Inclusive Care for LGBT Elders

“If anything, I want you to remember that sexual orientation and gender identity are completely different things,” says Paul Blom, presenter of the August CEU webinar, “Understanding the Older LGBT Community and Its Unique Needs & Barriers.” “They have nothing to do with each other. Lesbian (L), Gay (G) and Bisexual (B) are about sexual orientation. Transgender (T) is about gender identity.”

Around 2010, Blom, owner of Right at Home Greater Twin Cities, co-developed a training program on care for LGBT older adults for senior service providers, as local research in Minnesota showed there was a need for such community-based education. Read on for highlights of Blom’s presentation at the CEU webinar and his answers to questions from attendants.

Lesbian, Gay, Bisexual and Transgender Aging

Back in 2010, less than one in five respondents to the LGBT elder research study in Minnesota believed they would receive safe, good-quality service if their sexual orientation or gender identity were known to their aging service providers. As a senior home care provider himself, Blom intended to change perceptions and assumptions of not only elders within the LGBT community, but also members who work with, or are affiliated with, these elders.

“There are a lot of things that we as individuals and practitioners can do,” says Blom. “We can create a welcoming community by doing certain things. We can be mindful of people’s history and the words and terminologies we use. We can validate emotions and life experiences regardless of spirituality, morality, perspective about sexual orientation and gender identity.”

Q1: How can we identify ourselves as supportive of the LGBT community and let them know we are here to help?

A1: We can encourage the use of rainbow flags. The rainbow is a significant symbol in the LGBT community. Even in the broader heterosexual and cis-gender community, the rainbow with a diversity of colors is perceived as pretty. You may use a strip of the rainbow on name tags. Put a rainbow sticker or human rights campaign sticker on a tablet you use for the in-home care assessment, or on items you carry around with you a lot. People who identify as LGB and/or T would see those symbols and automatically know that you are supportive and are an ally.

You may also incorporate images of same-sex couples into marketing materials. Whereas a heterosexual or cis-gender person who sees a picture of two older women or men may think they are friends, an LGBT elder would perceive the picture of the same-sex couple as a welcoming sign. They would see it as though your marketing people have thought about them. That’s something we can do symbolically.

Q2: What are your thoughts about implementing LGBT education in long-term care communities?

A2: After years of training senior service providers on LGBT elder care, I realized that it’s equally important to educate seniors at large. Peer and senior bullying — discrimination and isolation of other community residents or seniors if their sexual orientation and gender identity were known — are significant.

I have also met clients and senior community residents who are heterosexual and cis-gender, whereas the person who coordinates their care — be it their adult children or other family members — identifies as LGBT. The sensitivity training, therefore, is not restricted to how we can project ourselves as welcoming and supportive to just LGBT elders, but also to individuals who are a part of the LGBT community and are involved in the care of an elder.

It’s critical to implement LGBT education in a long-term care setting. For example, I am doing an educational session on combating bullying for residents of a suburban senior community. There are staff members in the facility who are transitioning from one gender to the other, and there are people who are gender neutral — someone who does not subscribe strongly as masculine or feminine. The residents often ask, “Are you a boy or a girl?” My goal there is to help residents understand gender identify in a very real way, which, in turn, will help staff members’ employment experience, as well.

Q3:  What are the key points to discuss with in-home caregivers about working with LGBT clients?

A3: Caregivers aren’t just helping seniors in their homes — they are also the eyes and ears who provide peace of mind to family members of the seniors. So, the biggest thing is to help caregivers feel comfortable with the idea of gender identity and its expression: Guide caregivers to validate their care recipients’ emotions, and inform caregivers how clients may perceive their interactions. These are all critical ideas to discuss.

Q4: During the in-home care assessment, state regulations require me to ask, "What was your sex at birth? With what sex do you identify? What is your sexual orientation?" It is important to ask these questions so those who feel unrecognized have an opportunity to disclose their identity. However, some clients and/or family members get frustrated with being asked these questions. Do you have any suggestions on how to help them understand why these questions are being asked?

A4: You could identify clearly at the beginning that you are not making any assumptions. For example, you could say, “I am not going to assume that you need me to TALK REALLY LOUDLY because you have gray or white hair. I’m going to let you tell me if I need to speak louder because of a hearing deficiency. I’m not going to assume that you want German sausage and sauerkraut for dinner every night because you have German ancestry. I am not going to assume anything about you. And by not assuming, that means there are questions I may ask that you were never asked before.” Then you can continue with, “Here’s the question, what was your sex at birth?”

Having the state law as a backup is great, and it gives you the opportunity to have a little educational moment. It’s a good practice to say, “There’s less than 1% of the time where people are born with confusing or both genitalia. A lot of time, the sex or gender is chosen by the family or the doctor in that moment, before the child is sent home. To be brutally honest, the path of least resistance was to create female genitalia. But down the road, the child may have the moment when she feels that everything inside her head says Daniel instead of Danielle.” This conversation is meant to say that sometimes, people who do not agree with the sex they were assigned at birth may live their lives expressing their gender identity.

Ask Open-ended Questions, Think About the Language You Use

Blom suggests that healthcare and home care professionals consider the language they use when asking questions to understand older adults and their families. “Think about open-ended questions,” says Blom. “Questions that ask if you are married, single, divorced or widowed actually identify a heterosexist world view. In an open-ended way, you can say, ‘Tell me about the significant relationship in your life.’ You are empowering the individual by not making any assumptions about them.

“We don’t give older adults enough credit for having the capacity to understand a lot more than we believe they do,” Blom continues. “We have this notion that people are close-minded. But experience has told me that’s not the case. When I first started my agency, I worried that potential clients would use a different company if they found out I was gay. But I decided 17 years ago to be my authentic self, and I have never lost a client because of my sexual orientation.”

Blom also mentions that the full version of this training lasts four hours. “In that training, we spend a significant amount of time looking at history and the timeline of things that happened in our country over the past 100 years,” he says. “The extensive exercise allows participants to realize what really impacted the coping skills for this population, which contributed to creating a unique set of needs for the older LGBT folks.”