This article was published in the May 2015 edition.
In any discussion of LGBTQ elders we must always acknowledge their History. A history of inequitable treatment coupled with their suffering from stigmatization, family rejection and social isolation, and lived experiences of the fear of rejection and persecution along with the impact of potential or actual discrimination. (As I write this I am aware of the recent number of suicides among our LGBTQ youth across Newfoundland.)
The Province of Newfoundland and Labrador must continue to ensure that LGBTQ people have the same opportunities and options in long term care homes and assisted living facilities that are available all to Newfoundlanders and Labradorians. As a nurse/social worker working in St John’s pointed out, while elders of the LGBTQ community rarely want to to be solely defined by their sexual orientation or gender identity, for many it is an important part of who they are.
The growing number of lesbian, gay, bisexual, transgender, intersex and Two Spirit people accessing aged care and health care services represent an emerging and potentially challenging area for health providers to our elder LGBTQ community members. It is not possible for providers at any level, administrators, managers, nurses, PSWs, etc., to get by saying that , “We treat everybody the same”. That translates into “We treat everyone as heterosexuals.” This ignores considering members of our community as distinct individuals and fails to take into account the diversity within the group to which they belong. We know that at present there is only limited attention being paid to the needs of LGBTQ elders. We are not heterosexuals, we are not gender conforming. Treating everyone the same is a myth, a lie, and will continue to reinforce the invisibility of our communities. “Everyone” has not lived through a time in Newfoundland when they suffered stigma, discrimination, family rejection and social isolation.
There is a danger of pathologizing members of our community and that would betray those who, over the years, created positive change and developed and demonstrated a great sense of resilience. While many of us may have strong connections outside the LGBTQ community through our family, friends and social and community groups, many others have experienced rejection from their biological family and friends which has resulted in the formation and development of ‘families of choice’. These families of choice cannot be ignored in health care planning.
If we are to recognize the diversity that is our community, then we must recognize that each gay, lesbian, bi, trans, intersex and Two Spirit community may have its own health needs. While some members within the communities may wish to conceal their sexual orientation, sex, or gender identity as they engage with health care services at various stages in their lives, others will expect and demand more than mere tolerance but rather will disclose and have their identity recognized and embraced. (Stonewall, gay liberation, women’s liberation, bath house raids etc., attest to this.)
LGBTQ elders who are presently living in our long term care homes and facilities grew up knowing that they could be imprisoned or forced to undergo medical ‘cures’ if their sexual orientation or gender identity were known. Considered to be suffering from a mental illness, these people could be and often were subjected to aversion therapies like electric shock or chemical castration as happened to the famous code breaker Turing who is the subject of the recent film, The Imitation Game.
It comes as no surprise that these same people learned to hide their identities, especially when integrating with members of the medical profession. It comes as no surprise to read in a recent Medical Express article that, “Many LGBT medical students chose to stay in the closet.” The study was based on a survey sent to all medical students in the USA and Canada. Thirty percent of the respondents reported that they concealed their sexual identity in Medical School. As one student explained, “You don’t want your personal identity to affect your grades”, and another student recounted a situation where a trans patient was treated like a freak and ridiculed by resident staff.
Myths about members of the LGBTQ community went unchallenged until the 1970’s, a time when in several countries male homosexuality was decriminalized and mental health professions removed homosexuality from their list of mental illnesses. I was 33 years of age when The Diagnostic and Statistical Manual no longer considered me to have a mental disorder (a position that many churches still hold today).
There is clear evidence now that the more discrimination an LGBTQ person encounters, the poorer their health and wellbeing. This, coupled with isolation and depression, can lead to death.
Here in Newfoundland and Labrador, as well as elsewhere, the voices and experiences of LGBTQ individuals have started to be heard by service providers. Eastern Health now has a Diversity and Sexuality Committee, the Tommy Sexton Centre invites and provides training in the treatment of members of our community, and we know that at MUN classes in Social Work and Nursing are addressing the needs of LGBTQ elders. Both the Coalition for LGBTQ Inclusion made up of social service providers and Caregivers Out of Isolation are mindful of being inclusive in their programming and continue to be supportive allies. Through Eastern Health and MUN we have advocates for both younger and older members of the trans community as well. Planned Parenthood has been a staunch ally and has organized meeting and facilitation with other social agencies such as Foster Parents and PFLAG.
However, other service providers and agencies have done little to address issues of homophobia, biphobia and transphobia facing older members of the LGBTQ community. Perhaps they feel ill-equipped or unaware of the issues or the necessary actions to be taken. The question remains, what does the government of Newfoundland and Labrador need to do in addition to what has already been done to provide a safer and more welcoming environment in LTC and assisted living facilities? How can the studies and research that is available to address this situation be transformed into practice in these homes? For years now, LGBTQ individuals and organizations across Canada have promoted and participated in research about the particular issues and needs of older members of our diverse communities.
The need to document the ‘invisibility’ of LGBTQ seniors in Long Term Care is paramount. While there is now a great deal of research on Lesbians and Gays and their needs and concerns, there has been much less on Bi, Trans, Intersex and Two Spirit issues. If we want to develop policy and initiate practices to promote healthy aging of Newfoundland’s LGBTQ seniors more research is required. Otherwise, cultural competency will be lacking.
LGBTQ elders must be able to feel that they are being understood and respected in the discussions regarding inclusive health care for the aging, inclusive health care policies for the aging and in inclusive programs for elder members of our community. We will only have LGBTQ inclusiveness when our elders feel that they really are included, that they feel empowered and have access and equity in the health care system, a system that provides quality care, and where the capabilities of the LGBTQ community are recognized.
How can the NL government convince and assure our community that their elders’ needs are being met in the government’s planning and carrying out of health care policies for these people? What mechanisms will be put in place to allow them to express their needs and what forum will be provided for an open discussion that addresses and promotes individual and collective LGBTQ health and well being?
Does the government of NL want its elders to develop and have a sense of empowerment? If, for example, an LGBTQ elder chooses to self-identify, will government policy assure that that self-identification will be respected? Our community elders will be empowered when they feel they have the confidence to use fully the health care system that will support and act for them and they do not feel that they ‘have to fight the system’.
Will the government of Newfoundland provide accessibility and equity through positive inclusive health care service for elders of our community and for those who are living with HIV? This will be possible only if there is an appreciation of their history, health status (including HIV status), culture and experiences. We know that in Newfoundland Labrador many LGBTQ people are geographically isolated and yet need to have access to the range of services across the health care continuum.
Will the government of Newfoundland and Labrador assure quality health care by providing a welcoming, inclusive, confidential and culturally appropriate environment for not only elder members of the LGBTQ community but also by responding to the needs of older people living with HIV? Will the government provide funding for training and in-service to raise the level of cultural competency for those who work in the LTC homes and other health care facilities? Training in Cultural competency will provide the skills and knowledge of health care workers to challenge negative stereotypes that still endanger the health and lives of our community members.
Will the government of NL recognize and make use of the capabilities of the LGBTQ community in articulating the needs of the community? Will the government recognize that people in our community have the capacity and the will to engage with, contribute to and shape the development and delivery of health care services through volunteering?
Going back into the closet is not an option. We do have allies within Eastern Health and coupled with our own advocacy and theirs, there is the hope that Newfoundland and Labrador can provide for its citizens policies and programs where
- LGBTQ people will experience equitable access to appropriate aging and health care services.
- Health care services for the aged in the LGBTQ community will be supported and given the resources to proactively address the needs of LGBTQ seniors.
- Aging and health care services will be supported to deliver LGBTQ specific services.
- LGBTQ-inclusive aging and health care services will be delivered by a skilled, competent paid and volunteer workforce.
- LGBTQ communities, including older LGBTQ people will be actively engaged in the planning, delivery and evaluation of aging and health care policies, programs, and services.
- LGBTQ people, their families/families of choice and carers will be a priority for aging and health care research.
It is possible. It has been done. There are long term care homes across this country that aim to provide a welcoming environment for LGBTQ residents, their families and staff members. This is accomplished through diversity and sensitivity training of staff, recruiting of LGBTQ volunteers in the homes, using inclusive sensitive language in assessment forms, seeking staff experienced with LGBTQ seniors in job recruitment, and maintaining LGBTQ programming open to all residents in the homes.
To quote a member of the LGBTQ community who was instrumental in the creation of one of these homes: “So, I am feeling excited, you know, there is a safe place for LGBTQ seniors to go to. We have laid the foundation for a welcoming environment.” The Closet No More.