a publication of the sexuality and aging consortium at widener university

Consortium Speaks Out on Sexual Expression, Consent and Dementia

Currently on trial in Iowa for third degree sexual abuse, Henry Rayhons is accused of having sex with his wife Donna, after she was deemed incapable of consenting to sexual activity, due to advanced Alzheimer’s.

Henry Rayhons admitted to having sex with his wife after she began living in Concord Care, a long-term care facility. He claims, however, that he did not have sex with her on the day his wife’s roommate reported that she thought the couple was having sex behind a privacy curtain.

Donna Rayhons had Alzheimer’s for four and one-half years before dying shortly prior to her husband’s arrest.

“This case illustrates the need for education and training about older adult sexuality in general as well as sexuality and dementias specifically,” says Melanie Davis, PhD, co-president of the Sexuality and Aging Consortium at Widener University. “It appears in this case that decisions were made about Donna Rayhons’s ability to consent to sexual activity without consensus on what constitutes the ability to give consent, as well as the nature of what constitutes sexual activity,” she added.

The Sexuality and Aging Consortium is an outreach initiative of the university’s Center for Human Sexuality Studies. Its mission is to advance the sexuality education, sexual health, and sexual rights of older adults.

Kansas State University associate professor Gayle Appel Doll, PhD, author of Sexuality & Long-Term Care, said some researchers have begun the task of determining how to understand the “voices” of persons with late-stage dementia.

“This task will likely involve interviewing the staff of dementia care units, especially those who work consistently with the same few residents and gain the ability to interpret their behaviors,” said Doll, who serves as an advisor to the Sexuality and Aging Consortium.

Input from professional caregivers may be helpful because, unlike family members, they are unlikely to confuse the resident’s current behavior and choices with their former self prior to the onset of dementia.

Consortium co-president Robin Goldberg-Glen, PhD, MSW, associate professor at Widener University, noted, “While this research is hopeful, too many staff persons and family members remain uneducated about sexuality. The pervasive, ageist belief that older adults are non-sexual can lead to inappropriate reactions when they engage in sexually active relationships. They can be made to feel abnormal and, in some cases, can be accused of sexual crimes.”

Several weeks after Donna Rayhons was admitted to Concord Care, her physician determined that she was no longer capable of consenting to sex. Her husband and her adult daughters were given that report. But as Doll interprets the situation, “This was early in her residency at the facility, and they couldn’t have known much about her. They certainly wouldn’t have been able to tell if she would have been a willing partner.”

The Rayhons’s situation might have been prevented if her physician, family members, and caregivers had been educated about the fact that intimacy is a basic human need that does not disappear with age or dementia, Doll said.

In addition, Doll said, Concord Care should have had a policy that enables each resident’s needs to be addressed individually. Staff training on the policy as well as educational programs for families would have ensured that everyone worked collaboratively to balance Donna Rayhons’s needs for intimacy as well as her need to be protected from possible abuse.

Sexuality and Aging Consortium members have helped several long-term care facilities develop sexuality policies that clearly define terms and expectations. They also have trained staff how to explain policies to residents and their loved ones and how to ensure the policies are followed.

Said Davis, “In the Iowa case, the prosecutor reported that Mr. Rayhons’s semen was found on Mrs. Rayhons’s bedding. We don’t yet know how the DNA got there or how Mr. Rayhons defined ‘having sex.’ It is possible that the couple did not have sexual intercourse, so he didn’t consider their behavior to be ‘having sex.’ It is also possible that Mrs. Rayhons appeared to enjoy whatever was happening, so he felt it was OK. Consensus on what constitutes sexual activity and consent would have been very helpful in this case.”

Doll added, “What this case could or should be about is whether Mrs. Rayhons wanted to be intimate with her husband. Legally, if she couldn’t say no, she also couldn’t say yes. In other words, she couldn’t get what she may have wanted. My friend, Dr. Maggie Syme, puts it simply, “We wouldn’t deny someone food if they can’t ask for it.” People with dementia can still communicate in non-verbal ways. If we can better learn to understand those cues we’ll all be better off.”

SAC Release on Rayhons Case 2015


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