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MASON CITY | Attorneys, Alzheimer's professionals, nursing home representatives and advocates for sexual assault victims say conversations need to take place about sexuality and the elderly in light of the trial of a former North Iowa legislator accused of having sex with his Alzheimer's-stricken wife.

A Hancock County jury acquitted Henry Rayhons, 78, Wednesday on a charge of third-degree sexual abuse. Prosecutors alleged he had sex with his wife, Donna Lou, while she was a patient in Concord Care Center in Garner and lacked the capacity to consent to sexual activity due to Alzheimer's. 

On the witness stand, Rayhons denied having relations with his wife on the day in question, but described the couple's intimate relationship which included touching, fondling as well as intercourse. Witnesses said Donna Lou could be flirtatious and that the couple loved each other very much.

The case drew national attention and started a debate about the ability of an individual with dementia or Alzheimer's disease to consent to sexual activity.

In her 11 years with the Greater Iowa Chapter of the Alzheimer's Association, Carol Sipfle, the executive director, said intimacy is an issue that has come up for patients and families. 

"Not necessarily in the courts, but it is something that facilities struggle with, families struggle with and it's one of the topics that not many people talk about," Sipfle said.

The association advises families to be pro-active.

"Get a diagnosis as early as possible. That's not always easy. I will be the first to admit that. What an early diagnosis will do is it allows the family to have difficult conversations while the person with the disease still has the cognitive abilities to participate in those conversations."

The Iowa Health Care Association and Iowa Center Assisted Living said there are issues that need to be addressed whether the patient lives at home, in a hospital, nursing home or assisted living facility.

“Any issue involving resident decision-making where a resident may have impairment requires a discussion with the attending physician as well as legal surrogate decision-makers, usually family members," said Steve Ackerson, executive director of the IHCA and ICAL, in a statement to the Globe Gazette.  

He said a nursing home's care team works hard to maintain communication when these types of issues are a concern.

A care conference dealing with Donna Rayhons was held  in mid-May 2014. At that time, Rayhons was told that a doctor had determined his wife could not consent to sexual activity.

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"Because the symptoms differ in each person suffering from dementia and progress over the course of the disease, care plans are periodically reviewed, updated and adapted," Ackerson said. "Federal regulations require that nursing homes' care plans meet residents' individualized care needs with dignity and respect."

Ackerson added caregivers in all health care settings are mandatory reporters of child and adult abuse and neglect.

The organizations represent more than 700 Iowa nursing homes, assisted living and residential care facilities, home health agencies, hospice and independent senior living and retirement communities.

Mason City attorney Richard Tompkins said families might want to consider adding directives about intimacy to legal documents such as a power of attorney for health care.

"Most clients aren't really excited about talking about intimate relationships," Tompkins said. But such conversations could become important as the cognitive abilities of one partner declines.

"While I am in a good frame of mind now and know and understand where I am, this is how I want to be treated when I may not be in that position," Tompkins said.

Tompkins said if the Rayhons had prepared such documents stating her wishes, a prosecutor would have a hard time trying such a case.

"It may very well be something to consider."

Sipfle and Tompkins agree one of the most important things you can do is to let your loved ones know your wishes about such matters before your cognitive abilities begin to fade. In that way, all parties including the patient can be protected.

“I think this is a sad case that really brings home the fact that care facilities, health care providers, families … there needs to be clear policies in place to protect vulnerable adults,” said Mary Ingham, executive director of Crisis Intervention Service. “I think it’s important to have those conversations in place before things happen.”

“I have great empathy for all involved in this case,” she said. “I think it really brings home these are things we need to talk about before things happen or allegations happen.”

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