"People in nursing homes often get treated like children," says psychologist Jennifer L. Hillman, PhD, author of "Sexuality and Aging: Clinical Perspectives" (Springer, 2012). And that means no sex. "Staff are often horrified and immediately separate people and chastise older folks," says Hillman. "Or they don't think the family will approve."

Older lesbian, gay, bisexual and transgender residents face even greater challenges due to staff's negative attitudes toward same-sex sexuality, adds Hillman. Some residents change their names to match that of a partner so they can pass as siblings and live in the same room, she says, while others — even if they were "out" before they entered long-term care — pretend to be straight and even hide photos and other evidence of their sexual orientation.

But denying older residents access to sensuality and sexuality deprives them not only of their autonomy but also of a key way to improve their moods. To start changing such attitudes, Hillman holds trainings for long-term care staff. The goal is to help them work through their own beliefs and tackle logistical concerns, including how to ensure privacy, whether to provide condoms and lubricant, even how to handle couples who need help undressing or getting in and out of bed.

One key issue is determining whether residents have the cognitive capacity to truly consent to sexual activity. Hillman relies on "Assessment of Older Adults with Diminished Capacity: A Handbook for Psychologists." Developed by APA and the American Bar Association Commission on Law and Aging, the handbook is available online.

Once staff undergo training, says Hillman, the tradition often gets passed down and becomes the norm.

"I ask people, ‘How would you feel if you were 80?'" says Hillman. "When you ask people to think about themselves in that situation, a light bulb starts to go off."

—Rebecca A. Clay