I’ve conducted hundreds of LGBT cultural competency trainings throughout Massachusetts for many different types of elder-care providers, including home health aides and staff at senior centers. In nearly every session, someone raises their hand and says, “But we treat everyone the same.”
In truth, 8 percent of LGBT older adults experience discrimination based on sexual orientation or gender identity by an elder service or health care provider. Many LGBT elders are fearful of coming out to the people who are assisting them with the daily activities of living.
A first-in-the-nation law signed by Governor Charlie Baker this past July will require elder service providers that receive either state funding or licensure to complete training in how to provide inclusive care to LGBT older adults. Only California has a similar law, but that training is limited to those working in the field of long-term care. The new law will not end discrimination against LGBT seniors, but it should reduce the likelihood of harm.
Like most health care initiatives designed to protect a vulnerable population, it will improve care for everyone.
One manifestation of trying to treat everyone the same are well-intentioned questions from providers about an opposite sex husband or wife, children, and grandchildren. But asking questions about family without assuming that everyone has had the same family experience — “Who do you talk with every day?” “Tell me who you consider to be your family?” “Who do you turn to in an emergency?” “Who provides care for you? Whom do you care for?” — yields much more information for providers about those they’re caring for.
By not making assumptions about the people they are serving, caregivers learn about the next-door neighbor who should be notified in the event of an emergency. They hear about beloved pets who are considered family and thus understand why someone is refusing hospital admission. They collect valuable information about the people they are serving that make it easier to provide much more meaningful care.
When providers try to treat everyone the same they also inadvertently erase the life experiences of LGBT seniors who came of age when being out or crossing gender boundaries was subject to imprisonment or institutionalization. Homosexuality was classified as a mental illness by the psychiatric profession, and many LGBT people were shamed and shunned by their families of origin. Most have had significantly different life experiences than those of their non-LGBT peers.
These adults, now in their 60s, 70s, and 80s are more likely to be aging alone, without a spouse, partner or adult children. Today, three-quarters of them worry that they do not have the support and assistance they will need as they age. All of these concerns are compounded for LGBT older adults of color, or those who are living with disabilities, have low incomes, or live in rural areas or even cities outside of areas with high populations of LGBT people.
In my work as an advocate for LGBT older adults, I repeatedly see the results of not treating everyone the same. A closeted gay man living in senior housing in Everett felt safe enough to confide in the resident service coordinator that he was being bullied by another resident and received the support he needed. A Boston-based elder service provider hosted a community event specifically for LGBT older adults. Two Black lesbians, a couple who had long been skeptical of the idea that they could safely welcome providers into their home, signed up for services the following day. After participating in LGBT cultural competency training, service providers on the Cape collaborated to offer a community meal program for LGBT older adults and their friends. The monthly dinners are an opportunity for LGBT older adults to connect with each other and to develop trust and connection with local elder service providers — before they need those services themselves. The dinner on the lower Cape draws 80 participants each month.
Despite recent setbacks, LGBT people have never experienced as much acceptance under the law and in society as they have today. For that, we can thank the LGBT pioneers who contributed to this significant culture change. Those pioneers are today’s LGBT older adults now seeking senior housing, personal care at home or nursing home care. At the very least, we should ensure that when providers say “we treat everyone the same,” it means that they give all the people they serve the support needed to live safely and authentically.
Lisa Krinsky, LICSW, is the director of the LGBT Aging Project, a program of Fenway Health, and a member of the Massachusetts LGBT Aging Commission.