On Jan. 1 2011, an article in The New York Times announced the coming of age of the oldest Baby Boomers who, over the next two decades, will be a cohort of 79 million looking to the industry for care and services. Many were children of the ’60s who crusaded for peace and love, and launched a cultural and sexual revolution. We now look with interest to the next step in their sexual evolution—their search for rights and sexual happiness as they make their way onto the healthcare scene.

At the same time, the healthcare industry is evolving, as it de-medicalizes to better fit the quality-of-life expectations of a more savvy, sexy and informed consumer. This new consumer is driving healthcare change away from “all things medical,” to make room for livability. Staying healthy to live longer is key to remaining in the game.

But toward what end, if our pursuit of happiness in late life ends at the nursing home’s front door? In crossing this threshold, are we transformed from people to patients? In late life, what becomes of the pleasures that sustained us in our “work hard–play hard” lifestyle?

The nursing home represents a convergence of older adults’ private lives and the healthcare industry, with the two intersecting intimately. For an example, let’s look at the Hebrew Home at Riverdale’s sexual rights revolution. In the 1990s, the Hebrew Home shook the healthcare rafters with its progressive policy and program on sexual rights. This was groundbreaking stuff—sex in the nursing home—previously a non-issue for an aged and infirm nursing home population.

Hebrew Home acknowledged the issue. Since 1994 and across more than 18 years of program development, the Hebrew Home introduced a paradigm shift, beginning with the idea that older adults might expect more of healthcare than just good care. As our logo suggests, they might expect to “live well.”

The Hebrew Home’s collective works on older adult sexuality began in 1995, with the nation’s first policy to legitimize “Resident Rights to Intimacy and Sexual Expression” in residential healthcare. As an affirmative sexuality practice, the Home’s policy defines resident sexuality, outlines residents’ rights, staff and organizational responsibilities and educates staff in achieving a universal standard of practice.

The policy is defined and driven by older adults’ civil and personal rights to privacy and intimacy. So long as there is mutual consent to sexual activity, these rights apply to all living at Hebrew Home. Whether heterosexual, gay, lesbian, bisexual and/or transgender, black or white, rich or poor, it is the right of older adults to decide their sexual fates.

Recognizing the formidable challenges of selling “sex in the nursing home,” in 2001 the Hebrew Home produced an educational video called “Freedom of Sexual Expression: Dementia and Resident Rights in Long Term Care Facilities.” It addresses a range of resident sexuality, including sex between residents with memory disorders, masturbation and same-sex relations.

As CEO and President of the Hebrew Home Daniel Reingold says, “it may mean there are people engaging in sexual behavior which an employee considers deviant or inappropriate … These are nonetheless their rights, no different than for people who continue to live in their own homes.” The DVD illustrates best practice approaches for staff, teaching them to support adult sexuality with objectivity and respect, and how to assess mutual consent.

Determining consent to sexual activity in older adults with dementia is both pivotal and plaguing to practitioners. In response, the Hebrew Home added a diagnostic guideline to its sexuality kit, called “Older Adult Sexuality: Intimacy or Abuse?” It helps to safeguard both an older adult’s right to be sexual, and to be protected from sexual abuse. The guideline was created in a strategic partnership of The Sexual Rights Program and The Harry and Jeanette Weinberg Center for Elder Abuse Prevention at the Hebrew Home.

When looking at older adult sexuality, there can be as many barriers to acceptance as there are apps for an iPod. But, much as technology is here to stay, so is sexual identity. Both programmed for the duration, and both integral to our existence. As we age, our core needs for fulfillment and happiness are rocked by compound losses. At such a time of vulnerability, we hold more tightly to our inner selves.

As an industry and a society, we must leave sexual bias, paternalism and ageism behind to uphold the dignity and diversity of older adults. The Hebrew Home has, across two decades, defended an entire cohort of older adults’ sexual rights. Whether one is a resident in a nursing home, a tenant in an assisted living or an older adult in a private home in the community, whether gay, lesbian, bisexual or trans sexual, or straight, these rights should not be subject to question or change.

To thyne own self be true…

I am Sam, Sam I am…the end.

Robin Dessel, LMSW, is the Director of Memory & Vision Care Services and Sexual Rights Educator at The Hebrew Home at Riverdale, New York.

This article was brought to you by the editorial committee of ASA’s LGBTQ Aging Issues Network (LAIN).