Sex Offenders in Long Term Care
Sexuality / Intimacy Education
is Key For Staff  Education!

Oklahoma Sex Offender Long Term Care Facility Bill was passed. Bill number 2704.  
This bill was passed and approved the building of a long term care facility that would
house elderly sex offenders.  They are currently waiting for a company to step forward
who is interested in building a long term care facility specifically for this group.  Years
ago, we did not have registries that held the names of convicted sex offenders.  We did
not have the web to do a search of where sexual offenders are living. You might have a
convicted sex offender in your facility.  

A Perfect Cause web site provides information about this topic. They conducted a study
about the number of convicted sex offenders living in a long term care setting. Every
facility they are placed in leave vulnerable elderly dementia residents at risk.

One advice strongly recommended is a “no touch” policy for any child visiting your
facility. The first and most important issue to consider is that we do not know if the
resident is a convicted sex offender. Secondly, residents and children can pass/transfer
infections and/or illness to one another just by doing something as innocent as
shaking hands. The only other solution is constant supervision and monitoring by staff
when children are present.

At no time should children be left with any resident unsupervised.  Families that bring
their children to visit relatives must provide supervision at all times. The person sharing
a two bedded room with their relative may be someone that has a criminal record.
Definitely remind families to wash their hands upon arrival to the facility and upon
leaving.

If you bring in children’s groups and pre schools into your community, there should be a
no touch policy. The activity staff should be present at all times when children groups
are in your facility and at no time can the group be left unattended.  Remember, not
every child wants to be touched by a stranger.

Every facility should provide sexuality and intimacy education to their line staff. Many
facilities admit that they do not provide any kind of sexuality, intimacy or sexual abuse
education for their staff.  Staff  need to understand appropriate responses and
interventions for a wide range of situations, behaviors, family concerns and staff
concerns. They also need continuous education on gender and lifestyle issues. In
order to provide compassionate care, staff  need continual education.

Sexual abuse is any form of nonconsensual sexual contact, including unwanted or
inappropriate touching, rape, sodomy, sexual coercion, sexually-explicit photographing,
and sexual harassment. It would include situations where the nursing home resident
was forced, coerced, tricked, or manipulated into unwanted sexual contact and where
the nursing home resident is too ill, frail, or mentally incapacitated to give consent. A
nursing home resident can be sexually abused by a nursing home staff member,
another resident, a stranger, or a family member in a variety of situations. (source:
nursing home abuse resource center)

Sexual abuse may be by family, visitors, staff, stranger, volunteers or other residents.
Dementia residents are the most vulnerable because often times they cannot effectively
communicate their experiences. Staff should be aware of signs of sexual abuse and
take immediate action and report immediately. “To date, we have located approximately
1,600 registered sex offenders living in long-term care facilities across America” From A
Perfect Cause.

Signs of Sexual Abuse

It is important that those who are involved with elders, are able to recognize signs of
sexual abuse, to aid in detection and treatment of victims.

The physical signs include:  (source: A Perfect Cause)
  • Bruising on inner thighs
  • Genital or anal bleeding
  • Sexually transmitted diseases
  • Difficulty walking or standing
  • Pain and/or itching in the genital area
  • Exacerbation of existing illness
  • Lack of appetite
  • Unable to sleep

Additionally watch for signs such as:
  • Genital infections
  • Frequent urinary infections
  • Bite Marks
  • Refusal to be washed in genital area
  • Difficulty walking or sitting
  • Torn or stained underwear
  • Suck marks on body

Emotional signs include:
  • Scared or timid behavior
  • Depressed, withdrawn behavior
  • Sudden changes in personality
  • Odd, misplaced comments about sex or sexual behavior
  • Fear of certain people or of physical characteristics
  • Usually sleeps with light off and now wants the light on

Additionally you might see:
  • Increased wandering
  • Increased outbursts
  • Violent behavior / striking / hitting / spitting
For a comprehensive list of indicators see Looking Beyond the Hurt. This is an excellent
training manual for your staff.

A Perfect Cause recommends Criminal Back Ground Checks of your residents so that
you are aware of their back ground and weather you wish to admit them. At minimum,
the question that should be on your admission paper work and is the same question
that is on employment applications is: Have you ever been convicted of a crime? This is
not a new concept. Many HUD subsidized senior housing buildings are required to ask
this question. At minimum all staff should have a police / criminal back ground check
conducted prior to employment.

Be aware of abuse indicators by an abuser. (Source: Looking Beyond the Hurt)
  • Refuses to permit hospitalization / diagnostic tests or assessments by social
    workers.
  • Ignores senior’s hospital admission  (doesn’t visit) or is always there so the
    senior
  • can’t speak to a health professional alone.
  • May refuse to participate in discharge planning to take senior home.
  • Impatient with staff/ procedures
  • Appears fatigued / stressed
  • “Blames” senior (e.g., for incontinence, wandering, etc.)
  • Responds defensively when questioned: makes excuses or is hostile,
    suspicious, irritable, demanding
  • Does not want senior interviewed alone
  • Excessively concerned or unconcerned about the senior
  • Treats senior like a child or non person
  • Has minimal eye, facial, physical or verbal contact with older person.

Because of lack of education dealing directly with sexuality, intimacy and sex abuse,
caregivers are not able to identify sexual abuse. Additionally, they are not trained to
report nor do they know how to handle the situation.  This continues the abuse due to
lack of education on the part of the care givers.  

Should a sexual assault take place in your facility, remember that the elderly resident
requires the same services as younger victims such as emotional support, medical
attention, protection from the abuser and legal assistance. (Source: Article Base-Sexual
Abuse in Nursing Homes)

Long term care settings must have policies and procedures regarding Sexuality,
Intimacy and Sexual Abuse. Education of your staff is extremely important in providing
compassionate competent care of your dementia residents.

Resources:

Oklahoma Bill  
http://www.aperfectcause.com/HB2704.pdf

Freedom of Sexual Expression: Dementia and Resident Rights in Long Term Care
Video. A must for training staff
http://www.terranova.org/Title.aspx?ProductCode=FOSVHS

Looking Beyond the Hurt. Huge 132 page download for training. Excellent.
Senior Resource Center Association of Newfoundland
http://www.seniorsresource.ca/beyond.htm

CMS State Operations Survey and Certification Group Training Site
Includes satellite and internet broadcasts. Excellent resources in Archives as well.  
See Abuse and Neglect Surveyor Training and resources with this module.
http://surveyortraining.cms.hhs.gov/

Nursing Home & Elder Abuse Resources
Developing Elder Abuse Training Programs: Free Download
http://www.ncea.aoa.gov/NCEAroot/Main_Site/pdf/family/training.pdf

Wisconsin Coalition Against Sexual Abuse has free downloads for training
http://www.casa.org/

Widening The Circle Free 195 page training document
http://www.wcasa.org/docs/WTC.pdf

Department of Health and Human Services Medicare
http://www.medicare.gov/

Sexual Assault and People with Developmental Disabilities: A Guide for Family, Friends
and Caregivers
http://www.wcasa.org/docs/family-caregiver-guide.pdf

Sexual Assault and Older Individuals: A Guide for Family, Friends and Caregivers
http://www.wcasa.org/docs/family-caregiver-guide.pdf

Preventing Elder Abuse free download
http://www.ncea.aoa.gov/NCEAroot/Main_Site/pdf/publication/preventing.pdf

Office for Victims of Crimes - Elder Abuse
http://www.ojp.usdoj.gov/ovc/help/ea.htm

Nursing Home Abuse Resource Center
http://www.nursinghomeabuseresourcecenter.com/

Nursing Home Abuse and Neglect Resource Center
http://www.nursinghomealert.com/

National Committee for the Prevention of Elder Abuse
http://www.preventelderabuse.org/

National Citizen's Coalition for Nursing Home Reform (NCCNHR)
http://www.nccnhr.org/

National Center on Elder Abuse
http://www.ncea.aoa.gov/ncearoot/Main_Site/index.aspx

American Bar Association - Commission on Law & Aging
http://www.abanet.org/aging/

American Association of Retired People (AARP)
http://www.aarp.org/
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