Date of Award


Degree Type


Degree Name

Doctor of Philosophy (PhD)



First Advisor

Dr. Erin Ruel

Second Advisor

Dr. Elisabeth Burgess

Third Advisor

Dr. Wendy Simonds

Fourth Advisor

Dr. Jennifer Craft Morgan


Assisted Living (AL) communities are residential care settings designed to offer support and assistance to adults aged 65 or older who demonstrate a physical or mental impairment that makes it difficult for them to care for themselves. These communities provide support with activities of daily living (ADL) without the level of medical care typically found in nursing homes. By offering housing, personal care services, and social engagement opportunities tailored specifically to older adults' needs, ALs aim to promote independence while improving quality of life. Apart from care, ALs provide an environment where social relationships, intimacy, and sexuality for residents are negotiated. Administrators of these communities face challenges when developing and implementing policies and processes that govern residents' behavior. These challenges are compounded by the physical and cognitive decline of the residents such as dementia frailties. AL administrators face difficult decisions on balancing the sexuality and intimacy needs of older adults with health and consent needs. Existing theoretical and empirical research on sexuality and intimacy among residents living with dementia is not sufficient, especially regarding how providers negotiate to balance the autonomy of residents’ sexual needs against ensuring residents’ health and safety as well as the expectations of their respective families using structured interviews and qualitative thematic analysis, I examine how administrators and care workers in AL define, understand, balance, and negotiate the sexuality and intimacy behaviors of residents with dementia.

Administrators are gatekeepers, policy-makers, and culture influencers in a setting. The level of protection entrusted to administrators and their role in governing sexual relations amongst residents while understanding the potential side effects of dementia is worth studying. Administrators informal policies regarding residents’ sexual needs are shaped by many factors that tend to stifle the residents' sexual autonomy. The health, safety, and family expectations often trumped the intimacy needs of AL residents. Findings highlight oversight strategies, such as surveillance, redirecting, and reporting, that care workers employ, undermine residents’ privacy, dignity, and respect. In this dissertation, I expand on earlier studies on sexuality and older adults by examining the complex ways in which administrators negotiate and balance sexual autonomy using strategies within the AL communities.


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