OT and sexuality

[SadieMoon]

This doesn't come up too often in my practice - but it did recently.  The home health client , 70some male, suffered a CVA two months ago.  SO 50 yr old female, seems to have shifted her role from partner to caregiver.  He started asking me about sex, she's standing behind him shaking her head.  She wants me to tell him not safe for his heart.  That isn't true of course.  He is difficult for her, will not follow through with PT and OT suggestions between visits, refuses to bathe unless I am there ( Could do with her asst, needs only CGA) and by both of their reports he has even hit her ( no physical harm caused) calls for help in the night to use urinal which he could do I, got mad and went to front door one day and just fell out of the door down the stairs - only way he could leave house alone.  So, what I said ( go ahead and beat me up, this is really out of my area of expertise ) It's not da! ngerous for him to have sex, and  maybe if someone would shave and bathe and be nice and cooperate, he might get some.  SO was OK with that response.  Patient agreed verbally, but continues to be cantankerous.  They haven't brought up sex anymore with me - ( probably due to my royal failure in this area).  On my last visit SO told me his daughter needs to find someone to stay with him some, she needs to stay at her own  house some,so it seems the relationship might be unraveling some.  I'm sure he is in a lot of grief over his losses due to this CVA, and try to address that grief, but he is just really kind of mean to the SO -- Jody