"Assisted Loving" - Will The Future of Senior Care Include the Last Taboo?

As the news broke about the pending arrest of the New England Patriot’s owner Robert Kraft for soliciting a prostitute, a bigger picture began to emerge – the reprehensible act of human trafficking. Although the 77-year-old Kraft reportedly had no knowledge of the trafficking aspect of the operation, he was one of more than 100 people who were linked to numerous Florida spas and massage parlors that were being used as a front for prostitution.

This story became front and center for several days, focusing on the investigation into the human trafficking. But within a few days came a secondary response to the story from advocates supporting the legalization of prostitution. And this group has been working under the radar screen for some time attempting to push lawmakers toward this end.

The proponents of legalizing “sex workers” latched onto three main issues to propel their argument. First, they stated that making prostitution legal would result in a decrease in sex trafficking since the activity would be legal and above board. This included the age-old argument of “taxing the activity” adding to the coffers of towns and cities that are struggling financially.

Second, by legalizing the act, it would lower the rates of STDs since regulating the workers would force them to be examined by doctors on a quarterly basis (an argument that really does not hold water given that such examinations are only as good as the last act they performed, but more on that later).

Finally, they cited that it was “a shame” that an elderly man worth over $6 billion and is a "cornerstone of the community" would now be viewed in a less than favorable light. If it were legal, they argued, no one would care about an upstanding citizen looking to get his needs met. One even cited age discrimination, making an argument that older adults in the United States are expected to be quiet and asexual despite having biological needs.

Before we dismiss the talk of legalized prostitution as extreme, let’s remember

that the cannabis industry worked behind the scenes for years pushing for the legalization of marijuana until it finally became a ballot issue and ended up being approved for use in states around the country. They too, cited that an activity engaged in by “millions” made criminals out of normally law-abiding citizens. When this gained only minimal traction, they took the medical route and held up cannabis as a cure all for scores of maladies. This approach pushed pot over the finish line.

Similar things happened in the gambling industry. First came state lotteries, then a few casinos outside of Las Vegas sprung up followed by a proliferation of casinos in states across the country. Now, on-line gambling and sports betting has been legalized, and soon, Rhode Island will join a number of other states in having a sports betting phone app, allowing in-state residents to gamble from the comfort of just about anywhere.

Behaviors that were once considered “vices” and “immoral” are now sponsored, promoted and taxed by state and local governments. And how do they clear their consciences when they know addicts are created by these activities? Well, they provide the phone numbers for Gambler’s Anonymous, Alcoholics and Narcotics Anonymous should someone need them. And for doing that, they feel good.

We know how the gambling industry grew with leaps and bounds until games of chance became available at nearly every street corner store, but can the legalization of marijuana lead to opening the door for legalizing recreational use of other drugs? No, say pot advocates, but a move is underway to accomplish just that.

Let’s look towards Colorado, one of the first states to legalize recreational pot. And if some have their way, this is just the beginning. Another drug is now being pushed along the same route – the so-called “magic mushrooms” (psilocybin). A group that calls itself Colorado for Psilocybin after the fungi’s scientific name, has proposed a measure that would do away with felony charges for people caught with mushrooms, and make them the lowest enforcement priority for Denver police.

Remember the initial push for marijuana was that it had properties that helped with all sorts of mental health disorders, including anxiety and depression? Now, those backing “magic mushrooms” are coming up with similar claims about this hallucinogenic drug. Michelle Ross, one of the backers of the group, claims that “psilocybin (magic mushrooms) is one thing that helps me overcome depression in a way that cannabis hasn’t.”

Some are even pushing for the legalization of LSD (lysergic acid diethylamide),

stating that it is the go-to treatment for PTSD (Post Traumatic Stress Disorder).

What about the unintended consequences of legalizing marijuana in Colorado?

Statistics show that there has been an increase in crime and homelessness while at the same time nationally, both rates have dropped. The Governor of Colorado sings the praises of the move but educators, police, social workers, doctors, drug counselors, parents, and others in the trenches of the world's first marijuana free-for-all see things quite differently.

The money-making opportunity lawmakers saw in taxing cannabis hit a high some three years ago and has been on the downturn ever since. Why? Because the high tax rate on legal marijuana has forced users to turn back to street dealers who sell it cheaper. This in turn has led to increased illegal growing farms, increased weapons and even an increase in the use of other drugs. Meanwhile, proponents of legal marijuana will tell you that these statistics are just being misinterpreted.

So why the discussion of gambling and marijuana in a blog about prostitution? It’s an example of how activities that were once considered criminal are now supported by law makers as a way to raise tax revenues. Each of the activities we discussed came with promises that regulations would make them safer and cheaper without addressing the unintended consequences that many predicted.

We also now know that among the aging baby boomers, drug use and gambling addictions are problems that are growing rapidly and must be addressed. And when it comes to sexuality and baby boomers, it appears we may be heading for another slippery slope.

Let’s look at some numbers. More than a quarter of adults aged 75-85 and over half of adults aged 65-74 are sexually active, according to a study by the New England Journal of Medicine.

We have pointed out that the prevalence of sexually transmitted diseases in people 45 and over has doubled over the past decade, according to the Centers for Disease Control and Prevention (CDC) with the highest concentration of these outbreaks occur in the so-called Sunbelt states (Alabama, Arizona, Florida, Georgia and Texas, to name a few) where many seniors go to retire.

We have written about the changing face of the senior entering retirement homes and the need for administrators and staff to be more open about sexuality and teaching them about healthy sexual behaviors. However, there is a growing group of “forward thinkers” in the senior care industry that are looking towards Europe and how they are handling sexuality in senior care facilities and -- get ready for this -- studying the impact of bringing prostitutes into nursing homes if and when the government legalizes the “sex trade”.

So just how has Europe moved “forward” with this?

When it was discovered that many senior living centers were hiring prostitutes

to attend to the “needs” of their residents, administrators and treatment professionals defended the decision by stating they were only thinking about the best interests of the residents. They argued that by helping a senior “safely and legally” express themselves sexually is an essential facet of providing complete holistic care - a philosophy that focuses on treating the whole person and not just a collection of symptoms. Some even went so far as to say that “sexual release” helped stave off some mental health issues. Germany, it appears, has been one of the leaders in this movement.

The country’s “sex workers” began carving out a niche which included specializing in the elderly and those with handicaps. And in the very best of political correctness, the use of descriptive words like “sex worker” or “prostitute” became “sexual assistants” as they plied their trade in the retirement homes.

In Artemis, Germany, a “wellness brothel” was set up that featured seating in showers and the changing rooms were enlarged to accommodate wheelchairs for those who were delivered there by staff of the care homes. Those who performed as sexual assistants fancied themselves as caring people who serviced those seniors in need. One of those assistants is named Nina.

According to a German newspaper, Nina works as the “assistant” for a gentleman named Josef who has dementia. “Every time I go see him, I have to introduce myself again,” she said. “Then I ask whether he’d like a massage and he says, ‘oh yes, that would be nice.’”

She states that her time with Josef involves them being naked, touching and holding each other, and it will end with him [being satisfied]. And Nina makes no apologies about what she does -- after all it is just business. “I prefer the term sexual assistant because it doesn’t carry any negative connotations, but I don’t shy away from describing what I do as a sexual service for which I expect to get paid.”

Nina even compared herself to social workers, psychologists, nurses and CNAs, calling herself a professional who works to provide compassionate care in another way.

Stephanie, a 49-year-old prostitute, boasts over 25 years of experience. She proudly counts many elderly and disabled men among her clients – but for her, they’re not just regular run of the mill johns. She must go through hoops to make things seem legitimate, or so she says.

“Of course, you can’t just go to a retirement home and say, ‘I’m a prostitute and I’m going to be spending the next three hours satisfying Mr. Jones’. So instead you tell the receptionist you’re his niece or his former neighbor, or he just comes down to meet you and then you walk up to his room together.”

According to Stephanie, the staff knows why she’s there, and there’s a wink and a nod. She says that all concerned are aware that she is providing a needed service that makes their jobs easier.

However, some are not so sure that the service they provide is all that altruistic and they explain why.

The sex industry in Germany was legalized in 2002, however many years later, issues like HIV, Hepatitis B and other STDs scared away many customers. A once thriving business took a steep downturn and the sex workers, who did pay taxes, were forced to collect welfare from the state in order to live. The recession of the industry lasted many years before it began to recover and when it did, an influx of younger, more attractive women replaced the older workers.

When the industry recovered and they realized their age no longer made them a viable commodity, they returned to their old profession and found a niche in senior care homes. So, some say it is a need being addressed, others say it is a way for older prostitutes to survive. In any case, it is happening.

England has also introduced sex workers in senior care facilities. The Times of London reported that a nursing facility in Eastbourne regularly scheduled visits with sex workers, who met residents in a room where a “special red sock” was put on the door for privacy. Caregivers were said to check on the rooms every fifteen minutes, the paper reported.

The manager of the facility told The Sun, a British tabloid, that arranging for these sexual activities was not done by the staff, who she hinted did not agree with the practice, but by a third party consultant (can you say pimp?), who handled the procurement of the sex workers and helped residents meet their “needs.”

An ex-manager of the facility told The Sun that the sex workers are “professionals” who offer a service that is both therapeutic to residents “frustrated” by “primeval needs” and helpful for the staff. Here it is, citing the benefits for staff.

Another one of the “therapeutic” activities offered there is strippers. One stripper who performed there also performed before the United Kingdom Royal Society of Medicine at a conference on sex and disability, where she provided a lap dance to a deaf and blind man, according to the Daily Mail, another English newspaper.

The ex-manager of the facility defended the practice by stating “If you have a resident who is groping staff, one way of resolving that problem is to get a sex worker in who is trained to deal with that situation. The fact is sex workers are allowed by law to sexually enable people, but care workers are not.”

And yet again, the argument that this service is for the safety of staff is introduced as a way to justify the activity.

A social worker named Marion, who works for a self-help and advocacy organization for sex workers, says, “People working in retirement homes have very ambivalent views towards prostitution. When they do encourage a visit from a prostitute, it’s usually only after a patient has been causing them problems, grabbing the nurses or touching himself too often.”

And here it is again, the argument that using prostitutes will keep senior care staff safe from being grabbed and assaulted. But more on this later.

So just how do senior care staff feel about sex workers in their facilities? Marion used the words "very ambivalent" but many employees are downright disgusted by the activity and have looked for work elsewhere. This threatens an industry that is already struggling to hire employees to work with the increasing numbers of baby boomers entering care.

But not to fear, the "forward thinkers" of Europe ran into a problem like this just over a decade ago and who did they turn to? Why prostitutes, of course.

Earlier we spoke of the decline in the sex industry in Germany in the first decade of our new century. At the same time, senior care homes were experiencing a major staff shortage. Enter Rita Kühn, a "forward thinker" from Diakone Westfalen, a German welfare program, who hired and trained out-of-work prostitutes as senior care workers.

"It was a logical move," said Kühn, since prostitutes have "good people skills,"

and aren't easily disgusted and have "zero fear of contact." She was so confident that prostitutes were cut out for nursing care jobs that she offered 30 women the chance to have a new career with two years of courses and vocational training.

Heinz Oberlach, who worked for Germany's Federal Labor Agency said the idea of using prostitutes as care workers was "very logical" and "fit together like the pieces of a puzzle". But, Kühn offered some advice to the operators of senior care facilities, "nursing home bosses will have to be discreet so that elderly men don't try to get more than they are paying for."

But here’s another issue to consider – will only those with enough funds to pay for sex workers be viewed as discriminatory? Well, back to Germany where this issue needed to be addressed – and you may be shocked.

The German Green Party proposed that care home residents should be provided with state funded visits by sex workers. The party spokesperson, Elisabeth Scharfenberg, stated that medical doctors should be given a right to prescribe sex with prostitutes just like prescribing a drug, which would be subsidized by tax money.

"I can imagine a [public] financing of sexual assistance," she said. Local officials could provide information about "offers of this kind in the area," as well as grant the necessary funds,” she said.

And now, let’s address the argument of “safety” for senior care staff. One of the arguments brought forth by supporters of bringing “sex workers” into senior care facilities is that female staff are less likely to be the targets of seniors trying to accost them. However, not everyone believes this is true and argue that sexual activity in care has led to increased acting out by residents and not less.

In European nursing facilities, staffers routinely field patient requests for personal lubricants, pornographic magazines, larger-size beds, and prescriptions for Viagra. And within a decade or so, the senior care homes there will soon swell nearly four-fold as baby boomers and their liberated ideas arrive. It has been speculated that because staff are forced to provide these items and even expected to support prostitution, residents associate them with the sexual activity and view them as one and the same. There have also been reports that senior care administrators have "softened" reports showing an increase in groping and grabbing of female staff.

"I hope that as a society, we are smart enough not to move in this direction, but ten years ago, I would have said the same thing about this country's current love affair with everything cannabis and the fact that someone can sit in their hot tub and bet on sporting events using their cell phone. So I guess I should never say never," said Attorney RJ Connelly III.

"But, if such an activity becomes a reality," continued Connelly, "the door would be opened for so many levels of abuse, neglect and exploitation that I would suspect that most senior care providers would not venture down that road."

What if medical providers started writing prescriptions for sexual activity for senior care residents as part of their treatment plan, much like medical marijuana led to the acceptance of recreational marijuana use?

"Again, it's all hypothetical, but suppose a doctor writes a script for these services and the family or guardian object based on fears of exploitation, moral or religious grounds?" said Connelly. "Would that create an accusation of neglect against the guardian for refusing to comply with medically necessary services? There is just so much here that it's difficult to even speculate."

As our society continues its move towards legalizing and accepting once taboo activities, the “forward thinkers” of the senior care field are already busy laying the groundwork for such services to become a part of treatment in senior care facilities. But one thing I have learned after nearly four decades in the human services field, once the unintended consequences arise, the “forward thinkers” will quickly look behind them and point their fingers at others. It's predictable.

Attorney Connelly practices in the area of elder law. This area of law involves Medicaid planning and asset protection advice for those individuals entering nursing homes, planning for the possibility of disability through the use of powers of attorney for the both health care and finances, guardianship, estate planning, probate and estate administration, preparation of wills, living trusts and special or supplemental needs trusts. He represents clients primarily in the states of Rhode Island, Connecticut and the Commonwealth of Massachusetts. He was certified as an Elder Law Attorney (CELA) by the National Elder Law Foundation (NELF) in 2008. Attorney Connelly is licensed to practice before the Rhode Island, Massachusetts, Connecticut, and Federal Bars.

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