Older LGBT+ people have lived through a time when homosexual sex was illegal and in which same sex relationships were stigmatised. The impact of a lifetime of hostility about your sexual preference or gender identity is apparent in later life, with older LGBT+ people having poorer health outcomes than the general population. And while the legal position has improved, there is much more work to be done to ensure that older LGBT+ people have fair and equal access to health and social care.
Experiences of prejudice, abuse and violence have a lasting impact on many older LGBT people’s physical and mental health, and affects their ability to comfortably access health and social care services. Often older gay, lesbian and trans people worry about being discriminated against by health and care services, which means they put off accessing the support they need to the detriment of their health. As well as direct discrimination, we know there is also a failure of services to recognise and respond to older LGBT people’s needs, identities and relationships.
It is common for older people to worry about needing social care and losing their independence, yet for older LGBT+ people this is compounded by fears that care staff will be hostile to their identities or dismiss their needs. We hear from older LGBT+ people who have hidden photos of their partner before care staff come to their home, to avoid facing prejudice. Or of people who have ‘returned to the closet’ when they have gone into a care home because of attitudes from staff and residents.
As well as having to cope with these stresses, many older LGBT+ people do not have familial support to provide care or advocate on their behalf. Older LGBT+ people are less likely than the general population to have children which makes them even more dependent on care services- a frightening prospect if the service is unsupportive of your identity. Many LGBT+ people who do have partners also tell us that their relationships are not taking seriously or that they feel unable to be affectionate with their partner within the care home.
And it isn’t just overt discrimination which is the problem. Most health and social care staff want to support older LGBT+ people but lack understanding about the best way to do this. An approach of treating everybody the same may seem fair, but in reality it can lead to a heteronormative environment where LGBT+ people’s preferences are overlooked. Even amongst the LGBT+ community there is significant diversity and it is important that all older people receive personalised care which recognises their past experiences and how this may continue to impact them today.
This can only be achieved through conscious inclusion, where proactive steps are taken to respond to the unique needs of older LGBT+ people, and older LGBT+ are provided with explicit assurance that they will be safe and supported in care. There are resources available to help care homes achieve this.
Opening Doors is a London-based charity which helps LGBT+ over 50 to live happy, sociable and independent lives. In 2017 Age UK worked with Opening Doors London to develop a resource pack for professionals working in health, social care, or the voluntary sector, called ‘Safe to be Me’, on how to support older LGBT+ people.
Opening Doors London has also developed the Pride in Care quality standard, which has been endorsed by Care England and Skills for Care, and which is awarded to care providers assessed as providing quality care for LGBT+ people over 50. Pride in Care accreditation is attained through a short, step-by-step process which includes policy reviews, staff surveys and management briefings, supported by ongoing consultancy advice from a team of specialist LGBT+ quality advisors from Opening Doors, London.
It is of vital importance that staff working in care homes receive appropriate training which helps them to understand and respond to the needs of older LGBT people. This should include training on avoiding heteronormative assumptions, such as assuming that people have a husband or wife, but also the importance of recognising the impact of past histories on older people’s needs and preferences.
Finally, a lack of data around the size and profile of older LGBT people needs to be addressed. Without this data we cannot commission services which meet the needs of older LGBT+ people.
These are all simple yet essential steps. Older LGBT+ people deserve to be heard, their histories and relationships taken into consideration, and deserve to be treated with the same level of respect and dignity as anyone else. Simply knowing you have somewhere safe to turn to support your health and care needs can make all the difference in leading a happy, healthy life.
