Sunday, December 2, 2012

Elderly Patients and Modesty
by Misty Roberts


In Nursing Homes and Hospitals

The elderly patient presents a unique problem when dealing with the modesty issues they may face.  An elderly patient’s modesty is often compromised because they are unable to speak up on their own behalf, making them vulnerable.  Dementia at any level in an aged patient also poses problems because medical professionals assume that their modesty does not matter if they are not 100% cognizant of what is going on.  

Nursing homes and hospitals have become gender neutral. It is common for male nurses / aides to bathe, perform intimate procedures (changing diapers, urinary catheterizations, shaving their genitals for procedures, etc), and assist with in the bathroom, female patients they have been assigned to. Many families have been shocked and outraged to discover that their family members were bathed by opposite sex nurses or aides without their consent. Nursing homes and hospitals need to work to accommodate elderly patients’ wishes for privacy. 

I personally think it is risky for nursing homes to assign male nurses or assistants to female patients for intimate care tasks (bathing, changing diapers, dressing, cleaning women’s private parts after bowel movements, etc) due to the potential for sexual abuse. Cases of sexual abuse by male nurses and assistants at nursing homes are in the news frequently. The false assumption exists that the elderly do not care about their modesty. This could not be farther from the truth. Many female nursing home residents will not even allow their sons, grandsons, or male relatives help them with intimate care tasks. Why should they have to give up their boundaries about men not helping them with intimate care in nursing home and hospital settings?  I personally believe that male nurses and assistants can certainly work with female patients, but they should have no contact with female patients’ private parts.  This will not only honor their wishes but also help to ensure that sexual abuse does not happen.Elderly nursing home residents are easy prey for sexual predators, because they are often weak and defenseless. They may also fall victim to sexual abuse because they had a stroke or other medical condition that caused them to lose their speech or motor skills. When a nursing home resident is unable to protect themselves or speak, the likelihood of becoming a victim of sexual abuse increases” according to Sexual Abuse in Nursing Homes – Edgar Synder & Associates.

Nursing homes and hospitals may use this excuse: a male nurse has to assist in bathing some women for the purpose of lifting them and ensuring that they are not dropped. This is not true.  Due to the potential of sexual abuse, this is very risky. It is my opinion that a female nurse or assistant should always bathe a woman. A male nurse or assistant could help to lift a clothed woman in the bathtub if necessary and leave while a female nurse or assistant bathes her. Then the female nurse could call for the male assistant to come back to get her out of the bathtub after the woman has been dressed.  Sponge baths can be given to very frail patients in their beds, requiring no lifting or male assistance whatsoever.

A number of relatives of elderly female nursing home residents have expressed how upset they were to find male nurses / assistants handling their loved ones’ intimate care issues.  Here are a few examples:

1.)    A very painful incident for me involved my mother, who in the advanced stages of Alzheimer’s, was hospitalized with a broken hip. I visited her room one day and found a male nurse cleaning her up after a bowel movement.  She was highly agitated and terrified.  My Dad, who was present, had not protested, so I didn't say anything.  I cannot believe that I was such a coward.  Mother passed away five years ago, and I have not gotten over the regret of not speaking up for her.    Given the opportunity again, I would have insisted on female nurses and aides ONLY!
– Man from South Carolina 


2.)    I have a grandmother in a nursing home that requires assistance in the restroom, help bathing and changing. She is also not completely there in her mind. She can easily be taken advantage of and cared for by a male. The position my grandmother's in is already degrading enough, but to have a male nurse taking care of her and seeing her exposed is wrong in many ways. My family does not want to have a male nurse taking care of her because of the degrading and immoral nature of the situation.”
– A young lady from Durham, NC 


Modesty issues are not reserved for only elderly female patients, elderly male patients also struggle with them.  Years ago, male nurses were very rare. It’s wonderful that we are seeing more male nurses / aides for elderly male patients who are not comfortable with female nurses / assistants. Some nursing homes hardly have any male nurses or aides to help with male patients who are modest. A nurse / aide actually swore at an elderly man who asked her to leave the room for a few minutes so he could use the bathroom. She thought he was crazy for asking her to leave the room.

A pastor shared this with Medical Patient Modesty: A very pleasant, likeable, and religious congregant found himself in the hospital for a prolonged period, prior to his death. His recurring conversation with me, over the course of my many pastoral visits was his resistances to female nurses inserting Foley catheters, giving him complete body baths, and dressing him. Disclosing that he could accept the immense physical pain foisted on him and that he was prepared for death, this sheep of my flock related that the most difficult problem of his entire life was this issue of frontal nudity before strange women! It was foreign to his life experience. "It's not right!" was his plea. His tearful eyes looked to me for counsel. The only consolation this veteran clergy provided him was that if I were in his shoes my feelings would be identical to his own! The female nurses told this suffering, dying patient, "You don't have anything we've never seen before!" "Don't worry about it, we do this all the time!" and "You'll get over it!"

If you have to place a loved one in a nursing home, take time to meet with the nursing home administrator, supervisors and other staff members to discuss how you want the loved one’s modesty to be protected. Ask questions about how they can ensure the protection of your loved one’s modesty.  Make sure that all of your directives are put in writing and be succinct with what you want.  For example, state that no male nurses or aides are allowed to bathe your elderly mother.

The same protocol should be followed if your elderly one has to be hospitalized. Make sure you take time to speak to the nursing supervisor and staff members. Utilize signage, prominently displayed on the door stating that no male nurses can participate in her care for intimate issues. Make sure you take time to discuss with your loved ones about how they feel about their modesty in medical settings.

Take time to educate other people about the potential of sexual abuse of elderly female patients in hospitals and nursing homes and how they can advocate for their loved ones.


Misty Roberts is the founder of Medical Patient Modesty , a 501c3 non-profit organization.

19 comments:

Joel Sherman MD said...

This article certainly raises an issue which modern medicine tries to ignore. Many patients, both young and old, are concerned about their modesty and unwanted exposure to opposite gender providers. All patients have trouble expressing this concern, but it is especially hard for the elderly and infirm.
All patients should be free to express their preferences for care and have it followed. Women who prefer same gender care in routine settings, can usually get their wishes followed. Men often cannot; indeed they are sometimes belittled for asking. I still do not know what percentage of patients care. It is likely near 50%, though far far fewer are willing to speak up. It is an uncommon request in the hospital setting.
But Misty implies that men cannot be trusted to provide intimate care for females which I find highly objectionable. People should be judged as individuals not by gender, a tendency which has historically hurt women more than men. The fact that there is a higher reported incidence of abuse by males is not relevant. Indeed abuse by female caretakers is rarely reported when it does occur, though the incidence is surely less than for males.
My mother was frequently cared for in a nursing home during her last few years by a male aide whom we trusted implicitly. We of course did not stay in the room when she was receiving intimate care. That would have indeed bothered her, but aides were a different matter. Patients should get their preferences met whenever possible, but we need to recognize that many patients do not care and same gender care should not be imposed on them.

Doug Capra said...

I agree with everything Dr. Sherman has stated in his post. I would add one other observation, based upon this quote from the article:
"If you have to place a loved one in a nursing home, take time to meet with the nursing home administrator, supervisors and other staff members to discuss how you want the loved one’s modesty to be protected. Ask questions about how they can ensure the protection of your loved one’s modesty. Make sure that all of your directives are put in writing and be succinct with what you want. For example, state that no male nurses or aides are allowed to bathe your elderly mother."
The major element missing from this statement is that the relative should first meet with the patient to determine what the patient wants, not what the relative wants. The relative may want to get an advance directive signed which lists what the patient wants and appoints the relative as authorized to make decisions about that care.
If the patient is capable of making these kinds of decisions on his/her own, and the provider or caregiver infers that the relative is either speaking for the patient, or controlling the patient's decisions, I can see the provider not trusting the relative. Elder abuse doesn't only occur in nursing homes. It also can occur in the elder's home and when it does it is most often committed by relatives-caregivers. Providers are on the lookout for these kinds of cases.
I'm all for patient choice of caregiver gender, esp. for intimate care. But it's the patient's decision, not the relatives. And I, too, find offensive the notion that male nurses and cna's can't be trusted as a group.
Otherwise, I think the article makes some good points.

Bootz65 said...

The issue isn't just active sexual abuse - for a female like me passive sexual abuse is being expected to allow a male nurse to have access to my sexual organs and private body areas.

Just as one you state that we should recognise that some patients don't care - I would argue that this group aren't of concern - Im sure no one will feel deprived because they couldn't get the opposite sex to cater for their intimate needs....however the more alarming scenario is that spoken of here by Misty....when a patient does care and it's disregarded

For this reason - the assumption should be that patients do care and so they should always be offered same sex. If they want to request the opposite sex - then that should be where the negotiation takes place

The problem is - as stated - many patients cant speak up for themselves - so it is an afront to assume that in their senior years - they dont mind the opposite sex having full and tangible access to their genitalia and other traditionally private areas

Boots65

Older and Wiser said...

Dr. Sherman,
Would you take your child to a physician who was sexually attracted to children? Then why did you allow your mother to be attended by a man who is presumably sexually attracted to women? It is the height of hypocrisy.

You may not see your mother as a sexual being, but "granny porn" exists and if you happened to be someone who is "turned on" by it, what better place to work than in a nursing home. Similarly, while you may not find obese women attractive, there was a case (in Ottawa, Canada, if I remember correctly) of a physician taking advantage of the low self-esteem of his morbidly obese patients to engage in sexual encounters.

Your statement "The fact that there is a higher reported incidence of abuse by males is not relevant" belies belief. It ignores the widespread sexual assaults by opposite gender medical providers. ---and if you don't think that it is widespread, you haven't done your homework.

Do female physicians and nurses abuse men? They most certainly do. Female psychiatrists, psychologists and nurses often end up in romantic liaisons with their patients. I was stalked (although not in a threatening way) by a female psychologist before I became enlightened to the risks. I merely ignored her and nothing further happened.

This very topic came up at a Christmas party last night. A friend's (married) cousin, a prison psychologist began a romantic relationship with an inmate. ...lost her job. ..married him when he got out and subsequently divorced him 5 years later. Needless to say, her indiscretions were not well received by relatives.

No Dr. Sherman, in any other field, if there were this many "incidents", there would be laws enacted to protect vulnerable patients by making opposite gender health care illegal.

Joel Sherman MD said...

Older & wiser, I can't believe you could assume that any man who works in a nursing home is sexually attracted to the residents. Do you assume that any person who gets a job does so because they have a sexual attraction for whoever they come in contact with? By that reasoning athletes become athletes because they're attracted to other men. Women become nurses because they're attracted to patients?
Yes perverts exist but to accuse every man who works in a nursing home (and they are fairly common) of being a pervert is outrageous. And requiring same gender care is no cure all in preventing abuse. By far most abuse in nursing homes is non sexual physical abuse.
My mother was oriented in the nursing home except towards the end and quite capable of protesting her care.

Janice Wright said...

JW said...
I think sexual abuse happens in medical settings more than most people realize or are willing to admit. I will only allow female doctors or nurses for myself since I was abused by two different male care givers years apart. I applaud Misty for her work in the areas of patient modesty and safety. When I am in the need of elder care I hope exclusive same sex care will be available to everyone who wants it.

Medical Patient Modesty said...

Doug,

I have interacted with a lot of people who are upset at the thought of male nurses or aides bathing women especially in their families. Many people are unaware that it is very common for male nurses or aides to give female patients bath without their consent or family members’ consent. It is important that we educate people about how gender neutral hospitals and nursing homes have become today. Family members should be able to boldly state that no male nurses or aides can give their elderly mothers a bath.

There are many patients in nursing homes who have severe dementia that cannot make decisions for themselves. It is true that some elderly patients are aware enough to make their own decisions. It is important for family members to discuss wishes about patient modesty and privacy issues with their relatives. To have a male she does not know bathe or provide other intimate care is likely felt to be an intrusion by an older woman - especially if she is somewhat mentally impaired with dementia.

It's at least as important that the patients feel that their boundaries are being respected, that they don't feel invaded by unwanted care from any caregiver.

The ones who are able to make their wishes known often have them overlooked, or just plain ignored. Or, they are whispered about how "silly" they're being, or, worse, "He'll just have to deal with it."

There is always a risk for sexual abuse when the opposite sex does intimate procedures on patients. Many families want to do whatever to minimize the chance of sexual abuse.

It is certainly true that some relatives do abuse their elderly ones. But at the same time, many families love their elderly ones and that’s why they are against their relatives having intimate opposite sex care. Many families know how their relatives feel about intimate opposite sex care. Even if there could be a guarantee that sexual abuse would never happen, many people are simply uncomfortable with opposite sex care for intimate issues because they have strong boundaries about modesty.

Look at our boundaries in general. Most of us do not have any problem staying out of the men's restroom if we are women, or the women's restroom if we're men. How is it less intrusive to look at and wash somebody else's genitals of the other sex than it is to be in a public restroom behind the stall from an opposite-sex person?

Let me share the story about my great-grandmother. Over 25 years ago, my great-grandmother got a severe case of Alzheimer’s Disease and ended up in the bed all of the time for the few last years of her life. She lost her mind completely. She could not talk, feed herself at all, etc. at all. My grandmother decided to not put her in nursing home and move my great-grandmother to her house. My grandmother hired a female caregiver to take care of her during the day when she was at work. The female caregiver helped to change her diapers, bathe, and feed her. Someone was always at the house to make sure she was okay. I really learned about boundaries about modesty when I was just a kid. My grandmother allowed me in the room when she bathed and changed her diapers. But I noticed that my grandfather never came in the room when her diapers were changed or she was given a bath. My grandfather is very trustworthy. I know he would not abuse his mother-in-law at all. But they chose the boundaries to respect her modesty even though her mind was gone. My grandfather stayed at home some with her while my grandmother went to store for a short time. I am glad that my grandmother showed her mom respect by protecting her modesty. I feel that my great-grandmother got very good care at home. It would have been hard for a nursing home to give her personalized attention.

Misty

Medical Patient Modesty said...

Boots65,

You made many excellent points. Your statement: The problem is - as stated - many patients can’t speak up for themselves - so it is an afront to assume that in their senior years - they don’t mind the opposite sex having full and tangible access to their genitalia and other traditionally private areas is very true. When elderly patients do speak up, many workers ridicule them so they stop speaking up. Some caregivers even convince elderly patients they should give up their modesty. For example, an elderly female patient might express that she is upset when a male aide comes in to give her a bath and the male aide might respond by saying something , “It’s okay. I’ve done this a lot. Don’t be silly.”

I wish that the medical profession would stop assuming that patients are gender neutral. Many patients are not gender neutral. I wish that all nursing homes and hospitals would start asking all patients about their gender preferences for intimate procedures like they ask about allergies. I think gender preferences is as important as allergies and other questions.

Misty

Doug Capra said...

Misty:
My position isn't as complicated as you make it out to be. You seem to be focused on your value system. I'm focused on the patient's value system. Where the two merge, fine. Where they don't, I say let the patient decide. That's why I recommended, when possible, an advance directive or another document that clearly puts a relative in charge when the patient can't make decisions for him/herself.
You write: "Many people are unaware that it is very common for male nurses or aides to give female patients bath without their consent or family members’ consent." Well, I'm not one of those many people. I realize this and I'm firmly against doing this against the patient's consent, AND/OR the family's consent when the family and the patient agree OR when the patient is unable to make that decision. What I am against is you or anyone else making these kinds of decisions for others.
You would have a hospital create a police that would stigmatize an entire gender because of the way you and some others feel. Are you assuming that every female feels that way? Do you have evidence to back that up? What if a female actually wants a male nurse. Are you saying you'll refuse that request?
You write: "The ones who are able to make their wishes known often have them overlooked, or just plain ignored. Or, they are whispered about how "silly" they're being, or, worse, "He'll just have to deal with it." Of course that's wrong. We've been writing about that attitude on these blogs for years.
You keep writing "many people" this and "many people" that and "some people" this and that. Well, that's the point. This doesn't apply to everyone, yet you want to make rules based upon your personal value system that apply to everyone.
I've been advocating for protecting patients from medical humiliation and unnecessary embarrassment and trauma for years now. I don't deny it exists. But I've also been advocating for patient rights -- that is, "patient" rights. If patients feel strongly about this issue, or if their relatives do, they need to talk about it and make sure they protect each other. Patients who can speak up need to start speaking up and/or relatives who know how the patient feels about an issue and sees that they're not speaking up needs to encourage them to do so. We'll never get past this wall until patients and their relatives start talking about this with doctors and nurses and aides.
But I'm not willing to see policies set that blatantly discriminate against any gender based upon stereotypes and baises.
Doug

Medical Patient Modesty said...

It is certainly true that some female patients are fine with male nurses. But at the same time, I’ve interacted with many women who are uncomfortable with male nurses for intimate care.

I was aware that you are very familiar with how gender neutral hospitals and nursing homes are. But many people out there are unaware. I did not know how gender neutral hospitals had become in their nursing assignments until a few years ago. I assumed they always assigned female nurses to female patients. I was well aware for years that there were not enough male nurses to tend to male patients who are modest though.

I wish that the medical profession would stop assuming that patients are gender neutral. I wish that all nursing homes and hospitals would start asking all patients about their gender preferences for intimate procedures like they ask about allergies. I think gender preferences is as important as allergies and other questions. Each patient is different. The gender preferences section could say something like: Do you prefer female, male, or no preferences for intimate care?

Doug Capra said...

Misty:
I agree with most everything in your last post. You write: "I wish that the medical profession would stop assuming that patients are gender neutral." I think a significant number in the profession, probably a majority, don't assume this. They know. Why they don't ask is another question, and there are many reasons -- some, unfortunately, are connected to staffing availability and skills, time constraints, and the bottom line. I'm not justifying these excuses, just acknowledging them.
You also write: "I wish that all nursing homes and hospitals would start asking all patients about their gender preferences for intimate procedures like they ask about allergies." I would like that, too, but you know what they say about wishes -- if wishers were _____ then _______. I don't have the answer here -- but my thought is that this won't happen until it's forced upon the system and the best way to do that is for patients to speak up and let the system know what they want. The system will always use the excuse that patients just don't complain or ask for same gender care -- and they'll be mostly right -- until patients who want same gender care make it clear and do complain if they don't get what they expect.

Medical Patient Modesty said...

One issue I did not mention in this article is the fact some patients prefer that their relatives especially spouses come to the hospital/nursing home to give them a bath. This would work well in cases where the relative came to visit daily. Those patients should let the nursing staff know that they do not want to be bathed at all and that they will be bathed by the person they have chosen to be responsible for their bathing needs. For example, some men are very uncomfortable with either female or male nurses/aides bathing them and they prefer that their wives give them a bath. The nursing staff should respect those patients’ wishes and allow undisturbed privacy. Patients in those cases could have a sign on their door saying something like” Bath in Progress. Do not Disturb”.

Anonymous said...

"The fact that there is a higher REPORTED incidence of abuse by males is not relevant."
Older and Wiser:
I find this to be a valid statement...I can't imagine that anyone would be offended by it.
It is true that society looks at male abuse different than female...therefore men (for many hundreds of years of conditioning) are hesitant to even bring the issue to light.

It often happens in these blog comments that men are looked at as Neanderthal predators, and women are looked at as hapless emotional beings and hopeless romantics. The examples in your above posts were regarding women entering in to emotional/romantic (albeit wrong)attempts whereas men would be pigeonholed into much more lurid thoughts and deeds.

Until people / society can see male abuse the same as they see female abuse, then males stand much less chance of having their needs of dignity met in medical situations.

Suzy

john smith said...

How absolutley sexist can one get. This article just flat out says it's ok that female nurses handle male patient, but male nurses should not handle female patients. Hate to break it to ya, but male patients deserve modesty too. YOU PIG !!!

StayingFit said...

I don't condone the language used by John Smith, in his post of December 26. However, I completely understand his reaction to this article.

Misty, why do you reserve your outrage only for those incidents when a woman's modesty is violated? If you claim to care about all patients, then advocate for all of them, with equal vigor.

As for sexual abuse, you are sorely mistaken if you think that it can only be perpetrated by a man against a woman. Most often, it is committed by a stronger party over a weaker one. In a nursing home, the patients are in a very vulnerable position, both physically and mentally. Hence, the opportunity for abuse, by workers of both genders against patients of both genders, is greatly increased.

While you do a disservice to the male health care providers, by assuming that they cannot be trusted, you also do a disservice to your father OR your mother, if you assume that they cannot be abused by a woman. Such assumptions can blind you to evidence of mistreatment, which you otherwise might have detected.

I would also argue that, for sufficiently modest patients, intimate care by an opposite gender provider is, itself, a form of sexual abuse. Since, as you state, men can be very modest, and, since we know that roughly 90% of the nurses and aides in a nursing home are women, we can conclude that a modest man is almost guaranteed to be "abused" in a nursing home.

Where is your outrage?

Finally, it is unfortunate that your bigoted view of men is shared by some in the health care industry and by society, in general. It is very difficult for men to obtain employment as nurses, aides, and as certain types of technicians, because it is assumed that they cannot be trusted to care for vulnerable patients, especially women. Women, of course, face no such discrimination.

Even if, by some miracle, a company will hire them, society discourages men from puruing employment in these fields. So, while I agree that the numbers of men in these professions has increased somewhat, the bigotry of people, such as yourself, ensures that those numbers will remain small for a long time to come.

Anonymous said...

I wasn't going to comment on the above post. but without it the comment seems to hang in the air like silent approval......

John Smith: Very childish and ridiculous to reduce your thoughts to name calling. If you really feel this way, where is your article? Where are your public thoughts to change the way males are looked at in the medical arena?
While I agree the article can be viewed as one-sided, where are your efforts to help male modesty?

Show us your better side. Show us your advocacy.

Suzy

Medical Patient Modesty said...

John Smith,

I actually discussed male patient modesty in the article I wrote. I fully support men's wishes for male nurses. I have heard more complaints about women being treated by male nurses than men being treated by female nurses.

Male patients can certainly be abused by female nurses. We just do not hear much about this. Many men who have been sexually abused by female nurses or doctors won't report the abuse they experienced.

Did you not read the two paragraphs that focus on male patient modesty in the article below?


Modesty issues are not reserved for only elderly female patients, elderly male patients also struggle with them. Years ago, male nurses were very rare. It’s wonderful that we are seeing more male nurses / aides for elderly male patients who are not comfortable with female nurses / assistants. Some nursing homes hardly have any male nurses or aides to help with male patients who are modest. A nurse / aide actually swore at an elderly man who asked her to leave the room for a few minutes so he could use the bathroom. She thought he was crazy for asking her to leave the room.

A pastor shared this with Medical Patient Modesty: A very pleasant, likeable, and religious congregant found himself in the hospital for a prolonged period, prior to his death. His recurring conversation with me, over the course of my many pastoral visits was his resistances to female nurses inserting Foley catheters, giving him complete body baths, and dressing him. Disclosing that he could accept the immense physical pain foisted on him and that he was prepared for death, this sheep of my flock related that the most difficult problem of his entire life was this issue of frontal nudity before strange women! It was foreign to his life experience. "It's not right!" was his plea. His tearful eyes looked to me for counsel. The only consolation this veteran clergy provided him was that if I were in his shoes my feelings would be identical to his own! The female nurses told this suffering, dying patient, "You don't have anything we've never seen before!" "Don't worry about it, we do this all the time!" and "You'll get over it!"


We have a web page about male patient modesty that you can check out on our web site.

Misty

New Park House said...

I agree with everything that you mentioned in this post. It is more appropriate that female nursing home residents must be assisted by a female nurse for intimate care tasks. A male nurse or assistant could help to lift a clothed woman in the bathtub if necessary and leave while a female nurse or assistant bathes her. Well said. I learned a lot. Thanks for sharing.

Anonymous said...

Misty

Again, your articles are discriminatory at best. Perhaps
you are unaware of what happened at a nursing home
in Albert Lea Minnesota. Three young female cna's
physically and sexually abused male patients.

PT