Is aged care failing LGBTI+ people?

Many older LGBTI+ people feel pressure to “straighten up” and “blend in,” concealing their identities to feel safe in aged care facilities, say researchers at the University of South Australia.

In a study published in The Gerontologist journal, UniSA researchers found that aged care experiences for older LGBTI+ people are often shaped by prejudice, exclusion, and a lack of respect.

Synthesizing findings across 55 studies (comprising the voices of more than 3000 LGBTI+ people aged 50-94 from 11 countries), then cross-referencing these with the lived experience of a consultant group of LGBTI+ older adults living in South Australia, researchers confirmed four commonalities:

1. Aged care assumes heterosexuality: Heterosexism is deeply embedded in aged care, shaping the environment, dress codes, activities, and assumptions about relationships.
2. No one to protect us: LGBTI+ adults feel unsafe and vulnerable in aged care settings, due to historical discrimination and care providers being away from the public eye.
3. Hiding who you are: While being open is ideal, many older LGBTI+ people feel forced back ‘into the closet’ to stay safe in aged care.
4. Good care, not different care: Participants want inclusive, respectful care that affirms their identity, not special treatment that keeps them separate.

With Australia’s aging population rising (now the third highest in the world), it can be inferred that the LGBTI+ population is also increasing, highlighting an acute need for inclusive, quality aged care services.

Yet with the Royal Commission into Aged Care Quality and Safety identifying systemic issues of neglect, abuse, and substandard care across the age care sector, particularly for LGBTI+ people, it’s clear that more needs to be done.

The findings are timely ahead of the International Day Against LGBTQIA+ Discrimination! (IDAHOBIT) on May 17.

Lead researcher and Ph.D. candidate, UniSA’s Sarah McMullen-Roach, says LGBTI+ older adults have reservations about aged care.

“From dress codes to daily activities, aged care settings are often assumed to reinforce heterosexual norms, making LGBTI+ residents feel invisible or unwelcome,” McMullen-Roach says.

“LGBTI+ people worry that when the time comes to consider aged care they’ll be met with ostracism and discrimination, with gendered roles and standards forced upon them when they can no longer present themselves as they choose,

“But it’s also about visibility. On one level, LGBTI+ older adults want to be seen and accepted for who they are, yet on another level, many feel that they need to retreat from their identities—ultimately ‘returning to the closet’ in their old age.

“Having to give up their hard-earned rights and identities is unthinkable, particularly when you remember that homosexuality was only fully decriminalized in Australia in 1997, with same-sex marriage made legal less than 10 years ago.

“Add to this that most aged care institutions are run by faith-based organizations that have histories of rejecting LGBTI+ people, and the already flawed Australian aged care system, and you can see why concerns of safety, vulnerability and homophobia are prevalent.”

McMullen-Roach says while LGBTI+ people deserve to access inclusive good-quality aged care services that affirm and accept them, multilevel interventions are needed to make this happen.

“Aged care services need to start thinking differently about how they signal inclusivity,” McMullen-Roach says.

“This could be so simple as displaying a rainbow sign at reception, using inclusive language on intake forms, engaging staff in training and development, and adopting advertising materials that showcase the diversity of their residents.

“Education is also a much-needed intervention that will help change the current state of aged care services, helping them reduce the risk of systemic homophobia while increasing the dignity and respect for older LGBTI+ people.

“Care providers need to know that the world’s not exclusively straight, and that LGBTI+ people may have different care needs that should be accommodated.

“Some of this education is happening in Australia, but we don’t know the impact it has on LGBTI+ individuals’ experiences and willingness to access care services.

“This is what we want to understand in the Australian context: is discrimination truly historical and left in the past? Are people being supported to age free from fear? If not, what needs to change to create a better, more inclusive future in aged care?”

UniSA is now extending this study through the perspectives and experiences of aged care for LGBTI+ older Australians. The current study is underway with preliminary results expected in the new year.