The fragmentation of social inclusion, integration and trust is the result of an array of historical influences, including the erosion of common theological and epistemological frameworks which have historically functioned to maintain social harmony, and the rise of autocracies amid postmodernism and its assertion of multiple truths. The influence of Calvinism in the Christian West, which paved the way for individualism and capitalism, is explored as an example. Contemporary research on trust and social inclusion rarely considers the theological roots of contemporary mistrust and takes for granted the economic dominance of capitalism. Discussions of social inclusion and trust should include considerations of legacy theological assumptions, the way differences are conceptualised and valorised, and the conflation of equality and equity. The article suggests that mistrust in the institutions of civil society is unsurprising when significant parts of a population are considered undeserving, are demonised for political purposes, or are emerging from colonial hegemony. Ways forward include articulating the implicit theological content of contemporary social policies, prioritising human dignity, and actively participating in the decolonisation project, whether as a formerly colonised or colonising nation.

Journal Article Review of HIV, Sex and Sexuality in Later Life Get access M. Henrickson, C. Charles, S. Ganesh, S. Giwa, K.D. Kwok, and T. Semigina (Eds.). ( 2022). HIV, Sex and Sexuality in Later Life. Bristol University Press. ISBN: 978-1447361961. Andrew Spieldenner, PhD Andrew Spieldenner, PhD Department of Communication California State University-San MarcosSan Marcos, CA, USA Email: aspieldenner@csusm.edu https://orcid.org/0000-0001-9321-3520 Search for other works by this author on: Oxford Academic PubMed Google Scholar The Gerontologist, Volume 64, Issue 5, May 2024, gnae012, https://doi.org/10.1093/geront/gnae012 Published: 15 February 2024 Article history Published: 15 February 2024 Corrected and typeset: 16 April 2024

Increasingly, kaumātua (Māori elders) in Aotearoa (New Zealand) live apart from whānau (Māori extended family) in residential care, where policies are shaped by post-colonial legislation and ethical principles that privilege individual rights over Indigenous priorities and rights. The communal context of residential care has created late-life opportunity for intimacy and sexual expression with new partners. These issues are addressed in the international literature, highlighting the benefits and complexities. Literature report there may be clashes between resident and family members’ wishes, and tensions around privacy and consent. This article considers survey data and semi-structured interviews with kaimahi (Māori care workers) and a kaumātua who were part of a larger study of staff, residents, and family in the residential aged care context. Post-colonial individualistic rights-based approaches do not necessarily fit with a Māori worldview. A Māori-led articulation of consent is essential to uphold the mana (authority, influence, power) of kaumātua and whānau.

This article has been selected, not because of the answers it provides, but because of the questions it poses and the insight it gives into the contested terrain that is global social work, and more specifically, global social work ethics. The aim of the new statement of ethical principles, approved by the International Association of Schools of Social Work (IASSW) and International Federation of Social Workers (IFSW) in 2018, was to move away from the ‘Western’ liberal humanist values that had characterised the previous statement, and at the same time, to respond to calls to decolonise social work. How far this has been achieved remains an open question. We invite readers to use this extract as a brief taster, and to make up their own minds about this important debate by reading the article in full.

Background The existing literature on sexuality and intimacy in residential care tends to focus on either the question of rights, or the value of autonomy. Where the literature does reference values other than autonomy, such values are considered in the context of being a guide to whether or not a resident is autonomous, rather than being important values in their own right. Objective This paper draws on qualitative data gathered as part of a larger study in order to inform practice on how care workers respond to intimacy issues that arise with residents with dementia and to inform a general ethics of sex and sexuality, demonstrating that an approach which permits value pluralism can be appropriate in certain contexts. Research Design The qualitative data referred to in this paper was gathered from semi-structured interviews undertaken as part of a larger mixed-method research project. The interview text was analysed using Thorne’s methodological approach, interpretive description. Participants and research context The qualitative arm of the project consisted of semi-structured interviews conducted between October 2018 and October 2019 with participants (staff, residents and family members) recruited from 35 residential care homes in Aotearoa New Zealand. Ethical Considerations Participation was informed, voluntary and written consent was gained before interviews. The project was approved by the Massey University Human Ethics Committee (Northern), number NOR 18/25. Findings Analysis of the scenarios presented in this paper shows that decision-making around sexual intimacy involving people with dementia in a residential care setting is complex and requires recognizing and weighing the different values that may be a in play. Conclusion A focus on safety and consent to the exclusion of other values which matter morally in this context is a mistake which prevents care workers from providing appropriately person-centred care to residents, as policies which focus on the goal of care allow space for critical examination of issues which are likely to be highly context-sensitive.

This chapter addresses the question of whether social work is a profession or something else. It establishes a conservative list of attributes of a profession that includes a clearly defined and altruistic purpose, transmissible theoretical knowledge, specialised skills or techniques, a common values base and ethical code, individual responsibility and autonomy in decision-making, self-governing association, and public and political recognition as a distinct professional group. Social work currently meets some of these criteria in some places in the world, but nowhere currently meets all of the criteria. Social work must consider to what extent it wishes to act in a social control function on behalf of the state. Social workers must decide whether establishing social work as a global profession is important. The chapter proposes four possible ways forward.

Introduction Sexuality and intimacy in residential aged care (RAC) are receiving increased research attention. In this article, porneia refers to access to sex workers, as well as online pornography, and masturbation by residents in RAC. Sex work is legal and regulated in Aotearoa New Zealand. Methods The present study was a two-arm mixed-method cross-sectional study using a concurrent triangulation design. A validated survey tool was developed. Data were collected in 2018-2019: 433 staff surveys were collected from 35 RAC across the country; 61 interviews were carried out with 77 staff, residents, and family members. Results Staff opinions about sex work and pornography were inconclusive. Nevertheless, access to sex workers occurs in many RAC facilities across the country. Interviews demonstrated a diversity of responses among the three groups; staff attitudes are paramount. Conclusions Some staff are prepared for resident requests for sex workers; others continue to look to policies and management for guidance, but such policies are often lacking. Most staff have adopted the language of needs vs. rights which dominates the literature. Policy Implications Staff education on sexuality and facility policy is essential; education for residents and their families is also desirable. Facilities often over-notify third parties. Discourse about sexuality needs to move towards a person-centred, salutogenic approach.

Background To investigate attitudes of staff, residents and family members in long-term care towards sex and intimacy among older adults, specifically the extent to which they conceptualise sex and intimacy as a need, a right, a privilege or as a component of overall well-being. Methods The present study was a part of a two-arm mixed-methods cross-sectional study using a concurrent triangulation design. A validated survey tool was developed; 433 staff surveys were collected from 35 facilities across the country. Interviews were conducted with 75 staff, residents and family members. Results It was common for staff, residents and family members to talk about intimacy and sexuality in terms of rights and needs. As well as using the language of needs and rights, it was common for participants to use terms related to well-being, such as fun, happiness or being miserable. One participant in particular (a staff member) described receiving intimate touch as a ‘kind of care’—a particularly useful way of framing the conversation. Conclusion While staff, residents and family frequently used the familiar language of needs and rights to discuss access to intimate touch, they also used the language of well-being and care. Reframing the conversation in this way serves a useful purpose: it shifts the focus from simply meeting minimum obligations to a salutogenic approach—one that focuses on caring for the whole person in order to improve overall well-being and quality of life.

Commonly, frail older adults move to residential care, a liminal space that is their home, sometimes a place of death, and a workplace. Residential facilities typically espouse person-centred values, which are variably interpreted. A critical approach to person-centred care that focuses on social citizenship begins to address issues endemic in diminishing opportunities for intimacy in the end-of-life residential context: risk-averse policies; limited education; ageism; and environments designed for staff convenience. A person-centred approach to residents’ expressions of intimacy and sexuality can be supported throughout end-of-life care. The present study utilised a constructionist methodology to investigate meanings associated with intimacy in the palliative and end-of-life care context. There were 77 participants, including residents, family members and staff, from 35 residential facilities. Analysis identified four key themes: care home ethos and intimacy; everyday touch as intimacy; ephemeral intimacy; and intimacy mediated by the built environment. Residents’ expressions of intimacy and sexuality are supported in facilities where clinical leaders provide a role-model for a commitment to social citizenship. Ageism, restrictive policies, care-rationing, functional care, and environmental hindrances contribute to limited intimacy and social death. Clinical leaders have a pivotal role in ensuring person-centred care through policies and practice that support residents’ intimate reciprocity.

This paper explores attitudes of staff, residents and family members towards sexually diverse persons based on data from the first national study of its kind in Aotearoa New Zealand. The study was a two-arm mixed-method cross-sectional study using a concurrent triangulation design. The quantitative arm included the results of 433 staff surveys related to knowledge, attitudes, behaviours and beliefs about sexuality, intimacy and ageing. The qualitative arm included interviews with 77 participants including staff, residents and family members. This paper focuses only on sexual diversity. A generational cultural effect was noted among all respondents; younger participants expressed the most open and accepting views of diversity. Residents were aware that they mostly held the views of their generation; nonetheless they also looked to staff to set the tone. Staff held varying views and felt that residents would be less accepting; some staff felt the issue of intimate relationships was not something they were willing to discuss at intake. Facilities will want to establish policies about sexuality and intimacy and communicate those policies and practices to staff, residents and family members. Facilities may also wish to consider specific educational events about sexual diversity for residents.

BACKGROUND:The ethical complexity of residential care is especially apparent for staff responding to residents' inappropriate sexual expression, particularly when directed towards care workers as these residents are typically frail, often cognitively impaired, and require ongoing care.OBJECTIVES:To explore staff accounts of how they made meaning of and responded to residents' unwanted sexual behaviours directed towards staff. This exploration includes whether staff appeared to accept harassment as a workplace hazard to be managed, or an unacceptable workplace violation, or something else.METHODS:These qualitative data are drawn from a national two-arm mixed method study in Aotearoa New Zealand undertaken in 35 residential care facilities. Semi-structured interviews were conducted with 77 staff, residents and family members. Interpretive description was used to analyse the data.RESULTS:Staff had numerous ways they used to respond to behaviours: (1) minimisation, deflection and de-escalation, where staff used strategies to minimise behaviours without requiring any accountability from residents; (2) holding residents accountable, where staff to some degree addressed the behaviour directly with residents; (3) blurred boundaries and complexities in intimate long-term care, where staff noted that in a context where touch is common-place, cognitive function was diminished and relationships were long-term, boundaries were easily breached; (4) dehumanising and infantilising residents' behaviours, where staff appeared to assert control through diminishing the residents' identity as an older person. It was evident that staff had developed considerable practice wisdom focused on preserving the care relationship although few referred to policy and education guiding practice.CONCLUSIONS:Staff appeared to be navigating a complex ethical terrain with thoughtfulness and skill. Care workers seemed reluctant to label resident behaviour as sexual harassment, and the term may not fit for staff where they perceive residents are frail and cognitively impaired.IMPLICATIONS FOR PRACTICE:Policy, education and clinical leadership are recommended to augment practice wisdom and ensure staff and resident safety and dignity and to determine how best to intervene with residents' unwanted sexual behaviours.