Elderly Patients and Modesty in Medical Settings

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.

Nursing homes should never 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? 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.

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. 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. 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 MPM: 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.

We strongly recommend that you look into purchasing modesty garments for elderly patients who require assisted bathing through Dignity Resource Council.