2015, Rahn, Alison, Lykins, Amy, Bennett, Cary, Jones, Tiffany

With Consumer Directed Care (CDC) on the horizon and a wave of baby boomers who are ageing, aged care providers need to be aware of and respect the desires and requirements of future 'consumers'. In contrast with current provider arrangements, funding is linked to the individual rather than the institution in a CDC model, with the likelihood that there will be greater demand for those facilities that meet emerging consumer expectations and offer couple-friendly environments. One group that has largely been ignored at all levels in residential care, from government policy to service provision, is couples, or partnered individuals. Situated within a broader study exploring the needs of partnered baby boomers, this paper investigates whether existing residential aged care facilities provide the conditions needed to facilitate the sexual and intimacy needs of partnered aged care residents. Such exploration is particularly pertinent at a time when the National Lesbian, Gay, Bisexual, Transgender and Intersex (LGBTI) Ageing and Aged Care Strategy is being implemented. In this presentation we report on early findings of a phenomenological study using semi-structured interviews conducted in 2015 with 29 key informants with expertise and experience in aged care law, policy, practice, health, education, research and related service areas. Early findings suggest that difficult though necessary conversations are being avoided by older people, by those representing them, and by service providers. Recommendations for aged care providers include the need for comprehensive education and training in the areas of sexuality and intimacy with the aim to facilitate communication around residents' sexual needs and the formulation of individually tailored care plans. We believe that such initiatives would have the potential to create more positive outcomes for partnered older persons and aged care staff.

2020-06-21, Rahn, Alison, Bennett, Cary, Jones, Tiffany, Lykins, Amy

Objective: Relationship‐enhancing behaviours that contribute to older adults’ well‐being are scarcely considered in "active ageing" discourses despite relationship quality having been repeatedly linked to health outcomes. This paper explores such behaviours in older adults.
Methods: Cross‐sectional data were collected in 2016 from 168 partnered baby boomers (born 1946 to 1965) using an online survey. The 36 qualitative and quantitative questions were analysed using mixed methods.
Results: Participants were predominantly women (85%), with a mean age of 62 years (SD = 5.2). Relationship‐enhancing behaviours included verbal and non‐verbal cues, physical affection and pleasurable sexual activities. A couple's shared bed was an important relationship setting.
Conclusion: For happily partnered older adults, relationship quality improves personal well‐being. As a social determinant of healthy ageing, health policies and programs are needed to support older adults’ relationship quality. To this end, the development of targeted relationship interventions for delivery in health settings is warranted.

2016, Rahn, Alison, Jones, Tiffany, Bennett, Cary, Lykins, Amy

Despite legal protections, couples in Australian residential aged care facilities experience institutional interference in their intimate and sexual relationships. Panoptic surveillance remains widespread in aged care. Little attention is given to privacy. Some residents' doors are kept open at all times. Couples may be separated or provided with single beds only, unable to push them together. Staff frequently enter without knocking, commonly ignore 'do not disturb signs' and often gossip about residents. This culture has its origins in colonial institutions. Attempts at legislative reform to redress this situation have been met with mixed responses, with the most vociferous opposition coming from religious conservatives. A recurrent source of conflict is the tension between the 'rights' of religious and political institutions versus those of individuals. This article identifies systemic issues faced by partnered aged care residents, their historical origins, and the legislation that is designed to protect residents. Using a thematic analysis methodology, it reviews political debates in the past 40 years, in both federal Parliament and newspapers, and provides a critical analysis of recurrent themes and ideologies underpinning them. It concludes with recommendations for legislation that is consultative and 'person-centred' and recommends proscriptive privacy protections. Adoption of these ideas in future policy reforms has the potential to create more positive outcomes for partnered aged care residents.

2020-06-21, Rahn, Alison, Jones, Tiffany, Bennett, Cary, Lykins, Amy

Objectives: Australian aged care policy is wholly focused on individual "consumers" and consequently neglects the needs of dyadic partners. This paper highlights partnered baby boomers' attitudes to maintaining sexual and intimate relationships in residential care.
Methods: In 2016, cross‐sectional data were collected using an online survey of partnered baby boomers recruited using social media. Qualitative data were analysed using word frequency, keywords‐in‐context and thematic analysis. Descriptive statistics were generated from quantitative data.
Results: There were 168 participants (85% female), aged 51‐71 years. Many reported that remaining together and continuing physical and sexual contact were important in aged care contexts—necessitating private couple's suites, shared beds, access to condoms, lubricants and sexual health professionals.
Conclusions: Considerable cultural change will be required to raise residential aged care to the standard expected by some partnered baby boomers. Shifting to a more couple‐centred approach may benefit partnered residents' health and well‐being.

2018, Rahn, Alison Ainslie, Bennett, Cary, Lykins, Amy, Jones, Tiffany

A third of Australians living in residential aged care facilities are married or partnered, however, institutional interference in residents' relationships is not uncommon. Practices in some establishments include keeping residents' doors open; staff entering without knocking, ignoring 'do not disturb' signs, and gossiping about residents. Partners are variously accommodated in separate beds, separate rooms or separate wings of a facility. Many are not permitted to enter care together. Such conditions make it challenging for couples to maintain their relationships. To date, insufficient research has focused on supporting older couples’ relationships subsequent to one or both partners being admitted into care. From July 2018, a public policy of consumerdirected residential aged care will take effect, developed in anticipation of the postwar 'baby boom' cohort becoming aged care consumers. This thesis reports on a study that explored the needs of Baby Boomers as aged care consumers, given that they represent almost a quarter of Australia's population. The aims of this study were to identify (1) which aspects of Baby Boomers' intimate relationships they considered essential to their wellbeing; and (2) practical measures that need to be implemented to support those valued relationship elements in residential aged care settings. To address these aims, a predominantly qualitative, three-part mixed methods study was designed. It adopted an interpretivist-constructivist perspective, drawing on grounded theory and phenomenology. The findings indicated that, in practice, a broad policy focus on 'person-centred' aged care did not adequately address the needs of couples as they envisaged them. Instead, this thesis argues that, in the case of partnered residents, what is called for is an industry-wide 'couple-centred' model of aged care. Conclusions drawn were that: (1) ageist attitudes to older adults' intimate and/or sexual relationships are pervasive at every tier of the aged care system; (2) the sector is failing the needs of many older couples; (3) these issues are not unique to Australia; (4) partnered Baby Boomers' needs are unlikely to be met by current aged care policies and practices; and (5) Baby Boomers' are already exploring alternatives to current models of residential aged care. These issues have wide-reaching implications at a societal level, for public institutions, the aged care sector as a whole and Baby Boomers themselves.

2017-11, Rahn, Alison, Bennett, Cary, Jones, Tiffany, Lykins, Amy

Currently, a third of Australian aged care residents are partnered, with many experiencing institutional interference in their relationships. Staff duty of care usually takes precedence over privacy. Some institutions separate couples; residents' doors may be kept open; staff enter without knocking, ignore 'do not disturb' signs, or gossip about residents; all of which make privacy a challenge. This paper reports on findings from an online survey into the needs of partnered Baby Boomers (born 1946-65) and the levels of privacy that they anticipate they will require to maintain their primary relationships in residential aged care facilities. At a time marked by a policy shift towards consumer-directed residential aged care, it is pertinent to understand the needs of this subset of future consumers. Our research found that the majority of respondents expected to remain sexual indefinitely, considered physical intimacy with their partners essential to their wellbeing, and required a high degree of privacy to maintain their relationships. Respondents were asked to rate seven domains of privacy. Those considered most important were visual privacy, private space, and bodily privacy. This paper outlines various ways for service providers to prepare for the next generation of consumers, initiatives that would enable residents and their families to make informed decisions when choosing a facility, potentially improving the experiences of both residents and staff.