Introduction

The transformation of intimacy and sexuality issues within historically and culturally dependent institutions is challenging established views about ageing (Bildtgard and Oberg, 2017). Health and social care is one such institution yet to respond fully to the growing empirical evidence on what constitutes a meaningful life for older people interacting with care services in relation to sexuality and intimacies across different sexual and gender identities. Transcending established views about the role of health and social care professionals in providing meaningful engagement and support for older people to fulfil their sexual needs requires providers to recognise opportunities for responding to the complexity of issues arising in care. Being open to the range of people's relationship situations, and making spaces within assessment and provision of care to enable information and support on sex and intimacy to be made available and to engage proactively with the topic, is beginning to be recognised within workforce development (SfC, 2017). Building on these initiatives involves developing new structures and methods of embedding sexuality within professional education, in policies and care practices and in the commissioning of, and evaluation of, services (Hafford-Letchfield et al, 2010, 2020).

This chapter engages with the literature focusing on what we know or need to know about how professionals and providers within health and social care exchange and interact around sex as a meaningful concept in the provision and quality of care. It focuses on themes that are important to initiating and supporting sexual expression in later life and addresses important transition points where older people are considered ‘vulnerable’ in care services and where their sexual rights are less likely to be promoted or transgressed. As we saw in Chapter 9, issues may occur in residential care for people with cognitive decline, and in this chapter we expand further on issues that may emerge at the end of life. Building further on Villar and Faba's contribution in this volume, I highlight some of the underlying theoretical concepts that forge pathways to improved practice and point to areas in which there is good practice guidance from the current evidence available. A shift in western societal perspectives has moved sex from being primarily situated within the context of marriage and reproduction to being a more central aspect of health and wellbeing in its own right (Hinchliff and Gott, 2011).