Despite all that older generations of LGBTQ+ people have endured – from conversion therapy, experiencing a time when it was a crime to be who they are, to the AIDS crisis- their struggle remains. Stephanie Farnsworth examines what issues older LGBTQ+ people are facing and what can be done.
The United Kingdom has a chronic lack of funding when it comes to healthcare services and support services for older people and this is especially impacting upon LGBTQ+ people who may have multiple needs. The LGBTQ+ world itself has been poor at campaigning for better rights for older members of the community. This is partly as a result of the fact that comprehensive services are still lacking and campaigns have often focused upon what wins headlines and therefore funding. There’s still also a great deal of ignorance surrounding older people which is standing in the way of delivering appropriate support.
Being out as lesbian, gay, bisexual or pansexual can face particular issues in certain environments- such as care homes. The idea of older people taking any kind of sexual interest in anybody is often seen as perverse or wrong and this is especially so if an older person does not identify as straight. It is expected that a person of a certain age will no longer have a sexual interest or there is shock at the idea that they will want to date which can create an extremely tense situation where one either complies to unfair expectations and risks loneliness or is treated as though immoral. Even long term partnerships can be treated as somehow wrong. This can be seen by the fact that married couples comprising of a cis man and a cis woman may be offered shared rooms or flats in care facilities and yet this is not always extended to couples of the same gender.
The idea of older people taking any kind of sexual interest in anybody is often seen as perverse or wrong and this is especially so if an older person does not identify as straight
Research conducted by The Older Lesbian, Gay, Bisexual and Transgender Network in Wales* also found that older LGBT people often worry too about who will be able to make decisions regarding their healthcare. There is a great concern that the wishes of any older person or even patient may be ignored if they have designated their partner or spouse as the one who should make medical and practical decisions in favour of a person from the family-of-origin. The fact that this fear is still so persistent is quite shocking and erodes the idea of just how much progress we have made. This was a particular issue at the height of the AIDS crisis in the 1980s with loving partners often being thrown out of hospitals at the request of highly homophobic family members. This then shows that little has been learnt and that in practice many older LGBT people are still facing this heartbreaking reality when their care should be their decision.
The same report also found that 65% of older LGBT people lived alone, despite preconceived ideas that they would likely be single and wealthy. Furthermore, there is evidence to indicate that older LGBTQ+ people are not claiming the social security that they are entitled to. This may be over fears regarding coming out but the practical result does not need speculation: older LGBTQ+ people are doing without income that they need. This is particularly worrying when legally in the UK same gender couples still aren’t entitled to the same pension rights as different gender couples.
Bureaucracy may also stand in the way. Not all couples cohabit but can be just as emotionally and even financially dependent on one another. The strict rules around form filling and what constitutes a couple in the United Kingdom often harms those who do not fit the narrow definitions recognised in law.
Older LGBT+ people who are single and have no family (which is not uncommon due to the slow changes in the law over the last century) are likely to become carers themselves for family members as they are seen as more available than a heterosexual, cisgender relative who is married.
The lower probability for having children particularly impacts lesbian and bisexual cisgender women beyond being presumed automatic care givers as there is some evidence to support that they may be particularly at risk for developing certain types of cancer, such as cervical. This is far less likely to be addressed due to the low screening rates as a result of discomfort to coming out to health care providers.
Many older LGBTQ+ people feel they will have to go back into the closet to be guaranteed good care. This is especially true for transgender people, particularly those who wish to undergo medical transition. They often feel that after so many years in their life that their health care needs will not be taken seriously or that they will not be believed at all if they have come out in later life. Furthermore, routine practices for most people such as shaving, getting a certain haircut or wearing certain clothes can be essential to a trans person’s sense of well-being and of managing gender dysphoria. In living facilities, such as care homes, they may not be trained or take the time to accept and understand a trans person’s needs. If hairdressers aren’t booked regularly or they do not shave someone every day despite their wishes this may cause considerable distress to the trans person. Not only would facilities be therefore showing transphobic policies and cissexist disregard for patients, but it would also violate their duties as carers to people with disabilities who are unable to perform certain tasks. Gender expression is an essential part of any person’s identity and to force anyone into styles, clothes or practices against their will is clear abuse.
They often feel that after so many years in their life that their health care needs will not be taken seriously or that they will not be believed at all if they have come out in later life.
The prospect of going into any residential care facility can be a deeply scary one. It means giving up independence for people who may not be accepting. Many care homes in this country sadly do have a poor reputation and so finding the right facility which is affordable can be deeply distressing and difficult for so many. That fear is compounded on for those who are LGBTQ+ and worry that those working in the facility or responsible for their care may be prejudiced in some way and so may immediately make them feel unsafe or take a dislike to them. There has been little research into religion with regards to older LGBTQ+ people despite the fact that many have expressed a desire to discuss this as a result of their own faith, their own bad experiences due to religion and/or the fact that they have received poor care due to health care professionals expressing prejudiced views as a result of their own beliefs**.
Andrew Hinchliff, Conwy County councillor and chair of Age Cymru Older LGBT, stated that, while many facilities give good quality care, the issue was that staff are “not trained to defuse situations where other residents show prejudice…” and this means that situations can escalate quite quickly so residents can feel threatened and disempowered. Hinchliff also noted that his area was one which is bilingual and tensions are often fraught. Barriers also raised due to language could mean that any LGBTQ older person may face added cultural pressure and stigmatisation.
It also should not be forgotten that many older LGBTQ+ people will have struggled to have ever come out at all. While today young people are more likely to come out than ever before (and that can still be a very dangerous and difficult time) for many older LGBTQ+ people coming out would have been illegal or resulted in abuse when they were younger. Sexual activity between men was illegal until the amended Sexual Offences Act of 1967 and homosexuality was only declassified completely in 1973- regardless of what current or past popes try to tell you. It was only three years ago that the American Psychiatric Association declassified being transgender as a mental disorder and finally abandoned the horrific concept of “gender identity disorder” in favour of acknowledging gender dysphoria. Coming out just was not an option for so many. There are numerous tales over the decades of LGBTQ+ people being sent to hospitals to be cured and even to this day intersex babies are still regularly operated on and forced to undergo a medical transition. The fear of being dependent on a care facility can thus be truly terrifying to any older LGBTQ+ person who has only known abuse and prejudice from health care institutions. Additionally, because of the higher likelihood of sustained abuse and prejudice endured throughout the years older LGBTQ+ people are far more likely to develop conditions related to extended periods of stress, such as digestive illnesses and autoimmune conditions. This could be combated by more support groups and activity groups arranged either specifically for older LGBTQ+ people or at the very least be welcoming and inclusive to LGBTQ+ older people.
The fear of being dependent on a care facility can thus be truly terrifying to any older LGBTQ+ person who has only known abuse and prejudice from health care institutions.
Furthermore, many LGBT residents at care facilities worry about how other residents= and not just care providers- will treat them. There are fears of outright abuse, blackmail and sexual assault. Additionally, certain illnesses (such as dementia) can see stages where a patient becomes highly sexual yet does not possess autonomy due to the progression of their condition. Staff may be unable to cope with this and it is not uncommon for patients to masturbate publicly but this can create a distressing environment, particularly to older LGBTQ+ residents who are likely to be at greater risk of assault (particularly trans residents).
One study conducted in 2014, ‘Swimming upstream: the provision of inclusive care to older lesbian, gay and bisexual (LGB) adults in residential and nursing environments in Wales’***, found that there was inadequate training for staff with regards to LGBTQ+ issues and that staff still struggled to even say the words “gay”, “lesbian”, and “bisexual”. If one cannot even utter these identity labels then how could they ever be expected to understand the issues older LGBTQ+ people face? It also noted that other identities were given little acknowledgement with training – particularly race- so LGBTQ+ people of colour or from a certain religion could face multiple discriminatory or erasive practices.
An upcoming study, ‘We treat them all the same: the attitudes, knowledge and practices of staff concerning older lesbian, gay, bisexual and transgender residents in care homes’, supports this issue. Of a survey of 187 care homes in England, only 24% of respondents were aware of whether the facility monitored the trans status of its residence. Additionally, 28% knew of whether their facilities implemented relevant laws, 34% of respondents considered that care home respondents had distinct needs and a tiny 5% reported that they used LGBT images in publicity (inside or outside the care home). Dr. Paul Simpson, lecturer of Applied Health and Social Care, who helped conduct the study noted that there was a strong positive feeling among staff with regards to different sexualities yet there was still a lack of knowledge and training so that they struggled to translate this supportive empathy to good practice. Furthermore, he also added that attitudes towards trans residents were still far beyond the progress that had been made for attitudes towards LGB residents and that while many were happy to discuss sexuality, there was a reluctance to address specific concerns regarding transgender residents.
Dr. Paul Simpson, lecturer of Applied Health and Social Care, who helped conduct the study noted that there was a strong positive feeling among staff with regards to different sexualities yet there was still a lack of knowledge and training so that they struggled to translate this supportive empathy to good practice.
The fact is that small practical changes would greatly help older LGBTQ+ people. Many have noted that they would not mind having to come out to a healthcare provider so long as that professional was obviously and overtly accepting of all identities. Any facility or service could easily provide welcoming and inclusive literature, signs or symbols so that LGBTQ+ people can feel that they are at least being reached out to. Older LGBTQ+ people should always be listened to and their wishes followed devoutly. Many healthcare workers are underpaid and overstretched, they perform such marvellous jobs that the country would frankly not cope without them, and therefore they should receive thorough training on equality and diversity issues so that they can provide that same standard of care to all who access their services. Funding is still needed and nuanced plans should be put in place to deal with the multiple issues that older LGBTQ+ people face. Comprehensive and intersectional research is needed to be able to deliver focused support. There are few studies into older LGBTQ+ people’s experiences and those are often cis-centric. To be able to deliver appropriate support we need to listen to what older LGBTQ+ people are experiencing. Too often LGBTQ+ identities are seen as being only for the young and there is a great void for older people where support should be available. The younger generations of LGBTQ+ people owe them the respect they deserve and so should start fighting for their rights too.
*Older Lesbian, Gay, Bisexual and Transgender Network, (2009) A report of the Older LGBT Network into the specific needs of older lesbian, gay, bisexual and transgender people, [Online] Available at: http://www.openingdoorslondon.org.uk/resources/Age_Concern_Cymru_Older_LGBT_Network_report_2009.pdf
**Knocker, S. (2012), ‘Perspectives on ageing: lesbians, gay men and bisexuals’, Joseph Rowntree Foundation, [Online] Available at: https://www.jrf.org.uk/report/perspectives-ageing-lesbians-gay-men-and-bisexuals
***Willis, P., Maegusuku-Hewett, T., Raithby, M. and Miles, P. (2014) ‘Swimming upstream: the provision of inclusive care to older lesbian, gay and bisexual (LGB) adults in residential and nursing environments in Wales’ , Ageing and Society, Cambridge, Cambridge University Press, pp.1-25.
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