This post has been updated.

Whatever happened at the Iowa nursing home where Henry Rayhons was accused of having sex with his wife, an Alzheimer’s patient in her last months of life, it wasn’t a crime, a jury decided Wednesday.

Rayhons, a 78-year old retired farmer and former state legislator, had been charged with sexual abuse last fall, a month after his wife Donna’s death at the age of 78. State prosecutors and Donna’s daughters from a previous marriage accused him of having sex with the ailing woman even after doctors told him that her dementia made her no longer able to consent.

Rayhons pleaded not guilty to the charges, testifying that all he had done on the night in question was pray, hold hands and kiss.

Many say that the case, which experts believe to be the first of its kind in the U.S., points to the need for nursing homes to have clearer policies — especially as the population of people with dementia continues to grow.

Much of the state’s evidence that Rayhons and his wife had sex on the day alleged was inconclusive. Rayhons admitted to having sexual contact during an interview with a state investigator in June, but a hospital examination and rape kit for Donna found no evidence that she had been assaulted. And though stains on her bed sheets matched Rayhons’s sperm, a lab technician testified that the age of the samples was unclear.

According to Minneapolis-based attorney Mark Kosieradzki, who has tried several cases of sexual abuse in nursing homes, it’s not clear on what basis the jury found Rayhons not guilty. They may have concluded that Donna was able to consent, despite her Alzheimer’s, or they may have decided that prosecutors hadn’t provided enough evidence that Rayhons had sex with his wife after being told not to, Kosieradzki told the Associated Press.

But the conclusion of the trial is unlikely to end the national conversation the case launched about sex and dementia.

“The legal question doesn’t change. It should always be a matter of consent of the patient,” Kosieradzki said.

For Henry and Donna Rayhons, both widowed from previous marriages, their 2007 wedding was a second chance at love. The two were besotted with one another, friends and family said, and reveled in their relationship.

But less than two years later, Donna became forgetful. She started to lose things, repeat herself and drive on the wrong side of the road. She was diagnosed with early onset Alzheimer’s, which took a marked turn for the worse in early 2014, when her daughters had her admitted to the Concord Care Center in Garner, Iowa, a five minute drive from her home with Rayhons.

In mid-May, Donna’s daughters sat down with her doctors to evaluate their mother’s mental health. They concluded that she was no longer capable of giving consent to sex, and drew up a one-page document informing Rayhons of the fact, according to Bloomberg News.

“That’s not a problem,” Rayhons said in a tape of the meeting played in court.

A week later, on May 23, Donna’s roommate reported to nursing home staff that she had heard noises that made her uncomfortable coming from behind a closed curtain around Donna’s bed while Rayhons visited. Surveillance video from the day showed Rayhons dropping his wife’s underwear into a laundry basket on his way out of the building.

But in court, the roommate said that she wasn’t sure whether the sounds she had heard were sexual. Rayhons testified that she probably heard him rearranging his wife’s bed — she wanted to sleep with her head at the other end, he said.

Rayhons also denied that he ever had sex with his wife after being presented with the document from her doctors. They’d been intimate in the nursing home before he was told she was mentally incapable, but Donna always initiated it. He only admitted to the May 23 incident during his interrogation because the state investigator “had me completely out of my brain,” he said.

Rayhons broke into tears 10 times during his 3½ hours of testimony, according to Bloomberg News.

“We just loved to be together,” he said in court. “I treated her like a queen. She treated me like a king. I loved her very much. I miss her every day.”

The case fell into a vague area of sexual assault law. Though an Iowa statute defines sex with a person suffering from a “mental defect or incapacity” as sexual abuse, it is not explicit about what is meant by the term “mental defect.”

Meanwhile, medical experts say that the argument that an Alzheimer’s patient is incapable of consent is a tricky one. Although dementia can severely impair a person’s cognitive ability — Donna Rayhons, for example, was unable to repeat the words “sock” and “blue” — the desire for physical contact may be unaffected. In many cases, intimacy is comforting to patients. Nursing home staff said Donna never resisted intimacy and always seemed glad to see her husband when he visited.

“There’s nothing about being cognitively impaired that means that you wouldn’t necessarily appreciate being connected with other people through both nonsexual means and sexual means,”  Tia Powell, who directs the Montefiore Einstein Center for Bioethics at the Albert Einstein College of Medicine, told New York Magazine.

During closing arguments, Rayhons’s attorney Joel Yunek told the jury that their decision could affect all future relationships between couples in which one person has dementia.

“It’s an unprecedented case. The decision that you make here will be debated, discussed, followed for years,” Yunek said.

On that last point, Alzheimer’s experts, legal scholars and patients’ rights advocates seemed to agree — regardless of what they thought about Rayhons’s trial.

“Very, very few nursing homes have delved into this topic because it is so darn complicated,” Daniel Kuhn, a licensed clinical social worker who has conducted trainings on dementia and sex for nursing homes, told New York Magazine last week.

Most facilities, Kuhn says, are squeamish about addressing sex among seniors: “They have just sort of turned a blind eye until there is some kind of a crisis, and then they scurry around figuring out what to do, hoping it all goes away,” he said. “Except in this case it didn’t go away — it blew up.”