ROANOKE TIMES
Copyright (c) 1996, Roanoke Times
DATE: Thursday, January 4, 1996 TAG: 9601040002
SECTION: EXTRA PAGE: 1 EDITION: METRO
DATELINE: NEW YORK
SOURCE: By MATTHEW PURDY THE NEW YORK TIMES
They met last New Year's Eve. He was tall with an easy manner. She was petite with a girlish smile. He asked her to dance and held her close. "I didn't push him away," she said. "I've been around awhile. I've pushed a lot of men away."
It was a modern romance, at once pure and complicated. First, there was his wife. He was still married, although separated. Then, there was his walker.
Fritzie Heilbron's prince came to her not astride a white horse, but in black orthopedic shoes, shuffling along with the help of a walker. He is 76, impaired by Parkinson's disease, and with enough fear of his wife to want his name kept private. But Heilbron is smitten. She's 85 and has waited 45 years, since her husband died, to fall in love again.
This is not a case of geriatrics going clubbing. It is a scene from a nursing home, where those who care for the elderly and infirm report a kind of sexual revolution.
The revolution is not among the elderly, who experts say have always demonstrated an enduring urge for intimacy, but in the attitude of those who provide care. They are beginning to recognize that sexual activity is normal and beneficial for patients - even for those with Alzheimer's disease.
"It's not just a matter of dirty old men and disgusting old women," said Robert Butler, the director of the International Longevity Center at Mount Sinai Hospital. "The importance of tenderness, touching, being together in bed is an expression that remains vital to the end of life."
At the Hebrew Home for the Aged, a 1,200-bed nursing home and Alzheimer's research center in the Bronx where Heilbron and her companion found each other, a new policy gives patients the right to privacy so they can carry on intimate relationships. In confronting the issue directly, the Hebrew Home is in the vanguard of the shift away from seeing sex in nursing homes as a behavior problem.
The policy states that "residents have the right to seek out and engage in sexual expression" and the right to obtain "materials with sexually explicit content," including books, magazines and videos.
The home is training its staff to recognize and respect intimate relationships, and officials there say they will try to assist budding romances by moving one member of a couple to a single room to provide privacy. (None have asked to live together.) In the case of Alzheimer's patients or other cognitively impaired residents, the nursing home officials consult with social workers, nurses and families to determine if both residents are willing participants and decide whether the relations should continue.
"A couple of years ago, when there were people who were sexually involved, we thought we had to separate them," said Robin Bouru, a social worker at the Hebrew Home.
Because most nursing home residents share rooms, some homes around the country have set aside rooms that couples can use for privacy and others have formalized policies for addressing sexual activity, like the one at the Hebrew Home. But Meredith Wallace, a geriatric nurse at the Hospital of Saint Raphael in New Haven, Conn., who has written about sexuality of the aged, said many homes are moving slowly, if at all, to break down "the old stereotypes."
Antonette Zeiss, a clinical psychologist at the Veterans Administration Health Care System in Palo Alto, Calif., who has instructed nursing home administrators in California on sexual relations among patients, said the subject is difficult to confront because "it's the conjunction of two taboos about sex."
"The first," she said, "is that sex is for the young. The second is that sex is for the cognitively intact."
She said that in her experience, most people who run nursing homes agree that residents have a right to sexual expression, but it is difficult for staff members to support "because they feel uncomfortable with it."
Others have raised more straightforward objections, from the danger of patients physically hurting themselves to the violation of moral laws at homes that are run by religious organizations.
Janet Lowe, a nurse's aide at the Hebrew Home, said that the first time she realized two unwed residents were having a relationship, "I was shocked. You don't think of your grandparents having sex."
Lowe said other members of the staff had stronger objections. "Some people thought it should be stopped because they weren't married."
Jacob Reingold, the vice chairman of the Hebrew Home, which is run according to Orthodox Jewish law, acknowledges that the home would face a quandary if two unwed patients wanted to live together as a couple.
But Reingold, who directed the sexual expression policy at the home, said he was intent on fighting the tendency in the nursing home industry "to sweep this issue under the cover."
For many at the Hebrew Home, romance is a welcome relief from the unbroken landscape of aches and pains and dwindling days. "I think it's beautiful, seeing a man and a woman walking together holding hands," said Ethel Hoberman, who is 81, healthy, spry and available. "It sort of gives the place the feeling of being alive, rather than waiting to die."
Some staff members and residents find the sexual relationships between unwed, elderly people immoral or distasteful, or both. ``There are some women who say: `Yuck, that's disgusting. They're going to give them rooms so they can do things there?''' said Grace Meltzer, a resident of the Hebrew Home.
Sonya Kantor, who is 86 and president of the residents council at the home, discreetly said, "I have a gentleman friend here" and explained the negative comments this way: "The disapproval of some of the women may come from the fact that they don't have male friends."
Officials at the Hebrew Home said intimate relationships return some dignity to residents who give up privacy and freedom in exchange for assistance and security. "Can't we allow them to have some vestige of normalcy in this critical area?" said Douglas Holmes, a psychologist who heads the home's research division. "I'm totally pro-sex as long as no one is victimized."
The thorniest issue of sexual conduct at nursing homes involves relations between patients with dementia.
Psychologists and doctors say aberrant behavior like public masturbation and unwanted kissing and touching of others is common with Alzheimer's patients, who often lose the ability to make social judgments. But, said Dr. Philip Sloane, a professor at the University of North Carolina medical school who advises the Manor Health Care chain of 170 nursing homes on Alzheimer's care, "a lot of time, the activity we think of as sexually deviant behavior is just reaching out for intimacy."
But determining what sexual behavior is appropriate for patients with dementia is difficult for nursing home administrators, who not only have to worry about what is best for their patients, but also what is acceptable to patients' families and what will keep them out of court.
Like the Hebrew Home, the Manor Health Care homes have a protocol for evaluating instances in which patients with dementia exhibit a strong attraction. He said it is not unusual for the staff, in conjunction with a resident's family, to allow casual intimacy - holding hands, hugging - but that sex is rarely if ever allowed, out of concern for the patients' safety and the difficulty of determining whether they consent.
"It's pretty hard to feel comfortable that there's consent when you have two people who don't know what they're doing," Sloane said.
At the Hebrew Home, Meltzer, who lives on a different floor from her husband because he suffers from dementia, said even in his confused state, his need for closeness emerges.
"I think intimate sex is the farthest thing from his mind," she said. "He reaches for my hand and kisses me. And he says why don't you just get undressed and get into bed. I think he just wants intimacy."
Meltzer said the need for companionship doesn't fade with age. She said that when she first moved to the home she was told about a man who was found naked and dead in the bed of a woman who lives there. Meltzer said she still remembered her reaction: "I said, `Well, anyway, he died happy.'''
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