According to Dr. Ruth, you’re never too old to have sex.

But that doesn’t mean the sex remains without complications.

When older adults can no longer live on their own and enter a residential care facility, their sex life frequently becomes more difficult.

Maybe they don’t have a private room and have to strategize a good spot to have sex.

Perhaps a man begins dating a woman, but that woman has dementia, and the staff is unsure that she is capable of consenting to sex.

Maybe the would-be partners are entirely lucid, but they’re both on medications that make it difficult or painful to have sex, even though those medications are maintaining their health. Do they stay on the drugs? Or not?

These scenarios have all happened at the Jewish Home of San Francisco, said Jay Luxenberg, the

facility’s medical director.

“We have a written policy to encourage and respect sexuality, but the devil is always in the details,” Luxenberg said. Ultimately, “it becomes a customized management strategy. There’s no formula.”

Luxenberg, a geriatric physician, has worked at the Jewish Home for 30 years. As the current medical director, he oversees a team of doctors, nurses and psychiatrists.

He said sex and intimacy are frequent topics of discussion among staff, residents and their families.

“Sometimes families are very upset” by their parents’ intimate relationships that develop at the Jewish Home, Luxenberg said.

For instance, he remembered a time when a resident with dementia began a sexual relationship with another resident and called that person by the name of his deceased spouse.

“How do you handle that? Is it truly a consensual relationship when one person doesn’t know who the other person is?” he said.

Another complicated situation: A resident with dementia moves into the Jewish Home, while their spouse — who has remained healthy — lives on their own. Meanwhile, the resident starts a sexual relationship with another resident.

“Often, the family will say, fine, if they’re enjoying themselves and nobody seems to be harmed, go ahead,” Luxenberg said. “But other times, the family is very upset, and they ask us to move their loved one to a different floor to keep their spouse or parent away from the other person.”

In that case, it can be an emotional and awkward situation, said Janice Corran, a geriatric psychologist and executive director of the Reutlinger Community for Jewish Living in Danville.

“It’s hard on the children [of residents], to visit and think that their 82-year-old parent slept with who?” Corran said.

“We would not stop a relationship just because the child said ‘I don’t like it,’ if the resident has the capability to enter into a relationship,” she added.

Of course, a resident’s mental and physical health person’s ability to maintain their health and an intimate relationship.

For example, Corran recalled a female resident who was diabetic and started seeing a man. Once their relationship began, she started skipping lunch to spend time with him.

The woman’s blood sugar shot up because she was not eating properly. Though she was capable of making decisions for herself, “she wasn’t capable of saying to him, ‘I have to eat something or I’ll get sick,'” Corran said.

“When it becomes a medical issue, we have to step in,” she added.

Sometimes it’s not just medications that present problems.

Studies indicate rates of sexually transmitted diseases are on the rise in assisted and skilled nursing facilities.

Joy O’Donnell of the San Francisco- based National Sexuality Resource Center said, compared to younger populations, elderly men and women are less likely to use a condom during sex, and both are more likely to be more susceptible to infection because of sensitive immune systems.

Recent statistics from the Centers for Disease Control indicate that older people are at increasing risk for HIV and other STDs. In 2005, people 50 and older accounted for 15 percent of new HIV/AIDS diagnoses and 24 percent of those living with HIV/AIDS (up from 17 percent in 2001).

Luxenberg said while that might be true nationally, in his 30 years at the Jewish Home, he “doesn’t remember a single STD incident.”

Luxenberg and Corran added that it’s important that staff members are well-trained and well-versed in sexuality and how it affects a resident’s mental or physical health.

For instance, residents may take medication to reduce incontinence, but the medication can produce vaginal dryness, which can make sex painful.

But a resident may not feel comfortable mentioning this to her nurse.

“Medical staff in those settings need to be cognizant of the side effect and be willing to talk about it with the resident,” Luxenberg said.

At the Jewish Home and Reutlinger, staff participate in a wide variety of continuing education workshops, which often have a sexuality component.

They also lead workshops for residents about sex.

“I would say that 20 years ago, it would be rare in a managed care facility to have a social worker or physician give a seminar on sexuality and aging and have anybody show up,” Corran said. “Now, it’s just as common to talk about as any other subject.”