This is a guest post by Sujay Kentlyn, a project officer with Outrageous Ageing, a NSW health organisation that works with older people who are lesbian, gay, trans, intersex or bisexual. Sujay outlines the ways that nurses and other service providers, especially in aged care, can respond to their needs.
‘We treat everyone the same’, we often hear from service providers who are keen to demonstrate that they don’t discriminate.
They are trying to reassure us that whatever a client’s gender, ethnicity, class, politics, disabilities or life experience, they will receive the same high standard of care. Which is great!
But the problem is that everyone isn’t the same.
Some clients have spent their lives struggling with profound disadvantages, which can impact their health, their experience of ageing, how they engage with aged care services, and indeed, whether they engage with aged care services at all.
The Commonwealth Government has come to understand that this is the case for a number of groups in our society and have made provision for them under the Aged Care Act 1997 by listing them as groups with special needs.
These include indigenous people; people from culturally and linguistically diverse (CALD) backgrounds; people who live in rural and remote areas; people who are financially and/or socially disadvantaged; people who are homeless; veterans and their widow/ers; and care leavers – people brought up in care away from their family as state wards or raised in children’s homes, orphanages or other institutions or in foster care.
This means when the Commonwealth allocates funding for aged care services, it takes into account the capacity of service providers to meet the needs of these groups.
In 2012, Lesbian, Gay, Bisexual, Transgender and Intersex (LGBTI) people were added as a Special Needs group under the Act, in recognition of their historical experiences of discrimination and their particular needs and concerns around aged care. The Productivity Commission report, Caring for Older Australians, drew attention to this group:
The recognition of sexual preference and gender identity as an aspect of diversity has been relatively recent and this has important implications for the provision of aged care services for the current cohort. Many older gay, lesbian, bisexual, transgender and intersex … people have experienced considerable discrimination over the course of their lives and this may continue in aged care where their sexuality and/or gender identity are not recognised or supported in the delivery of aged care services.
So what is special about this group? And how does this impact on the delivery of
aged care services?
Prejudice, discrimination, and minority stress
The current generation of LGBTI seniors were coming of age at a time when their sexuality and/or gender identity could result in:
- Enforced medical and/or psychiatric ‘cures’
- Lack of access to appropriate medical care
- Harassment and entrapment by police
- Prosecution and imprisonment
- Loss of family and friends
- Loss of contact with children
- Rejection by community of faith
- Loss of employment, and/or opportunities for advancement in their career
- Loss of housing or inability to find housing
- Victimisation: bashing, bullying and harassment on the streets, at school, in workplaces, in sports
- Lack of recognition and protection of their intimate partner relationships.
Not to mention the impact on the gay male community of the AIDS epidemic of the 1980s.
Even if individuals have not experienced these things directly, they belong to a stigmatised and marginalised group within our society. Studies have shown that such groups suffer from chronically high levels of stress, known as ‘minority stress’, and that these stress responses accrue over time, leading to poor mental and physical health.
LGBTI people on average have substantially worse health outcomes than their non-LGBTI peers, with higher rates of smoking, overweight and obesity, drug and alcohol use, anxiety, depression and suicide attempts.
Moreover, fear of prejudice and discrimination prevents many LGBTI people from accessing health services or means they postpone seeking treatment (making their conditions harder to treat).
And when they encounter discriminatory treatment, they are often reluctant to make a complaint, especially if they fear it will result in further victimisation or discrimination for themselves or their partner (in a residential aged care facility, for example).
This excerpt from an email I received (used with permission) may help to give an insight into the kind of stress faced by LGBTI older people.
I am actually worried about old age as we are there, just about! I am 65 next year and [my partner] will be 70, we have been together 44 years. I worry about the religious angle and general discrimination or non-inclusion. What if we both need to go into a nursing home? Will we stay together? Things like that. I am hoping we both die before anything like this happens and would make sure I don’t get that far. 50 Valium and a bottle of vodka will be on the agenda for me … I am saving the Valium now just in case.
So how can we, as service providers, help to address the special needs of LGBTI older people?
Help to create a climate where people feel safe to disclose their sexuality and/or gender identity:
- Work on the assumption that any one of your clients, even if married with children, may be LGBTI.
- Show by the way you respond to other people’s homophobic/transphobic jokes or comments that you don’t share their views and that you value LGBTI people.
- Make positive comments about a client’s photos or memorabilia so the client will feel safe to tell you more if they want to, eg. “What a lovely photo! Is this someone who is special to you?”
- Mention in a positive way your LGBTI friend/relative/co-worker (with their permission of course!) to show the client you will be friendly and supportive if they do choose to disclose to you.
How to respond to disclosure:
- Let them tell their story in their own time.
- Respect their privacy and don’t discuss their disclosure with anyone else, including other staff, in or out of the workplace.
It’s not just about names; especially in small communities, people can
figure out someone’s identity from a surprisingly small amount of information.
- Do your own research and don’t expect the client to educate you.
Provide culturally-appropriate service:
- Recognise and fully involve a client’s same-sex partner if they have one.
- Be aware of LGBTI issues and people – what’s in the news at the moment? On TV? At the movies?
- Always be positive, affirming, and unshockable!
- Whatever your personal beliefs, always be professional.
The Commonwealth Government is predicting a large increase in demand for aged care by LGBTI older people. These people will come with a history of experiencing prejudice and discrimination, the possibility of worse health outcomes as a result of minority stress, and profound concerns about the kind of treatment they can expect. We can make a huge difference to their lives by providing compassionate and culturally-appropriate care.
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