Case Study: An Ethical Dilemma in the Field

I started my 440-hour internship journey at an adult living facility. This was an all-around care facility, including people who were completely independent to those who needed extra support in a memory care setting. I mainly supported people within the assisted living part of the facility. Some of the individuals experienced physical disabilities, others experienced different levels of dementia, and some experienced both. Everyone was different and unique with their own personal care needs. I gained a couple of amazing skills while interning there. One of those was how to redirect. Towards the end of my internship, I had gotten the hang of how to use this skill but had one very unexpected challenge arise involving sexual consent among older adults. Now, this situation tends to become a hot-button issue because it revolves around sexuality. This is not really talked about in facilities, which leads to the stories of rampant sexually transmitted diseases (STDs) within nursing homes. Families may not want to have these types of conversations and, in some situations, forbid their parents from engaging in these activities.

I got to experience this situation unfold firsthand. A new woman entered the program and immediately was smitten with one of the residents. The woman was said to have been highly functioning with the dementia she experienced, whereas the male was stated to have a lower amount of cognitive function. He would recite nursery rhymes and make funny noises. He could answer questions in the moment but did not remember a lot. The two began a physical relationship. Not long after, the family of the man found out that they were together and decided that was not okay. They told the facility to keep her away from him and that it was wrong for them to be together. This was my first experience in learning about the intricacies of working with people.

The family was the legal guardian and had the power to make decisions on his behalf because he was deemed unable to make decisions in his own best interests. It could be that he did not have the mental capacity to consent to a physical relationship. The family saw the woman was very aggressive in her pursuit of this relationship, and they saw her behavior as predatory. The man said yes to her, but the concern was whether or not he was able to consent and if he understood what was going on. So, the family then told them they were not allowed to continue the relationship, and now the facility, myself included, had to enforce it.

Since I was new and unknowledgeable about how to handle the situation, I did what I was instructed to do and kept them away from each other. This was easier said than done on a bus with limited seating and two people determined to see each other. My supervisor told them they could not sit together and did not allow any type of wiggle room. So here we were, me sitting next to a confused, upset man and the women behind us yelling and complaining about the treatment that they were receiving. This only made the man even more upset.

Using the tool of redirection, I asked the man, “Hey, how was your lunch? I only had the biscuits and soup. What did you get?” He said, “I do not remember what I had.” The lady behind us said, “Oh, you had the seafood alfredo.” He said “What? I did? Are you sure? I don’t have any leftovers.” She replied, “Well, because you ate it.” He looked at me and said, “Welp, guess it was good then.” This kicked off laughter about the food, and everyone jumped in on the conversation. I will always remember the sigh of relief that came from my supervisor. This encounter and how I handled the situation was the best use of the skills I learned working with these individuals. The gift of distraction became another tool in my tool belt.