(A) My record shows that your name is . How would you prefer or like us to address you? (more than one option can be selected)
Pronouns
(B) How important is it to you for us to address you by your preferred name and pronoun?
(C) Would you like to add or tell me anything else about this before we move onto the next question?
(A) How do you identify your gender identity?
(B) Is your gender identity different from the sex you were assigned at birth?
(C) How important is it to you for us to acknowledge your gender identity?
(D) Would you like to add or tell me anything else about this before we move onto the next question?
All people have a need for intimacy in their lives. Intimacy can mean different things to different people.
(A) What does intimacy mean to you?
(B) How important is it to you to have intimacy in your life?
(D) What forms of intimate behaviour do you prefer or enjoy?
Sexuality can be an important part of life for older people. Sexuality can mean different things to different people.
(A) What does sexuality mean to you?
(B) How important is it to you to be able to express your sexuality in your life?
(D) How would you prefer or like to express your sexuality? (check all that apply)
(E) What, if anything, is getting in the way of you being able to express your sexuality the way you want to express it?
(A) What does sex mean to you?
(B) How important is it to you to engage in sexual behaviour/activity in your life?
(D) What forms of sexual behaviour/activity do you prefer or enjoy?
(E) What do you think is preventing you from being able to engage in sexual behaviour/activity that you enjoy?
(A) How do you identify your sexual orientation?
(B) How important is it to you for us to acknowledge your sexual orientation?
(A) How important is it to you to be in a romantic and/or sexual relationship with someone?
(B) Would you like to add or tell me anything else about this before we move onto the next question?
(C) Have you been married or involved in a romantic and/or sexual relationship with another person?
(E) How important is it to you for your spouse/partner/significant other/lover/special friend to feel comfortable visiting and spending intimate and private time with you in this place of residence?
(F) Would you like to add or tell me anything else about this before we move onto the next question?
(G) How would you like us to support you and your spouse/partner/significant other/lover/special friend to have an intimate and private time together? (more than one option can be selected)
(A) Have you heard of the expression “Safe Sex”?
(B) What does safe sex mean to you?
(C) Do you know what sexually transmitted infections are?
(D) Do you know how to protect yourself from getting a sexually transmitted infection?
(E) Have you had a sexually transmitted infection in the past?
(A) Do you know what the term ‘consent’ means in the context of sexual expression with another person?
(B) What does ‘consent’ mean to you?
(C) Have you experienced any type of sexual encounter that was not mutually consensual?
(D) Is there anything else you would like to tell us at this time? For example, if you have experienced abuse or trauma (sexual, physical, emotional or verbal). We want you to feel safe and supported and if you do not feel comfortable disclosing this information at this time, we understand. If you would like to discuss any of this in the future, please let us know.
(E) Is there anything else you would like to ask us?
(A) Do you think intimacy and/or sexual needs and preferences should be supported in long term care?
END OF QUESTIONS