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Exploring Issues about Sexuality & Dementia: Assessing and Mitigating Risk event discussion continued
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Lori Schindel Martin, RN, PhD, - (10/7/2016 9:25:09 AM)
RE:Personal Directive
The question you ask is an important one about the use of a prior Personal Directive about sexual behaviour and its validity once the person is no longer considered competent to make decisions. The document would no longer be valid, and cannot be used as the single piece of evidence to support a relationship that may be developing between two residents in facility-based care. However, this does not mean that the relationship should be forbidden or prevented. Rather, a prudent clinical team would use this prior Personal Directive as just one piece of a total package of assessment information to be considered when figuring out with the resident/family and clinical team the status and parameters of a current developing relationship between two residents. The full assessment must include an account of the Personal Directive + Family conversation to document their understanding/belief/values from questions listed in the slide deck + Clinical Condition and cognitive assessment + additional SDOS documentation about the frequency, intensity and duration of the sexual behaviors + the current personal account of the resident using the questions posted in the slide deck + organization policy and practice guidelines + long-term care home act and regulations as RELEVANT to the current case + consultation with a local ethicist/clinical expert + team conversation = final decision-making and care plan development --> then evaluate and refine the plan of care. This is a complex behavioral phenomenon that requires equally complex assessment practices and care plan development. (Lori Schindel Martin, RN, PhD, October 4, 2016 @ 1320 hrs). 

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