When it comes to the elderly, almost no one wants to talk about sex. This is especially true when nursing home and residential care are involved.

According to new report by a group in Australia in the Journal of Medical Ethics, the idea that adults should be able to engage in sexual relationships whenever, and with whomever, they choose becomes very complicated for residents in most nursing homes. For residents with dementia, romantic intimacy is especially discouraged.

Many older people, including those with early stage dementia, enjoy sex while living at home with their spouses. But this ends once they move into a nursing home, even for long-term couples, note the researchers from the Australian Centre for Evidence-Based Aged Care. Married or not, sex ends at the nursing home door.

Nursing homes are simply not set up to permit romance. Privacy is at a premium and few room doors lock. Most rooms are double-occupancy with single beds. And nursing home staff don’t typically encourage romance and sex. It's one less thing for nursing home owners and administrators to worry about.

We're so prudish about the elderly and intimate relationships that we don’t even broach the topic when a loved one is heading to a home. We consider freedom and autonomy when debating who will have the right to pull the feeding tube or turn off the dialysis machine if Mom or Dad can't communicate, but we do nothing to ensure their right to enjoy themselves in an area of life that matters a great deal to them.

Sex may not be for every nursing home resident, but it is surely for some. That's autonomy worth talking about.

A nursing home ought be at least as tolerant as a prison. Some prisons permit conjugal visits. Shouldn’t we expect the same of nursing homes? If you care about your parents' and grandparents' dignity, sex ought to be a topic of conversation regarding the nursing home if that's where they're headed or where they now live.

Bioethicist Art Caplan is the head of the Division of Medical Ethics, NYU Langone Medical Center.

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