on the witness stand.

Dorothy's son-in-law suspects Bob's son of fearing for his inheritance. Bob had repeatedly proposed for all to hear and called Dorothy his wife, but his son refused to even discuss her family's offer to sign a pre-nup. According to Dorothy's daughter, Bob's son told her, "My father has outlived three wives, including the one he married in his 80s, and your mother is just one of many." But surely Bob's safety was a true concern, too, and maybe his son had religious or moral qualms? "I don't think so," the manager said. "I don't think he meant his dad any harm, but he couldn't see what his dad needed. … He wanted his dad to have a relationship but on his terms: You can sit together at meals, but you can't have what really makes a relationship."

Though Dorothy might or might not remember what happened, "there's a sadness in her" that wasn't there before, the manager said. Bob "gave her back something she had long lost -- to think she's pretty, to care about her step and her stride." She eats in her room now rather than in the dining room. And she no longer plays the piano.

Dorothy's doctor took the experience personally. "Can you imagine as a clinician, treating a woman who's finally found happiness and then suddenly she's not eating because she couldn't see her loved one? This was a 21st-century Romeo and Juliet. And let's be honest, because this man was very elderly, I got intrigued; my respects to the gentleman."

And though the doctor never laid eyes on Bob, in general, he said, the fear of sex causing heart attacks is wildly overblown: "If you've made it to age 95, I'm sorry, but having sex is not going to kill you -- it's going to prolong your life." But after the trauma of losing Bob, Dorothy's doctor came close to losing his patient, he said. "We can't afford the luxury of treating people like this. … But we don't want to know what our parents do in bed."

Then the daughter interjected that Bob's son certainly didn't want to see them having oral sex, and the doctor proved his own point. Holding a hand up to stop her from saying any more, he told her, "I didn't need to know that." Maybe the rest of us do.

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