Addressing Discrimination in Healthcare Against LGBT Elders from within the LGBT Community

By Robert Versteeg

Much progress has been made in gaining equality for lesbian, gay, bisexual and transgender (LGBT) people in the United States. However, institutionalized discrimination and homophobia the healthcare realm and in senior services remain problematic.

LGBT older adults face dual discrimination when accessing healthcare: homophobia and ageism. The invisibility of their unique identity as LGBT elders in healthcare settings impedes their ability to communicate honestly for fear of discrimination and denial of treatment. Studies have identified the changes needed in professional practice, and various ways to implement these changes.  LGBT elders need change in order to freely express their sexual orientation or gender identity, and healthcare providers need change to create a safe environment in which their LGBT patients can be open about who they are. Healthcare providers’ standard body of knowledge also needs to include eldercare competency in LGBT issues.

Aging adults present with common worries, including age stigmatization, finances, health-related issues, fear of institutionalization, loneliness and loss of loved ones. However, according to Thurston, older LGBT adults deal with additional unique problems and barriers not faced by mainstream elders. These added worries relate to sexual orientation and include discrimination, unequal treatment under Social Security, by 401(k) and pension plans, and concerns regarding housing, healthcare, and long-term care. Morrow writes that a considerable challenge for any LGBT individual is to develop and foster a positive self-regard living as an LGBT individual within a largely homophobic society in which institutionalized and societal heterosexism continues to exist.

Heaphy, Yip and Thompson wrote that most older adults view residential care and nursing homes as undesirable. For LGBT elders the anxiety about entering such facilities is heightened by the perceived threats to their identity and way of life. Knauer writes:

“… at a time when LGBT individuals enjoy an unprecedented degree of social acceptance and legal protection, our LGBT elders are aging and dying alone and invisible, and are often denied the basic dignity of being able to share their memories of a life well-lived without fear of rejection and reprisal.” .

Sixty-one percent of LGBT baby boomers between the ages of 40 and 61 report they are worried about growing older, while this number for non-LGBT baby boomers is only 33 percent, according to Knauer. Shankle, Maxwell, Katzman and Landers write that the options of finding assisted living or nursing facilities suitable for older LGBT individuals shrinks to less than a handful of places that will provide quality care, be empathetic about LGBT older adults’ specific needs and treat LGBT elders with respect.

When examining the issue of combined homophobia and ageism experienced by LGBT elders a crucial problem stands out: very little research has led to action. Most research related to this topic concerns collecting and analyzing data and concluding that LGBT elders face dual discrimination when accessing healthcare. Very few studies, although indicating that change is needed, have proposed solutions or action to create such change. Jackson, Johnson and Robert advised that providers of caregiving services to elders, as well as their staffs, should be trained to be competent in issues of sexuality and gender. However, until now such efforts have been few, which has impeded creating change for LGBT elders.

Based on these findings, Sunshine Social Services (SunServe), in Wilton Manors, Fla., developed an LGBT Senior Care Training Program. When a healthcare organization signs on to go through the training, the process starts with an organizational self-assessment to identify where the agency scores well in LGBT sensitivity, and in what areas they need to improve. This is followed by separate training sessions for agency leadership and line staff that target specific organizational change. This comprehensive program seeks to engender more LGBT-competent services for older adults. The management and staff of these organizations learn through an interactive training about the culture, the needs and the concerns of LGBT older adults, and how culturally competent care can be provided to their LGBT patients.

This training was developed to help caregivers working with older adults to become more deeply aware of the special needs of this vulnerable group, and to better equip such caregivers to address their needs. Led and facilitated by clinical experts in LGBT care from SunServe, the training makes use of a variety of engaging and informative approaches to provide accurate and up-to-date information about this special group. The training sessions include a lecture on historical perspective, small -group discussions of real-life scenarios tailored to a variety of healthcare settings, and a video in which older LGBT adults share their life experiences. The training is also designed to equip caregivers who, by the nature of their calling, want to be more sympathetic, supportive and effective in their ways of caring for all older adults.

The objectives for the training are: for healthcare providers to understand the life history and background that is unique to many LGBT elders; for care providers to identify the life-long impact of LGBT older adults’ experiences of rejection, discrimination, hostility and fear; for healthcare providers to understand the myths and facts about being LGBT; for participants to understand how to be compassionate caregivers for LGBT patients; and, for participants to become familiar with the resources in the community for caregivers and their LGBT patients.

If healthcare professionals can incorporate sensitivity toward LGBT elders into their practice, it should result in increased equal treatment of our LGBT elders when they require help in later life. Additionally, LGBT elders will have less fear of coming out to healthcare providers and in healthcare settings if they know that those taking care of them are sensitive to and knowledgeable about their particular needs and issues.

SunServe’s LGBT Senior Care Training Program is the first step in a healthcare organization’s commitment to providing LGBT sensitive care. The on-going connection between SunServe and healthcare organizations provides the support needed from within the LGBT community to continue this path to change. The goal is to expand the number of LGBT-friendly healthcare organizations, so that LGBT elders can live out their lives without fear of discrimination, or of having to return to hiding their sexual identity. An identity such older adults established over the course of many years and which they should not have to conceal again at a later stage of life, while already coping with the universal difficulties of aging.

Robert Versteeg, Ph.D., lectures on the issues faced by elder LGBT adults and provides sensitivity training to healthcare providers.