Carol Finkelstein’s elderly father Ted was causing trouble. His sexual desires and encroaching dementia collided with restrictions at a long-term care facility, making him even more combative. He pulled fire alarms, stole floor keys and once touched a female resident’s breast. He was kicked out.
He was then welcomed into a San Francisco facility known for its progressive attitudes toward sensuality and mental health. There, Finkelstein worked with the staff to address her father’s unmet needs – including sexual ones – which underpinned his rebellious behavior.
And she hired him a surrogate sexual partner.
“I was fortunate that Ted’s neuro-psychiatrist had such an original suggestion,” says Finkelstein.
“He was always very sweet with me,” recalls Linda Poelzl, a San Francisco Bay Area-based surrogate partner whose weekly encounters with Ted over nearly seven years included touching, cuddling, kissing and intercourse. “The family was really happy it was working out so well with me… It was like I was his sweetheart.”
Although Ted no longer sees Poelzl, today the staff at AgeSong offers him human touch on a regular basis — rubbing his hands or tousling his hair. The facility’s engagement director often walks around the neighborhood with him, arm-in-arm.
Could surrogate partners be more widely adopted to help address the powerful lifetime desire for sex, intimacy and human touch? Could they further help calm the emotional turmoil of people with dementia?
For those with hands-on experience as surrogate partners — including a former international courtesan — the answer is an enthusiastic “Yes.” For academics, including those promoting healthy sex throughout the aging process, concern about the various legal hurdles and resistance from long-term care facilities produces a vastly different response: “No way.”
Kendra Holliday, a self-described “sex surrogate” in St. Louis, Missouri, has worked with a variety of clients with sex and intimacy issues that range from the physical to emotional. Holliday considers her work intimate, loving, and vastly rewarding.
One family approached Holiday about working with their 90 year-old father with dementia, commonly known to everyone as a “grumpy old man.”
Holliday could certainly relate.
“Sex is like food,” says Holliday. “If I don’t get it I feel grumpy and on edge myself.”
Holliday shared erotic touch with him, including massages and showers.
“It can be so rejuvenating,” says Holliday. “Offering a sexual person a steady diet of healthy sexual release offers improved quality of life and thus prolongs it.”
Holliday cites the vast health benefits that come from sensual healing, which can improve joint pain, arthritis, blood flow, diabetes, depression and especially anxiety — “the biggest culprit when it comes to erectile dysfunction.”
Clients in their 50’s and 60’s “are trying to make up for lost time and are seeing their mortality looming,” says Holiday. “They are very much trying to tap into this creative life force.”
Creative life force? Or sexual opportunism?
“What you seem to be proposing is the engagement of surrogates to gratify the sexual arousal of older adults with dementia,” replied one national expert when asked if surrogate partners could help soothe the emotional turmoil of dementia.
Even those who advocate for surrogate partners are skeptical of such a practice, including the head of the International Professional Surrogates Association, which trains surrogate partners and sex therapists.
“If it doesn’t involve a therapist it’s not surrogate therapy,” says Vena Blanchard, the association’s president and senior trainer, who works in Los Angeles and San Diego Counties. (Poelzl works with therapists while Holliday typically does not.) Consent issues, she adds, are also a stumbling block for long-term care sites.
While countries around the world vary in their attitude towards surrogate partners, Blanchard cites her favored location: California.
While the state has no laws protecting sexual surrogates, it’s not illegal. California’s approximately 25 surrogate partners practice inside a grey area that sees them offering therapeutic benefits for those with sexual issues.
Don’t ask, don’t tell.
“There is no alternate place in the world where surrogates are recognized and treated by the state in a similar manner,” says Blanchard.
A former courtesan who is today a relationship coach for couples, Nevada City-based Veronica Monet says the shame sometimes associated with sexuality prevents it from being used more widely as a therapeutic tool.
“When we take our elderly and put them in sexually sterile environments it’s tantamount to denying them food,” says Monet, author of the blog The Shame Free Zone. “To deny that birth right, to deny this innate aspect of one’s self is to me one of the cruelest things you can do.”
Much like the sight-impaired who develop an acute sense of hearing, Monet describes the intense sensitivity felt by quadriplegics in areas immediately above their paralysis.
What does that say about older adults whose whole bodies have been deadened by lack of sensual stimulation for years — even decades?
Typically, long-term care facilities aren’t even asking the question.
“It’s not even on their radar,” says Melanie Davis, co-president of the national Sexuality and Aging Consortium. Davis warns that most long-term care facilities don’t even want to address the issues of sexuality in their facilities between residents, let alone a hired surrogate. While a handful of progressive sites dot the country, just getting others to create a policy on sexuality has proved daunting.
One facility told Davis they actually had a “privacy room” for intimate encounters.
“Do you use it?” she asked.
“Yeah, for staff meetings,” came the reply.
Prevailing cultural attitudes reveal a wildly conflicted attitude towards sex. It’s healthy. It’s violent. It’s beautiful. It’s perverted.
What’s not so conflicted is our attitude about growing old. As one aging advocate has claimed, in a society obsessed by youth, the simple act of aging means failure.
And so, as older adults age, their bodies cry out for the simple sensual engagement of human touch — including, yes, sex — that many compare to food and water as essential ingredients to living.
“If you want to kill a spirit, deny what is dear to them — freedom, sex, food,” says Holliday. “Cutting them off from their inherent needs will end their life sooner.”
Monet echoes the sentiments of many who have worked in the field.
“We’ve demonized lust,” says Monet. “We’ve demonized sexual desire.”
Like many surrogates, Holliday helps with the disabled and recalls one experience in particular with a younger man.
“One time, after sharing intimacy, I collapsed on him, all happy and out of breath,” she writes in an email. “He started crying. When I asked why, he said something I will never forget: ‘This is the first time I’ve ever felt someone else’s breath and heartbeat before.’ That made me cry, too. So beautiful.”
“Sex connects us to the divine, particularly when it’s not connected to shame and violence,” says Monet. “It’s sad to me that in America we’re still criminalizing adult consensual sexuality.”
What does the future hold?
Holliday sees sex as a natural human act. “It’s kind of like going to your chiropractor and getting adjusted.”
While hugely beneficial in private settings, Blanchard says surrogates in long-term care facilities won’t be mainstream any time soon. “If we had people going in and holding hands and rubbing feet we wouldn’t even be talking about surrogates.”
Davis thinks there are more basic battles to wage. “If the Baby Boomers are going to campaign for something, they should start with a massage.”
Yet Poelzl, who has worked as a certified surrogate partner for two decades, sees immense benefits for physical and emotional health.
“An army of surrogates could help a lot of people,” she says. “Especially elders.”