Older LGBT Adults Have Special Concerns About Long-Term Care

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In recent years, unpleasant members of society have felt emboldened to express their hostility to members of different races, ethnicities, and gender identity groups. Many believe that the rapid rise in hate crimes is at least partially attributable to political leaders who polarize constituents in the interest of retaining their own political power. 

The LGBT community continues to struggle with discrimination and a lack of social acceptance. Older members of the community are not immune from those consequences. All aging Americans may eventually need long-term care and support services, including nursing homes, adult day care centers, assisted living facilities, residential care facilities, and home-based caregiving. The reality or fear of discrimination and harassment may prevent older members of the LBGT community from receiving the care they need.

A comprehensive report suggests that more than 20% of LGBT older adults conceal their sexual identities from healthcare providers because they fear discrimination or harassment. That fear is not unfounded. A 2016 survey found that 14% of transgender nursing home or extended care facility residents experienced unequal treatment or service, verbal harassment, or physically assaults because of their transgender identities. 

Staff Member Training and Bias

Healthcare professionals working in the field of gerontology conducted a review of literature addressing “the unique needs of aging LGBT populations.” Studies of long-term services and support providers found that only a third of staff members received any training regarding LGBT issues. Staff members were more likely to receive training regarding racism, sexism, ageism, and ableism than homophobia.

The literature review noted wide variances in the degree of sensitivity training and LGBT-inclusive practices within long-term care facilities. Most studies concluded that more training is needed to provide competent care to LGBT older adults. It is encouraging that 90% of staff members expressed at least some willingness to learn about LGBT issues. 

Another study suggested that negative attitudes toward the LGBT population are the root of the problem. Training combined with careful screening to weed out staff members who cannot overcome their biases may be the key to serving the LGBT population effectively. 

The reviewed studies offered conflicting evidence about the attitudes of staff members toward LGBT patients. Some facilities apparently succeed at employing staff who feel no animosity toward LBGT patients, while others do not. While some staff members disapprove of same-sex relationships but not opposite-sex relationships between residents, staff members with LGBT training were more accepting of same-sex relationships.

In addition, staff members who claimed to have no personal objection to same-sex relationships between patients often expressed the view that other staff members would object to them. However, a recent (2018) study found that 21% of participants admitted that their discomfort in caring for LGBT patients stood as a barrier to serving that population.

Patient Perspectives

Several studies confirmed that LGBT individuals were “particularly fearful” of the treatment they would receive from long-term care staff. A study of lesbians who received home health services found that “one-fourth of participants reported they had experienced discrimination from home care workers with a few participants reported they had issues with home care workers who refused to care for them due to religious reasons.” On a more positive note, “85% of lesbians reported they had good relationships with their home care workers with approximately one-third stating they had become friends with home care staff.”

An overwhelming percentage of older LGBT adults expressed the belief that “LGBT-friendly retirement communities would be a positive development for the LGBT community.” Since retirement communities cannot lawfully discriminate in favor of or against LGBT residents, a retirement community that is equally friendly to all residents without regard to their sexual identity would be ideal. An openness to hiring LGBT staff promotes the perception that inclusion and equal treatment are important goals of facilities that serve older residents.

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