Case Study

Douglas

Douglas is 74 years old with early-stage dementia, and has been living in the residential aged care facility for the past six months. Douglas is married, however is currently separated from his wife, and does not maintain regular contact with her. He has four adult children who do not regularly visit him within the care home. Douglas does not consider himself to have a good relationship with his children.

Several complaints have been made about Douglas engaging in inappropriate behaviours towards staff and other residents within the care home, including inappropriate comments or remarks, touching, and providing unwanted attention. However, Douglas claims he does not have bad intentions, and explains that this is how he communicates and forms relationships with others.

Note. The names and images in this case study are used in a fictional context, and are not intended to represent the real persons pictured.

1 PREFERRED NAME AND PRONOUN: Douglas prefers to be addressed by his first name, Douglas, using the pronouns ‘he, him, his’. He believes it is very important to be addressed by her preferred name and pronoun, and noted that he “do[es] not like to be called Doug”.

2 GENDER IDENTITY: Douglas identifies his gender as male, and that his gender identity is not different from the sex he was assigned at birth. He believes it is very important that his gender identity is acknowledged.

3 INTIMACY: Douglas defines intimacy as “having private time with a woman”. He identifies intimacy as somewhat important in his life. Douglas prefers or enjoys the following forms of intimate behaviour: touching, holding hands, talking/whispering, cuddling or hugging, and kissing (on the cheek, mouth, and hand).

4 SEXUALITY: Douglas defines sexuality as “showing that you want to have private time with a woman”. He believes it is very important to be able to express his sexuality in his life.

Douglas prefers or likes to express his sexuality through the following forms:

  • Appearance (i.e., clothing, makeup, hair)
  • Being in intimate casual and/or committed relationships with others (i.e., intimate touching, cuddling/hugging, kissing, flirting and/or romantic gestures)
  • Engaging in sexual behaviour/activity (i.e., with someone of the opposite sex and gender)
  • Talking about sexuality with someone else 

Douglas noted that “no privacy in the care home, [his] finances, lack of opportunity, and negativity from the staff” are reasons that prevent the expression of his sexuality in the way that he would like to express it.

5 SEX: Douglas defines sex as “pleasure and enjoyment”, and believes that it is somewhat important for him to engage in sexual behaviour/activity in his life.

Douglas prefers or enjoys the following forms of sexual behaviour: oral sex with someone of the opposite sex, penetrative sex with someone of the opposite sex, masturbation without adult toys. Douglas elaborated on this, with respect to masturbation without adult toys, and stated that “this is more realistic as I do not have a partner”.

Douglas believes that “age, and not having a partner” prevents him from being able to engage in sexual behaviour/activity that he enjoys.

6 SEXUAL ORIENTATION: Douglas identifies as heterosexual and believes that it is very important for his sexual orientation to be acknowledged.

7 ROMANTIC AND/OR SEXUAL RELATIONSHIP: Douglas believes that it is somewhat important to be in a romantic and/or sexual relationship with someone. Douglas is still married, however is separated from his wife.

Over the course of his life, Douglas has been married more than once, and has been involved in a romantic and/or sexual relationship with more than one person. He is not currently in a romantic and/or sexual relationship with someone. Douglas expresses that he would like to be in a romantic and/or sexual relationship with someone.

Douglas believes that it is very important for his spouse/partner/significant other/special friend to feel comfortable visiting and spending intimate and private time with him in his place of residence.

Douglas believes that he and his spouse/partner/significant over/lover/special friend (if he had one) would like to be supported in having intimate and private time together by having: a private room, a lock on my room’s door, a ‘do not disturb’ sign outside his room’s door.

8 SAFE SEX: Douglas has heard of the expression safe sex. Douglas defines safe sex as “using a condom”.

Douglas understands what a sexually transmitted infection means, knows how to protect himself (“a condom”), and has not had a sexually transmitted infection in the past.

9 OTHERS: Douglas knows what the term consent means in the context of sexual expression with another person. Douglas defines consent as “everyone deciding what they want to do”. He has not had any type of sexual encounter that was not mutually consensual.

10 SUPPORTING INTIMACY AND/OR SEXUAL NEEDS AND PREFERENCES: Douglas believes that intimacy and/or sexual needs and preferences should be supported in long term care. Douglas elaborates on this by saying “we should all be allowed to do what we want to do”.

Douglas has reported that he does not have a good relationship with his family. Although he is currently married, he is separated from his wife and does not maintain regular contact with her. Douglas’ children do not visit or contact him regularly. Douglas believes this is because “they have taken their mother’s side.” Douglas was previously a car salesman, and reported that he enjoyed that job as it allowed him to meet many people. Douglas appears to be very sociable and enjoy the company of others.

Douglas has indicated that he is a “touchy feely person by nature”, and is dismayed at the complaints he has received about his behaviour. He is particularly upset about a complaint from Caroline, who is “[his] favourite staff member [in the care home]”. Douglas explained that he did not mean to offend the staff, and was annoyed that the staff did not address the complaints with him directly. He did not appreciate the complaints to management, and said it “made [him] feel like a child.”

Douglas has expressed his need for an intimate and sexual relationship, however he has noted a barrier to this is that he is currently not in a relationship. It has been suggested to Douglas that he may like to hire a sex worker, and whilst he was open to this suggestion, he appeared embarrassed by the idea. Douglas also expressed concern about the level of privacy in the care home, and stated that he did not think that a lock on his door or a do not disturb sign would be sufficient. He believes that the care home staff generally have “negative attitudes towards us having relationships and private time”.

RECOMMENDATIONS:

  • Engagement of a sex worker (e.g., via Touching Base) may be beneficial
  • Exploring potential funding opportunities to assist with engaging a sex worker as part of Douglas’ care plan
  • Staff education and training to improve awareness on the residents’ needs in this area