Federal inspectors found that Hickory Creek at New Castle failed to evaluate the capacity of either resident involved in the relationship, which included hand-holding, card playing, and kissing. The facility also never created individualized care plans addressing their sexuality and romantic involvement.
Resident B, whose medical record showed stroke and behavioral disturbances, told inspectors on August 11 that she was in a relationship with Resident C. A quarterly assessment from July indicated she had moderate cognitive impairments that would affect her decision-making abilities.
"The relationship entailed her holding hands, playing cards, and kissing Resident C," inspectors documented after interviewing the woman.
Her romantic partner, Resident C, was cognitively intact according to his May assessment. During his interview with inspectors, he confirmed the relationship but said they had recently broken up. He described spending time together, holding hands, and kissing.
"Resident C stated it did not go further than kissing in the mouth," inspectors wrote.
Neither resident had been evaluated for their ability to consent to the romantic and physical aspects of their relationship. The facility's own policy required such assessments.
The Executive Director admitted during an August 12 interview that she could not locate any documentation showing either resident's capacity to consent had been evaluated. She also could not find care plans addressing their sexuality and relationship needs.
The missing assessments violated the facility's written policy on resident sexuality. That policy, provided to inspectors, clearly stated that "a determination of the ability to consent to sexual activities must be made in conjunction with the IDT and physician."
The policy further required that "determination of capacity to make decision regarding sexual activity will be documented by the physician in the medical record."
No such documentation existed for either resident.
The Executive Director told inspectors it was the Social Service Director's responsibility to develop the required care plans. Those plans were never created.
The oversight meant that a cognitively impaired woman engaged in physical intimacy without any professional evaluation of whether she understood the nature and consequences of her choices. Her stroke-related cognitive deficits could have affected her judgment, yet staff never assessed this critical factor.
Federal regulations require nursing homes to help residents achieve the highest possible quality of life through medically-related social services. This includes addressing sexuality and relationships in ways that protect vulnerable residents while respecting their dignity and autonomy.
The inspection was triggered by a complaint filed against the facility. Inspectors classified the violation as causing minimal harm or potential for actual harm to residents.
The case highlights the complex challenges nursing homes face in balancing residents' rights to intimacy with their need for protection. Facilities must navigate between respecting adult autonomy and safeguarding those whose cognitive abilities may compromise their decision-making.
For Resident B, whose stroke had already caused behavioral disturbances and moderate cognitive impairments, the lack of assessment meant no one evaluated whether she truly understood her romantic choices. Her medical conditions could have affected her ability to recognize potential consequences or make informed decisions about physical intimacy.
The relationship continued for months without professional oversight. Staff observed the hand-holding, card games, and kissing but never initiated the required capacity evaluations or care planning processes.
When inspectors arrived following the complaint, they found a complete absence of the documentation the facility's own policies demanded. The Executive Director's inability to locate consent assessments or relationship care plans revealed systemic failures in implementing basic resident protection protocols.
The violation affected both residents, though in different ways. Resident C, who was cognitively intact, was involved in a relationship with someone whose ability to consent had never been professionally evaluated. Resident B engaged in physical intimacy without the safeguards her cognitive impairments may have required.
The facility's policy acknowledged the importance of these protections by requiring physician involvement in consent determinations. Yet when tested by an actual resident relationship, the system completely failed to function as designed.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Hickory Creek At New Castle from 2025-08-12 including all violations, facility responses, and corrective action plans.
