Karen McPhail, RN, MSN
Creating Inclusive Care Providers and Care Communities!
LGBT older adults often face many challenges when it comes to accessing care and finding care providers that will best support their needs. I am always upset when I ask individuals at care communities if they are LGBT friendly and they simply state with a confused expression, "I think so." I then inquire further about whether they have any openly out employees, any residents that identify at LGBT, or about how they celebrate diversity, train staff to be inclusive, etc? The confused expression sadly remains and says it all, thus making me feel sad and disappointed as we are clearly still failing an entire generation of older adults.
For years the medical community has failed this population of older adults through a lack of understanding and training in LGBT health areas, and through at time cruel and inappropriate treatment for decades. Looking back at history and not too far back sadly, LGBT older adults were labeled as having a mental disorder for the first several decades of many of their lives. Some may have even been exposed to electroshock therapy, lobotomies, or even disfiguring surgeries including castration. In 1973, homosexuality was finally removed from the Diagnostic and Statistical Manual (DSM), and more recently, the DSM. stopped classifying transgender as a mental disorder. These older adults deserve to be treated with compassion, dignity, empathy, and respect as they have been through so much in their lifetimes and have so much to contribute to care communities.
All care communities and care providers should assume that they are caring for LGBT older adults and should do their best to ensure inclusive practices at all times. LGBT older adults do not look different and may not even identify openly, but they are there and need to be able to rely upon, safe, and individualized care practices just as any other client or resident. All older adults should feel safe, comfortable, and happy with their care communities and providers!
Below are some guidelines for creating an inclusive care community or organization:
1. Presume your community or organization has LGBT clients. Service providers should always work from the premise that they have LGBT clients even if no one has openly identified as LGBT. Many LGBT older adults do not feel comfortable coming out when in a care community or to a provider.
2. Ask your clients or residents about their sexual orientations and gender identities in a safe and confidential manner. Remember that while it is important to ask about sexual orientation and gender identity, along with all the other key aspects of care and services needed or preferred, LGBT individuals have significant histories of discrimination and negativity, which makes them fearful of health care providers and less willing to disclose these aspects of their identities. Ask open ended questions and do not force answering if individuals appear uncomfortable. If an individuals looks upset or hesitant to answer a question, move on to the next question.
3. Look at your current activities and programming to see if it could be change in any way to better accommodate LGBT clients / residents. Ensure that you support celebrations for all individuals and include open support for: LGBT Pride in June, LGBT National Coming out Day and LGBT History Month both in October, and National Transgender Day of Remembrance in November. Ensure that flyers, contracts, forms, and events state inclusive language always!
In addition, for example, while bringing in a guest speaker such an elder care attorney, care manager, or financial advisor be sure that they are using inclusive language in presenting information about particular issues that arise out of legal inequalities such as different tax implications for same sex couples or the latest information on the tax deductibility of transgender related surgery.
4. Train staff and correct pronoun usage for transgender inclusion. Staff should always know and use the pronoun that their client or resident prefers even when they are not within earshot.”
5. Respect gender identity when providing site segregated services. Where services, including shared rooms, are segregated by sex, assignment should be made based on the client’s gender identity, not their sex assigned at birth.
6. Review your organizational policies, contracts, and definitions of family, make sure that they include a client’s family of choice, friends, partners and other people close to the individual as well as family or origin, biological family members or those related by marriage or kinship.
7. Promote diversity and inclusion, be sure that your community or organization’s board and leadership reflect diversity and inclusion of LGBT older people by race, ethnicity, gender and socio-economic status among other characteristics.
8. Create a welcoming and safe environment. Tastefully display rainbow flags, rainbow colored items or “safe zone” signs in the community or agency to signify LGBT solidarity, support, and acceptance.
9. Promote cultural competency training for staff members! Ensure that all staff are trained on how to identify, address, and properly manage the needs of LGBT older adults as this is the key to making a care community or organization inclusive and welcoming for all!
10. Treat everyone with dignity, respect and kindness. Honor choices, wishes, and show empathy towards all individuals realizing that exclusion is hurtful and causes others pain.
11. Support a positive culture and environment at all times. Promptly address and deter any negativity or hate speech in a direct, yet private, and polite manner. Always explain that all residents / clients deserve to be treated with respect and kindness and to be given the opportunity to live authentically.
12. Never assume anything and remember that we are all more alike than we are different! Be kind, be inclusive, be accepting, show empathy, and support all individuals to live on their terms!
National Resource Center on LBGT Aging