With an estimated 9% of the world's population aged 65 and over, long term care is becoming a hot topic, especially considering that it is the fastest-growing age bracket amongst all ages and one that is set to double by 2050. Care providers already face a wide range of challenges amongst their heterosexual residents, outlined in the Gayther article, LGBT: Caring for the elder community (https://gayther.com/lgbt-care), adding the LGBTQ+ community challenges to the mix, will likely seem overwhelming for many care providers. Challenges that should not be ignored, not only does the community have serious global spending power; however, their wants and needs are not that different from that of their heterosexual peers. With many community members avoiding long-term care facilities all together or concealing their identities to blend in, providers wanting to create inclusive environments and tap into this lucrative and rewarding community is not as difficult as many might believe.
Exclusive vs Inclusive
Often you will hear phrases, such as exclusivity or tailored when referring to the care requirements, so we will start by clarifying their meanings. Exclusive in this context would mean any services or facilities that have been designed for and will be exclusively used by the LGBTQ+ community. Inclusive typically refers to conventional care providers creating policies, approaches, and environments to ensure that all customers and residents feel valued, free of discrimination, and fully integrated. Exclusive care related services and facilities will likely overcome many of the challenges and barriers many face today; however, the speed and business appetite to rollout dedicated facilities is a concern. Like with society as a whole, inclusivity is the immediate and short-term approach, to integrate and not isolate. It will likely take some work for existing providers to adapt their practices and business models to accommodate an inclusive approach. However, by doing so, they will benefit by tapping into new markets and setting a good standard and set of principles within their current environments.
Setting the environment
Some might argue that most developed countries have anti-discrimination laws in place, so that should be enough. Though this is true and is a critical step and a start; however, how these laws are enforced can be challenging and does not always help integrate elderly customers. Let us look at simple ways providers could use to help set the environment: -
- Set or adapt a code of conduct – creating a clear code of conduct for staff, residents and customers to follow. One that outlines acceptable behavior and states that everyone is treated equally and that discrimination will not be tolerated. Though many providers may live by these principles, not all have written them down or have stated them officially. It is incredible that having a publicly displayed statement and one that everyone signs up to can positively impact the environment. There are of course exceptional circumstances where enforcing may be difficult, especially where an individual has severe learning difficulties or is suffering from dementia; however, the actions of people in those groups are likely not meant maliciously, which would be understood by all involved
- Transparency – the quickest and easiest way to ease a situation or circumstance, for it to be accepted by everyone involved and to make it part of everyday life, is to normalise it. You achieve this by everyone, only if they are willing to participate, being open about their gender identity and sexual orientation, typically starting with the staff. Suppose you lack diversity within the staff population. In that case, there are different ways of bringing acceptance out, such as a declaration of family members that identify as LGBTQ+ or loved ones from different ethnicities. The key is to make it a topic of conversation and giving people the chance to involve themselves, should they wish. Group activities and even educational material designed to help older members who may, in the past, have had limited access to diversity, is an excellent way to help people adjust to their new environment
- Removing assumptions – when getting to know a person, it is common to start by asking questions; however, assumptions can be extremely damaging, especially to those most vulnerable. Though there are guidelines and helpful tips when engaging with people more inclusively, the best method is to remove all assumptions and listen to what they are telling you or just by asking, politely. If you are dealing with an older member of the LGBTQ+ community, ask how they liked to be addressed. Rather than saying were you married, instead, were you in a long-term relationship. Rather than he or she, use you or them, wherever possible until preferred pronouns have been established. The reality is some people do not like these generic terms and will quickly correct you, with yes, my wife or girlfriend; however, those scared or frustrated will greatly appreciate the effort you are making. The more you talk and get to know one another, the quicker and easier it is to find out people's preference and ultimately their background. People make mistakes, but instead of brushing off any mistakes you make, merely own up to them by saying something like apologies, I should have asked how you would like to be addressed?
- Sex & companionship – basic human desires do not change the older you get, the desire to be loved, to be close to someone, including intimacy, remain with us until we die. Anyone working within the eldercare industry will testify that sexual relations are commonplace amongst their residents and customers. There is nothing wrong with mentally aware and consenting adults seeking companionship or even sexual relationships in their later lives. Conventional care facilities will likely have the majority of residents or customers identifying as heterosexual, so members of the LGBTQ+ community would probably struggle to find that special someone; however, there are ways to combat the risk of isolation. Creating inclusive environments is not about match-making; instead, you are creating an environment for everyone to be comfortable and happy within. If your care facilities have very few LGBTQ+ residents, what about reaching out to neighbouring care facilities or even excursions which encourage residents to meet and socialise with other members of the community
- Privacy – inclusivity is around creating a welcoming and safe environment for all residents and customers; however, some may not wish to share intimate details about themselves and maintain their privacy. If this happens, that is fine; you are not falling at your job. All you can do is create the environment, and it is up to your customers or residents to participate or not
Inclusivity is about making clear statements relating to what you stand for as a business and showing through your actions that everyone is welcome. An environment that everyone is safe and comfortable, regardless of how a person identifies, their gender, or sexual orientation. Ultimately that everyone is welcome, is treated with respect, and treated the same as everyone else.
Specific Medical Needs
One potential barrier for conventional care providers relates to their concerns about their ability to provide adequate care for LGBTQ+ community members. There might be some small, minor medical requirements; however, the reality that most of those who identify as LGBTQ+ will have the exact or similar wants and needs as heterosexual customers. Let us look at specifically where some of the medical requirements might vary: -
- Hormone Replacement Therapy – those that identify as transgender, including those that may not have had sex reassignment surgery, will likely be required to take and maintain hormone replacement therapy for the remainder of their lives. The type of treatment received is dependent on how a person identified at birth and will either increase the body's estrogens, antiandrogens, or androgens. The purpose of the therapy is to help the individual align closely to their gender identity. The treatment will typically be administered in the form of a pill, patch, gel, or cream
- HIV Treatment – the number of infected elderly individuals among the LGBTQ+ community is relatively low, and it is important to remember that the virus also affects heterosexual individuals. Though the number is currently low; it is, set to grow in the future. Treating HIV means that many of those infected are untraceable, which requires those infected to a pill every day for the remainder of their lives. In addition to the medication, reducing cross-contamination and safety measures would need to be rigorously observed; however, no more than any care provider should currently be adopting (disposable of needles, handling of blood, etc.)
- Sexual Transmitted Diseases (STDs) / Urinary Tract Infections (UTIs) are not an exclusive LGBTQ+ community problem. However, certain groups within the community are more susceptible to certain STDs and UTIs; many of which are often easily treated
All of the specific medical needs will likely take the form of administering some form of medication, all of which is both a standard and frequent requirement for any care provider currently working with the elderly. The reality is that there are very few special medical requirements concerning the LGTBQ+ community, none of which would be a challenge or cause any issues for experienced providers.
Providing care for the LGBTQ+ community would not only be enriching to any existing services you provide, however, is also a natural evolution for any modern business. Accepting and attracting elderly LGBTQ+ community members are very different things. A care provider would likely struggle to refuse admittance to a community member on the grounds of their gender or sexual orientation due to discrimination laws; however, creating an environment in which members of the community actively seek out and want to be part of, is a significant accomplishment. There are the financial benefits of tapping into a community with serious spending power; also, the wealth of diversity they bring to any environment. A business does not need to offer tailored solutions, preferably by being more inclusive and making clear statements you will likely attract and retain individuals from this often, underserved and largely forgotten group. Lastly, it is important to remember that everyone, including members of the LGBTQ+ community, all want the same thing, to receive equal and respectful care, assistance, and treatment.
Ultimately, we all have the same wants and needs when it comes to long term care and assistance, and a person's gender or sexual orientation should not be a factor in the quality of the care they receive