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how do you even start to train staff in something like this?
A number of resources are available. In fact the Hebrew Home for the Aged even did a training video, “Freedom of Sexual Expression†which can be purchased online. Several videos and training pamphlets exist to help those that run facilities understand what the issues are. A good place to start your search is http://www.terranova.org or http://www.geriatricvideo.com.
So how do you know when the sex is consensual? I think I would have a had time trying to decipher if one partner had moderate to advanced dementia whether they could be having sex.
Well, someone with advanced dementia would probably not be able to engage in consensual sexual activity. But someone with moderate dementia is where the line gets blurry. This is something that would have to be taken on a case-by-case basis.