In nursing homes and assisted living facilities across Utah, a quiet crisis is unfolding — one that centers on elderly women, vulnerability, and the blurred lines between care and consent.

State officials say they are increasingly grappling with how to handle sexual relationships between long-term care residents and the unlicensed caregivers who work inside these facilities. While some of the encounters are described as “consensual,” lawmakers and advocates warn that the power dynamics at play make the issue far more complicated — and potentially dangerous — especially for elderly women who rely on others for daily survival.

Kaye Lynn Wootton, director of the Medicaid Fraud and Patient Abuse Division within the Utah Attorney General’s Office, has sounded the alarm.

Speaking to state lawmakers last year, Wootton described multiple incidents that highlight the growing concern.

In one case, an 18-year-old high school student working at a nursing home allegedly began having sex with multiple residents and even encouraged his friends to apply for jobs at the facility. In another, a nursing assistant started a sexual relationship with a resident more than 50 years her senior. And in one particularly troubling case, police discovered a physical therapy aide attempting to have sex with an 80-year-old woman who had been reported missing.

When officers asked the aide whether he had genuine romantic feelings for the elderly woman, he reportedly responded: “No. But she wanted me to, and I was willing.”

For many advocates, that statement alone underscores the imbalance.

“Imagine when that relationship, if there was a real relationship, goes south,” Wootton told lawmakers. “Those same people have to bathe them and dress them. And it’s just inappropriate and puts these people in a very bad position.”

The women at the center of these cases are often in their 70s, 80s, and beyond — some living with cognitive decline, physical disabilities, or isolation from family. Even when a resident appears to consent, officials say the question remains: can true consent exist when one person controls medication schedules, mobility assistance, meals, and hygiene?

Under current Utah law, non-consensual sexual contact between staff and patients is illegal. Licensed professionals — such as doctors and registered nurses — are also barred from engaging in sexual relationships with patients, even if both parties claim consent.

But those restrictions do not extend to unlicensed staff: certified nursing assistants, aides, techs, housekeepers, and food service workers.

That loophole has prompted legislative concern.

Jennifer Plumb, a state senator and practicing emergency room physician, sponsored a bill last year aimed at criminalizing sexual relationships between unlicensed caregivers and residents in long-term care settings.

While drafting the legislation, Plumb said she heard troubling accounts of individuals who moved from facility to facility, repeatedly becoming entangled in relationships with residents.

“I think this is happening frequently enough we probably need to look at what sort of standard we can set up and what sort of protections we can put in place,” she told Fox 13.

Plumb initially hoped licensing requirements might address the issue, creating a regulatory framework to track misconduct. But she concluded that such a system would be difficult to implement statewide.

“That means there has to be a criminal penalty piece associated with it,” she argued. “Otherwise, we are not going to be able to track these and we are also not going to be able to disincentivize it.”

Yet not everyone agrees that criminalization is the answer.

Nate Crippes, an attorney with the Disability Law Center, has pushed back, arguing that a blanket criminal ban could create discriminatory consequences for people with disabilities.

“My colleague uses a wheelchair,” Crippes told Fox 13. “And if each of us were to engage in sexual conduct with a nurse who was providing us care or something like that, it would be a crime for that nurse if she or he did that with him but not with me. And that really seemed discriminatory to us.”

Crippes maintains that if staff members are being fired for inappropriate relationships, that may signal existing accountability systems are functioning.

But for families of elderly women in care facilities, termination may not feel like enough protection.

Behind policy debates and legal language are women who may be lonely, medically fragile, or dependent on the very individuals with whom they become romantically or sexually involved. When relationships sour — or when cognitive decline worsens — those same caregivers may still control access to medication, mobility, and basic dignity.

The question Utah lawmakers continue to wrestle with is not whether older women have the right to intimacy. It is whether the structure of long-term care makes that intimacy inherently unequal — and whether the state has a duty to intervene before vulnerability turns into exploitation.