The transition from living independently to living in a care home is hard enough.
Coping with the fear of discrimination over your sexual orientation can only make it harder, but that’s the issue facing a growing number of seniors in the lesbian, gay, bisexual, transgendered or queer (LGBTQ) community.
A new report by Qmunity, a Vancouver-based advocacy group, has found that LGBTQ citizens who lived through the culture war that carved out a place for them in society now worry they’ll have to go back in the closet when they move into care.
The paper, part of Qmunity’s Aging Out project, found LGBTQ seniors worry they’ll face homophobia from staff and insensitive treatment from health care providers. Many already do, says Dara Parker, Qmunity executive director, ranging from overt homophobic slurs to condemnation of lifestyle choices.
“Let’s say I’m a butch lesbian woman who’s never worn dresses and then I start to lose the capacity to dress myself and my family members come in and put me in dresses,” Parker told Yahoo Canada News. “That would be completely inappropriate for my gender expression.”
Transgendered seniors have an even harder time, she said, with staff refusing to use their preferred gender pronoun or even ignoring choices in intimate care such as shaving or their preferred underwear.
Faced with that, many previously ‘out’ seniors opt to go back in the closet when they move into care to avoid facing discrimination.
“There’s various levels of closeting,” said Parker. “They might tell one person but not somebody else. They might choose to hold their partner’s hand in front of one nurse but not somebody else.”
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The report makes two main recommendations:
– Include questions about sexual orientation and gender identity on the intake form, known as the InterRAI, for seniors going into care, and ensure the intake is conducted by suitably-trained staff;
– Change the definition of “appropriate bed” to include those in facilities that consider LGBTQ needs. At the very least, care facilities should provide training for staff and have policies geared to making LGBTQ seniors feel comfortable and accepted.
The report, released this week, includes anecdotes from LGBTQ seniors recounting negative experiences with the health-care system. A transgendered woman in her seventies recalled visiting a specialist and asking for an HIV test. After asking if she was gay, the doctor asked if she’d been involved in “weird sexual behaviour.”
Many in the LGBTQ community say they have have often faced discrimination within the health-care system, which engenders mistrust that continues into old age. Some opt to hide their sexual identities and intimate relationships.
“This history also means that most LGBTQ seniors are fearful of entering facilities where the setting, health providers and peers may be similarly damaging,” the paper said.
A 71-year-old lesbian named Chris described looking in vain for a suitable “queer-positive” care home for her 79-year-old spouse Bridget, who was suffering from dementia. She realized Bridget would end up in whatever facility the local health authority deemed appropriate.
Chris, a longtime activist, said had been an “agent of change” much of her life but it was exhausting to continue that role into old age.
The issue affects a growing number of LGBTQ seniors, a demographic that research suggests makes up around 6.7 per cent of Canada’s population of people 65 or older. That figure is expected to climb as more Baby Boomers age into care.
“Glaringly absent in these numbers are those who are closeted and therefore do not disclose their gender or sexual identities to researchers,” the report said.
Parker pointed to a section of the report in which a researcher surveyed all the residential care facilities in one Vancouver suburb. Every one said they had no LGBTQ residents, a statistical impossibility that points to the need for gender orientation to be determined in a sensitive way during intake, she said.
“The biggest barrier right now is that queer seniors are largely invisible in these populations and there’s a deep level of self-closeting that’s happening among that population,” said Parker.
“Because of course this is a population that came of age when it was criminal to be gay. You were mentally ill if you came out. So there’s a reluctance among individuals to necessarily state who they are.”
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The Vancouver area has only one institution that openly states it provides a queer- and trans-positive environment, the report said. Parker said she’s aware of other such facilities in Canada, such as Toronto’s Fudger House, as well as some in the United States and a handful in Europe.
The Qmunity paper’s findings have been shared with the two major Vancouver-area health authorities whose representatives participated in the Aging Out project that spawned the report.
“Vancouver Coastal Health has been working collaboratively with the Qmunity and supports their efforts for change that speaks to better inclusiveness for LGBT clients in residential care,” Anna Marie D’Angelo, senior media relations officer for Vancouver Coastal Health, said via email. A spokesman for the Fraser Health Authority, which covers most Vancouver suburbs and the Fraser Valley, said it also supports Qmunity’s work and goals.
Parker said Qmunity is not expecting a formal response to the report.
“It’s really meant as a practical tool because it doesn’t require a major infrastructure change; it’s just a culture shift,” she said.
“We wanted to create something that’s pragmatic, that could be implemented right away.”