LGBTIQ+ COMMUNITY AND AGED CARE

Older members of the LGBTIQ+ community have lived through decades of dynamic cultural and social shifts in our society. Over the past decades, this community has fought for acceptance, liberation, equality and freedom for gender and sexuality diversity as a human right (AHRC, 2015). this paper has attempted to dismantle biopsychosocial needs of older LGBTIQ+ members and recognise the legislative actions currently in place to dissolve the social issues. The current trifecta of structural, institutional and systematic inequalities illustrates a harrowing landscape for older LGBTIQ+ consumers Australian aged care. Previously to current aged-care movements, the challenges faced by ageing LGBTIQ+ consumers had been neglected by domestic and global gerontology including; legislation, development of policy, appropriate training, and supported research. Through rich political, social and health discourses, this paper will attempt to dismantle biopsychosocial needs of older LGBTIQ+ members and recognise the legislative actions currently in place to dissolve the social issues. The purpose of this paper, therefore, is to critically illustrate and dismantle the intersectionality of the persistent social inequalities facing LGBTIQ+ Communities that are exacerbated with age. Drawing from critical social policy, social work and other relevant literature tackling gerontological concerns, a common theme throughout this paper will argue that despite the relative wealth of social welfare and lengthy historical provision in Australia, a critical framework is integral to the response to LGBTIQ+ social inequalities effecting ageing populations. Furthermore, a dominant feature will be to explore “both the personal experience of ageing LGBTIQ+ adults and their relationship to social and structural inequality” (Biggs, 2008 pg 15) whilst deconstructing ways in which gender and sexuality shape experiences of ageing.

Core Concerns

There is an abundance of international research evidence and literature directly related to ageing and aged-care LGBTIQ+ consumers. Within Australian shores, however, there is an increasing foundation of reporting literature focussed on the expectations, experiences, needs and voices of LGBTIQ+ aged-care consumers in addition to perspectives from service providers/practitioners.  A study by Barrett (2008) examined and explored the experiences of LGBTIQ+ consumers of aged-care services in the state of Victoria. Through research, Barrett (2008) identified eight core concerns that negatively impacted on the requirements of quality and appropriate care for LGBTIQ+ community members in aged-care settings; 1. experiences of discrimination throughout history and its impacts; 2. The invisibility of gender and sexuality as an ongoing consequence of current discrimination; 3. The concealment of identity and its impacts; 4. Inadvertent visibility and its negative impacts; 5. The impact of dementia on LGBTIQ+ consumers; 6. The enablement of cultural expression; 7. Inadequate care and failure to meet standards; 8. Achieving a safe environment.

LGBTIQ+ Invisibility in Aged Care

A strong understanding of the historical discrimination, and the turbulent life history LGBTIQ+ members experience is paramount to a critical conceptualisation of the specific aged-care needs of LGBTIQ+ participants/consumers. A large majority of current LGBTIQ+ aged-care consumers have lived through invisibility of their gender and sexuality, this is a direct consequence of ongoing historical circumstances and current discrimination faced by their community.  This invisibility, however, often translates into aged-care settings as service providers neglecting to address the specific needs of gender and sexually diverse consumers – thus development of policies, procedures and strategies is often limited, underdeveloped or are not appropriately implemented to provide inclusive or safe environments (beyond the Residential Aged Care Manual frameworks around respect for cultural heritage). A deficit of relevant and necessary LGBTIQ+ policies and procedures in aged-care settings often results in service providers failing to share or indicate that their services are inclusive of LGBTIQ+ community members. Threatened by prospects of unsafe or discriminatory environments, LGBTIQ+ consumers unvaryingly contribute to the cycle of invisibility by taking a route of non-disclosure of their gender or sexuality preferences.

Interpersonal, structural, and systematic barriers

There are a number of interpersonal, structural, systematic and intrapersonal disparities between older LGBTIQ+ community members and their heterosexual and cisgender peers. Furthermore, the implications of discrimination targeted at older LBGTIQ+ members can be compartmentalised into social, economic, personal and environmental factors that subtract from the health and wellbeing of individuals and communities, considering that a deficit of health is regularly exaggerated by psychosocial climates (HHS, 2016). A handful of studies has been collected to investigate the health and wellbeing ageing LBGTIQ+ communities. One in particular, Wallace & Colleagues (2011), conducted a study that highlighted the significantly poorer standards of health in older LGBTIQ+ sub-communities when compared to other heterosexual/cisgender populations. It should be noted, however, that whilst the disparities in health and wellbeing of older LGBTIQ+ sub-groups were significant, data also reveals that health-related concerns are common amongst variant sub-groups of the community regardless of age and not just in older populations. In addition to this study, Frediken-Goldsen et at (2013) conducted a study in response to Wallace & Colleagues (2011) findings. Their research focussed on evaluating the primary and secondary impacts of sexual orientation and gender identity on physical health, stress, depressive symptomology, and disability. They’re research group/participants were LGBTIQ+ community members as well as heterosexual/cisgender participants aged 65>. On all the variable outcomes, Frediken-Goldsen et al (2013) found conclusive evidence for significant discrepancies between the two groups. Nonetheless, the data collected from this study determined that older sub-groups of the LGBTIQ+ communities were at high risk of all faculties (physical health, stress, depressive symptomology, and disability) and its negative effects on individual health and wellbeing. Likewise, in a sub-finding of research Frediken-Goldsen et al (2012) further determined certain ageing sub-groups of the LGBTIQ+ community including those aged 65> are at heightened risk of financial instability and economic vulnerability/insecurity as a secondary consequence of access to health services, further adding to the never-ending list of disparities in health. It should noted that a third of the gender and sexually diverse participants of the study were living below the national economic threshold. In addition to these findings, a separate study conducted by Frediksen-Golden (2012) shifted its focus to exclusive disparities amongst younger and older homosexual living with HIV. As mentioned previously, these disparities were recognised as products of structural, systematic, interpersonal, and intrapersonal oppressions that collectively contribute to higher rates of suicide ideation, depressive symptomology, anxiety, discrimination, decreased social support, loneliness, and isolation.

Challenges and Responsibilities of Service Providers

There are plentiful challenges and responsibilities for service providers and practitioners delivering aged-care services/programs to complex minority groups such as older LGBTIQ+ community members transitioning from mainstream health services to aged-care settings. Specifically, the heteronormative narrative dictating aged-care practices needs to be challenged and rewritten in order for there to be long-lasting systemic and structural changes. The treatment of older LGBTIQ+ adults within the geriatric systems dramatically differs from their heterosexual peers. Throughout the aged-care system the former of these two are faced with significant concerns of discrimination, homophobia and mistreatment. As described by Tolley & Ranzijn (2006, pg. 76), the aged-care sector currently functions on a heteronormative system, that is “the general, and often silent, assumption and acceptance of heterosexuality as a norm”. Heteronormativity, when co-existing with institutionalised homophobia, facilitates discriminatory policy, practice procedure and action that threatens fear and further isolation by older LGBTIQ+ adults (Butler, 2004; Cahill et al, 2000; Shankle et al, 2003). As a consequence of this, transformation in attitudes, increased training, and the implementation of inclusive and culturally-appropriate policies and practices is integral to institutional and systematic change in the age-care sector (Brotman et al, 2003; Maccio & Doueck, 2002; Butler, 2004). Moreover, how aged-care facilities chose to advertise and contrast their services must integrate language that adopts gender-neutral frameworks and presents gender and sexually diverse inclusivity in their services. In this regard, it is necessary for service providers and registered practitioners to advocate for the rights of LGBTIQ+ human rights in aged-care settings, this should include the representation and recognition of the diverse spectrum LGBTIQ+ communities share. Taking a wider lens, there is an urgent need to explicitly challenge the deep-rooted institutional, systematic and structural homophobia and heteronormativity that currently characterise the aged-care industry in Australia. Building a better conceptualisation of LGBTIQ+ experiences and identities can be facilitated by adopting a number of practice approaches including; post-structural feminist; critical and anti-oppressive. Likewise, appropriately carrying out these practices can ensure safe, inclusive, nurturing and culturally-competent aged-care environments. By achieving this, not only can service providers be improved, but rather legislative, social and political reforms can be rewritten to dismantle the narratives of marginalisation and social exclusion that are guiding how services provide aged care to LGBTIQ+ ageing members. 

Federal and Local Government Response

Australia has undertaken a number of transformative changes in the social conditions of ageing LGBTIQ+ community members. The government’s new pledge to the aged-care sector was introduced in the 2018/2019 Budget with the ‘More Choices for a Longer Life Package’. Notable, this package has been campaigned with a purpose for all Australians “live a healthy, independent, connected and safe life” (Department of Health, 2018). This initiative, however, fails to tackle the specific challenges and oppressions of discrimination, homophobia and stigma faced by older LGBTIQ+ community members in the aged-care sector. Furthermore, this new campaign has failed to provide a framework for medical services targeted at concerns of sexual health that is safe and accessible, nor does it address strategies/frameworks that address increasing rates of poor mental health (suicide ideology, depressive symptomology and anxiety) in older sub-groups of the LGBTIQ+ community (Wright et al, 2015 pg 200). Due to these ongoing concerns, this approach also lacks appropriate measures of providing quality/appropriate healthcare services that underpin the intersectionality of psychological distress, gender, and sexual orientation diversity that remains “a unique underexplored form of sexual minority stress” (Wright et al, 2015 p 200).

Previously to the ‘More Choices for a Longer Life Package’, 2012 saw the release of the LGBTIQ+ Ageing and Aged Care Strategy by the Australian Federal Government. This initiative was introduced to reflect the alignment of Australian Government to an agenda that ascertained access to high-quality, culturally-appropriate and inclusive aged-care services that valued justice and was equitable of all sub-groups of community, including older LGBTIQ+ members. Since then, a broad range of government and NGO campaigns have been instigated in order to meet the needs of ageing LGBTIQ+ communities and members in a safe and inclusive manner (Harrison, 2001). A dominant feature amongst these programs and campaigns is a collective recognition that; a large number of those making up LGBTIQ+ communities have experienced moderate to severe social isolation, rejection, homophobia and stigma; over the last decade, LGBTIQ+ community members have been subjective to shamefully discriminatory and prejudiced treatment; and lastly, a predominant population of LGBTIQ+ communities have experienced decades of discrimination, persecution and rejection (Australian Government, 2019). The National LGBTIQ+ Ageing and Aged Care Strategy not only endeavours to improve responses to these ageless concerns, but rather recognise the diversity offered by LGBTIQ+ groups, as well as venture towards the bettering of aged-care and ageing experiences of this group. Moreover, the National LGBTIQ+ Ageing and Aged Care Strategy takes into consideration the calling and urgency for training of aged-care workers in culturally-appropriate, trauma-informed, anti-oppressive, client focussed and strength-based capacities (Harrison, 2002). A collection of aims specified in the strategy are predominantly centred around this resolve. With this agenda largely contributing to the momentum of change in the aged-care sector, the Australian Department of Health has granted the National LGBTIQ+ Health Alliance funding to best facilitate the delivery of training initiatives that focus on specific LGBTIQ+ needs in aged-care services nationwide. Ultimately, this projects main objective and aim was to develop and implement the national delivery of awareness training to aged-care staff specific to LGBTIQ+ aged-care needs. 

Stemming off from the National LGBTIQ+ Ageing and Aged Care Strategy, the recent agenda introduced by the Australian Government has been the Aged Care Diversity Framework. This framework has been designed to assist service providers and Government agencies to conceptualise, dismantle, and overcome the barriers, challenges and structural oppressions experienced by older sexually/gender diverse consumers with culturally appropriate Action Plans that frame the ongoing duty to ageing minority groups within the aged care sector. These Action Plan frameworks function under the recognition that those identifying as LGBTIQ+ (11% of population) (NSW Health, 2019), could additionally align themselves to a variety of intersecting demographics including; culturally and linguistically diverse (CALD); Aboriginal and Torres Strait Islander (ATSI); and communities living remotely throughout Australia’s rural areas. Additionally, coinciding with these discourses of diversity comes a plethora of literature demonstrating a significant percentage of Australians identifying as LGBTIQ+ presently living with concerns of mental health relating to persistent experiences of abuse, suicidal behaviours, prejudice, isolation, as well as discrimination (National LGBTI Health Alliance, 2018; Venn-Brown, 2015). The Action Plans proposed by the Aged Care Diversity Framework acknowledge that LGBTIQ+ inclusivity policies must endeavour to address each specified need of gender and sexually diverse aged-care consumers (including consumers living with HIV, or other sexual health concerns) given the unique diversity of the LGBTIQ+ nature. The Australian Government recognises that with the provision of culturally safe services, guided by the frameworks and safeguards of all-inclusive policy strategies, aged-care service providers will be equipped with the appropriate tools to build confidence and trust in older LGBTIQ+ members (as well as their carer’s and families) to access equitable support and care as they age (Australian Government, 2011).

Conclusion

In summary, all ageing LGBTIQ+ Australians warrant the unreserved right and complete access to equitable, high-quality, informed, and inclusive aged-care services that are attentive of the diverse individualities and life experiences the community offers. The Australian Government has undertaken a number of transformative changes to the social conditions of ageing LGBTIQ+ community members including the ‘More Choices for a Longer Life Package’, National LGBTIQ+ Ageing and Aged Care Strategy, and the Aged Care Diversity Framework. Whilst momentous actions assisting in the development of a fair, inclusive and quality aged-care industry, there are a number of critiques that continue to challenge legislative and political reforms currently taking place. Ultimately, there are a number of systematic, structural, institutional and cultural oppressions that hinder the development of an exemplary aged-care sector. By integrating a number of approaches including anti-oppressive, culturally-informed frameworks, feminist, post-structuralist approaches, and rich discussion of political, social and health discourses, this paper has attempted to dismantle biopsychosocial needs of older LGBTIQ+ members and recognise the legislative actions currently in place to dissolve the social issues. This was achieved through rich discussion of political, social and health discourses.

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