A dearth of policies related to sexual intimacy and an abundance of caution among administrators and staff members add up to limited sexual freedom for assisted living residents, according to new research published in the Journals of Gerontology: Social Sciences.

“Residents of assisted living facilities have the right to certain things when they’re in institutional care, but there’s not an explicit right to sexuality,” said Elisabeth Burgess, Ph.D., an author of the study and director of the Gerontology Institute at Georgia State University, Atlanta. The resulting environment at many communities, therefore, according to the researchers, contradicts the assisted living philosophy, which encompasses independence, privacy, a homelike environment and consumer choice.

Burgess and colleagues observed and interviewed administrators, staff members, residents and family members at six assisted living communities in the metropolitan Atlanta area. The communities varied in size, location, price, ownership type and resident demographics. The investigators also conducted focus groups with staff members.

Although staff and administrators said that they believed that residents had rights to sexual and intimate behavior, they also justified exceptions and relayed strategies undertaken in their communities that created an environment of surveillance, which discouraged and prevented sexual and intimate behavior, according to the study authors.

Administrators, according to researchers, said that their responsibility for residents’ health and safety often took precedence over other matters. “There’s oversight and responsibility for the health and well-being of people who live there, but that does not mean denying people the right to make choices,” Burgess said.

Administrators, investigators said, also expressed a desire to avoid potential conflicts with protective family members, many of whom are uncomfortable with the romantic or intimate relationships that their parents or grandparents may have.

Having a policy in place can help in such instances, Burgess said. “If you have a policy, you can say to the family when someone moves in, ‘Here are our policies, and this is how issues are dealt with.’ In the absence of a policy, it becomes a case-by-case situation, and you don’t have consistency in terms of what you do,” she said.

Administrators and staff members also expressed concerns about resident consent and cognitive impairment, even for residents who had not received formal diagnoses of dementia, according to the study. They told researchers that they wanted to guard against sexual abuse.