Consent, Capacity and Intimacy: Understanding the New Rules in Dementia Care

By Lise Barry

After the Royal Commission into Aged Care, Australia’s new Aged Care Act (2024) is set to kick in from 1 July 2025, and it brings a big change. For the first time, the right to intimate relationships is officially recognised as a basic human right, including for people living with dementia in aged care. It’s a big step away from outdated views that see older Australians as asexual or simply a ‘risk’ to manage.

But with this shift comes new territory for many healthcare workers, families, and carers, who are now learning how to balance respect for a person’s choices with keeping them safe.

For people living with dementia, the question of capacity to consent can be quite complex. 

To provide support in sex based decision making, care providers need to consider each situation in its full context, including the person’s history, relationships, current wishes and wellbeing. However, for people living with dementia, their ability to give consent can change over time. It may be affected by things like medication, tiredness, or their surroundings.

Success in this area rarely comes through rigid policies but rather through thoughtful consideration of how to support both safety and dignity. One emerging approach to navigating consent is the concept of Advance Directives on Intimacy. These allow people to outline their intimate relationship wishes before capacity changes. 

If you want to learn more about navigating consent and intimacy for people living with dementia, subscribe to The Australian Journal of Dementia Care.