Long-term care providers must understand LGBTQ issues
No one wants to enter a longterm care facility/nursing home/ old age home.
That’s a truism that like others has some exceptions.
I worked for some years as director of seniors services for a family service agency. We assisted isolated older people living in the community to find safer places to live where they could get the care they needed.
Many of these folk welcomed the old-age home. They got three square meals a day, had nurses and personal support workers to look after their needs and they had people to interact with. Card games, jigsaw puzzles and craft activities were welcome distractions. Life there was better for them.
A more common reaction was the one I heard from a trans woman who talked of her life in a women’s housing co-op where neighbours looked after one another, took each other to doctor’s appointments and picked one another up after a colonoscopy or cataract surgery. “I would take my life before I would go to one of those homes” was her response.
The conversation was of many I had with groups of older LGBTQ people when I started a job as coordinator of an older LGBTQ program at a community centre serving those communities in Toronto. The conversations were part of a series of community soundings on what it was like to be growing old as an LGBTQ person.
The people I talked to were not unhappy. They were growing old with some grace. They did complain about not having opportunities to get together with people like themselves. However, they all expressed serious concern about receiving home care services.
Most LGBTQ people have had negative experiences with the health-care system. Outright discrimination, excessive curiosity, discomfort on the part of providers, violation of confidentiality and misdiagnosis are among these experiences. The thought of a strange person who is part of the healthcare system coming into the safe, secure place they call home is frightening. “I feel like I’d have to “de-gay” my apartment” was one man’s comment.
Photos, pictures, books, statues and figurines to say nothing of clothes and jewelry all contain telltale signs that providers may see and read. LGBTQ folk fear they may be refused care, receive poor care or be judged and preached to by providers. These fears are not unfounded and are documented in articles and studies in different jurisdictions.
The thought of leaving their homes or apartments to live in a long-term care facility was even more frightening to the people I interviewed. Many feel they must return to the closet lest they be denied care or receive poor care. They fear the negative reactions of staff, of other residents and from families of residents. Again, in my experience, these fears are not unfounded. A recent small research study indicated how ill-prepared are health-care service providers in both the community and institutional sectors.
So what needs to happen to change things? What do we need to do to ensure that our gay and lesbian neighbours are safe and secure when accessing either community care or institutional care?
Education and training are first and important steps in the process of change. Staff at all levels, volunteers and residents in care settings all need and deserve training. Vocabulary tools are a first step in the training. Knowing and using the right words is a start. Learning about the history of human rights in Canada and Ontario and how it affected older LGBTQ people is important. Understanding typical experiences of older LGBTQ people and the effects of these experiences is crucial. With such knowledge and awareness providers can begin to see the error of “we treat everyone the same.”
We are not the same. We have been through experiences and grown up in a society that labelled us a criminals, mental health cases and sinners. These experiences leave a mark. They have consequences. We’re a tough group of folk. We’ve had to be to make it this far. We have keen senses to detect unsafe situations. We avoid them at all costs.
Other aspects of the change process to accommodate LGBTQ people is the crafting of antidiscrimination statements and policies that name sexual orientation, gender identity and gender expression as grounds for discrimination. A zero tolerance for homophobic behaviours by staff, volunteers, residents and family members is essential. A transparent and swift complaint procedure protects us in the case of homophobic incidents.
Forms used by health-care organizations are important tools that can give a message of inclusion or exclusion. If choices for gender are limited to male or female, trans people who may identify as both or neither are excluded.
The way questions are asked is another sticking point. Open-ended questions about people who are important in your life are more appropriate than husband/wife. LGBTQ people are not infrequently separated from their families of origin or spouses and children. We have developed what we call chosen families, people who we call in emergencies, people who we look after and are, in turn looked after by. These people are as important to us as are straight people’s families. Our chosen families have a role to play in care planning and in communication with health-care providers. They need to be included and respected.
The closet has provided safety in a hostile world. Many older LGBTQ folk chose to remain there and their decision to do so deserves respect.
What is needed is a health-care system and long-term care facilities that acknowledge us and our histories. Safety and security in our homes and in care facilities is something we have a right to demand. Dick Moore lives in Port Colborne where he serves on the senior citizens advisory committee of the city. He can be reached at moore.dick@gmail.com.