It is estimated that there are 1.2 million older gay and lesbian people in the UK (Semlyen 2016), and as many as 68,000 LGBTQ+ people living with dementia. (Dementia UK and the LGBT Foundation). There are currently very limited statistics for trans and gender diverse individuals living with dementia.
How are LGBTQ+ people with dementia disproportionally effected when accessing social care services?
Individuals who identify as LGBTQ+ who experience dementia often face unique challenges when accessing care, many of these can lead to an individual ‘going back into the closet’ and hiding their gender identity or sexual orientation (Harper, 2019 and Di Lorito et al 2022). One of the key issues within social care is a lack of understanding of the importance of knowing an individual’s gender identity and / or sexual orientation. It is common to hear that ‘we treat everyone the same’ from care professionals, but this can give the impression that the professional is not adopting a person-centred care approach. LGBTQ+ people with dementia have very specific needs that should not be ignored. These can include, trauma from negative experiences of the past, strained family relations, lack of recognition of the importance of gender identity and affirming support and medication, internalised prejudice and a lack of sensitive provision in social care (Harper 2019).
Social care can often be a scary place for LGBTQ+ individuals living with dementia and their loved ones. Environments often are not the most inclusive, for example, memory lanes in care homes that can cause an individual with dementia to re live previous negative events. This is especially an issue for LGBTQ+ individuals who may have had previous traumatic experiences (Harper 2019). Awareness around language and inclusive care cultures is also limited, such as awareness around pronouns and the impacts of gendered language. Same sex partners and recognition of families of choice is also cited as an issue in social care and concern from those accessing social care (Harper, 2019 and Di Lorito et al 2022). This commonly includes a lack of recognition of same sex partners and of families of choice who might be closer than an individual’s biological families.
What is needed to help ensure LGBTQ+ individuals living with dementia’s needs are met?
As stated, more work on ensuring care cultures are inclusive is required to ensure parity of outcomes. There is clearly a need for health and social care services to ensure their care is fully inclusive in order to truly meet the needs of everyone who draws on services. More training is also required as it is common for health and social care professionals to state that they feel uncomfortable discussing the needs of the LGBTQ+ community (Stewart and O’Reilly 2017). This may also contribute to the reason for why health and social care services rarely collect data regarding gender identity and sexuality. These points highlight the need for greater awareness of the needs of LGBTQ+ individuals, especially those living with dementia as this is commonly disregarded and overlooked in social care services (Cousins, De Vries and Dening 2021).
The hope would be that regulatory bodies, such as the Care Quality Commission (CQC), and wider government policy will adopt an approach which considers all aspects of a person’s identity, when regulating care. The CQC do commonly explore the need for inclusive services and state that it is an area of focus in inspections (Harper 2019), The Equality Act 2010 also does include Sexual Orientation and Gender Assignment as protected characteristics, however, there is limited guidance, especially in social care which can lead to providers often not knowing how to embed this into their services (hunt et al 2019). In 2019 the Equalities Office published a report that highlighted the need for more work on making health and social care services more inclusive for LGBTQ+ individuals. This report has highlighted best practice and gaps in provision. There has been limited work since, especially focusing on social care, this sadly demonstrates a lack of momentum in government and policy in ensuring services are inclusive for the LGBTQ+ community.
It is also important to highlight the challenging environment LGBTQ+, especially trans and non-binary individuals, find themselves in in the UK with regular attacks on rights and policy decisions. In order to move towards a more inclusive future and to ensure everyone who draws on services feels included and supported appropriately, it is essential for an intersectional approach to be adopted at all levels.
References
Cousins, E., De Vries, K. and Dening, K.H., 2021. LGBTQ+ people living with dementia: an under-served population. British Journal of Healthcare Assistants, 15(1), pp.26-35.
Di Lorito, C., Bosco, A., Peel, E., Hinchliff, S., Dening, T., Calasanti, T., de Vries, B., Cutler, N., Fredriksen-Goldsen, K.I. and Harwood, R.H., 2022. Are dementia services and support organisations meeting the needs of lesbian, gay, bisexual and transgender (LGBT) caregivers of LGBT people living with dementia? A scoping review of the literature. Aging & Mental Health, 26(10), pp.1912-1921.
Harper, P., 2019. How healthcare professionals can support older LGBTQ+ people living with dementia. Nursing Older People, 31(5).
Hunt, R., Bates, C., Walker, S., Grierson, J., Redsell, S. and Meads, C., 2019. A systematic review of UK educational and training materials aimed at health and social care staff about providing appropriate services for LGBT+ people. International Journal of Environmental Research and Public Health, 16(24), p.4976.
Stewart, K. and O’Reilly, P., 2017. Exploring the attitudes, knowledge and beliefs of nurses and midwives of the healthcare needs of the LGBTQ population: An integrative review. Nurse Education Today, 53, pp.67-77.
