By Rebecca DiGirolamo, published by the Sunday Mail, 18 August 2019
Born into an era when homosexuality was criminalised, many older LGBTI people are fearing spending their final years in the aged-care system.
OLDER LGBTI people are harbouring such great concern over entering aged care that they are considering an “exit” plan as a last resort, while some already in care are retreating back into the closet.
Stories of discrimination – including hormone therapy being halted without consent – are escalating an already deep distrust of a sector damaged by headlines of neglect and abuse of elderly residents.
In the past month, the Sunday Mail has been told multiple times of older LGBTI (lesbian, gay, bisexual, transgender, intersex) South Australians considering end-of-life plans or putting in place “Do not resuscitate” orders to bypass aged care.
“Of course I’ve thought about it,” says 66-year-old Adelaide archivist Jenny Scott. “If I’m 80 and frail, not able to communicate and without an advocate, what level of abuse am I leaving myself open to in the current aged-care sector?”
Ms Scott, a transgender woman, and an advocate since 1993, says she is aware of LGBTI people who have exit plans in place if forced into aged care and those already in residential homes who feel “not being out” is best for their personal safety.
The ongoing aged-care royal commission, in Adelaide last week, has heightened fears across the LGBTI community.
“We are an already vulnerable community dependent on a system that is currently being investigated for great suffering against non-LGBTI older people,” she says.
Ms Scott, who teaches LGBTI awareness to aged care and allied health service staff, and her partner, Anthea, have an aged-care plan, which is to remain in their home for as long as they can.
“The prospect of entering the aged-care sector, as it is now, is a terrifying experience that is retraumatising and restigmatising many queer people all over again,” transgender woman Sor›l Coward says.
“People are retreating back into the closet – they are assuming their biological identity, or suppressing their sexual orientation all over again, in order to survive in aged care that often does not care about LGBTIQ people,” says Mrs Coward.
The former Anglican priest and psychologist came out as gender-diverse 4½ years ago after her 50th birthday. She remains married after 27 years and the Adelaide couple have no children. “Towards the end of my life it is quite possible I will end up alone and reliant on the system for care into old age.”
Mrs Coward, an accredited social worker and counsellor specialising in the mental health of transgender people, is among 64,000 South Australians aged 50 and over who identify as LGBTI and will become increasingly reliant on aged-care services over the next 20 years.
They were born into an era when homosexuality was criminalised and any gender variance was treated with suspicion and social censure.
SA became the first Australian state to decriminalise male homosexuality in 1975. Tasmania was the last state to do so, in 1997.
Mrs Coward, who is part of the Council on the Ageing SA’s LGBTIQ Advisory Group, says past discriminatory social practices, and the consequences that often followed people coming out, have left many older transgender people socially isolated.
“They have lost family, friends, marriages and employment and have faced many examples of rejection and discrimination, often at the hands of state and religious run organisations – the same ones running aged care today.”
The first Baby Boomers, now aged in their 70s, are starting to enter an aged-care system Mrs Coward says is stuck in the Dark Ages, with untrained staff, and organisational cultures that expect ageing people to fit into heteronormative models of care.
“Because of this, LGBTIQ people in aged care right now are vulnerable to abuse and neglect,” she says.
Mrs Coward says there have been examples of transgender people being treated as their gender assigned at birth, being addressed using their birth names, and deprived of hormone therapy because it is deemed not “medically” necessary.
Unsurprisingly, she says, this is increasing the incidence of depression, anxiety, loneliness, isolation and self-harm.
“I, too, am scared of a future where my care might be in other people’s hands who may neither understand nor care,” she says.
Council on the Ageing (COTA) SA is among a strengthening cohort of advocates – inside and outside the aged-care system – urgently lobbying for much-needed change.
COTA has been providing Silver Rainbow LGBTI Aged Care Awareness Training since the beginning of this year. It is a voluntary program and, so far, 11 aged-care groups and about 250 people have been educated on appropriate and inclusive LGBTI services.
COTA Rainbow Hub Advisory Group chairwoman Christine Davis says SA aged-care providers are keen to understand the need for LGBTIdriven services but many lacked understanding of the historical trauma experienced by the community and that many LGBTI people were living hidden within their organisations.
“Training is a start to opening up conversations about how aged-care providers can make their services and staff open and welcoming to LGBTI people so they feel safe and comfortable enough to disclose their gender, sexuality or intersex status if they want to,” she says. “I would like to see all organisations associated with older people actually demonstrate that they are welcoming and safe for LGBTI people.”
Last year, COTA and the SA Rainbow Advocacy Alliance (SARAA) consulted with more than 160 older people as part of the LGBTIQ People Ageing Well Project. Accessing suitable aged-care and health services was a key concern raised by those involved in the project, with COTA and SARAA highlighting much more work needed to be done to meet the needs and increasing demands of older LGBTI people in SA.
Among those leading the way in SA is Enabling Confidence at Home (ECH). It is the only SA aged-care service provider, and one of a handful nationally, to have gained Rainbow Tick accreditation – a national voluntary program independently assessed by Rainbow Health Victoria.
“I kept hearing time and time again of older LGBTI community members going back into the closet because if they remained true to themselves they would not get the service they needed,” ECH chief executive Dr David Panter says.
“Stories about older people hiding themselves in their own home and hiding photos of same-sex couples in case they upset visiting aged-care workers – that’s outrageous,” he says.
ECH had to meet six standards – including provision of workplace education, disclosure and documentation, and culturally safe and acceptable services – to receive accreditation in 2017.
“The Rainbow Tick gives a clear signal to people from the LGBTI community that we can be trusted to meet their needs and respond appropriately,” Dr Panter says.
“All ECH staff – whether they are the home maintenance worker, the physiotherapist or the home carer – receive training around caring for the LGBTI community.”
ECH also runs an LGBTI Connect Service, co-created with members of the LGBTI community. Five Connect team members provide culturally safe access, advocacy and connection to aged care services for older members of the LGBTI community.
“We encourage older LGBTI men and women to talk to us about their concerns and fears and we talk to them about our own experiences and we relate – they know we’re here if they need us,” says Barry Horwood, one of two gay Connect Service members at ECH.
Stephanie Russell, also an ECH LGBTI Connect member, says a large number of older transgender people who did not have access to gender reassignment surgery were extremely anxious over aged care staff’s responses to the differences between their anatomy and their appearance.
“Some transgender people will refuse to be washed because they are so scared and they don’t want to have to explain every time a new staff member comes in – it’s like coming out over and over again and can be very traumatic.”
The prospect of entering the agedcare sector … is a terrifying experience that is retraumatising and restigmatising many queer people all over again
Ms Russell is a former infra-red physicist for British Aerospace who came out as transgender aged 59 in 2015.
Dr Elaine Pretorius, from SA’s only public Transgender Health Clinic, at Modbury Hospital, says Rainbow Tick accreditation and organisations such as ECH needed to become the norm.
“Because if we don’t, I think LGBTI people will postpone entering aged care homes and remain at home longer under sub-optimal conditions and possibly sacrifice their safety or their own lives,” she says.
“Or alternatively, they will revert back to their birth sex and be unhappy and unfulfilled in the last part of their lives.”
Eldercare chief executive Jane Pickering says aged-care organisations were bound by several key pieces of legislation to provide safe and inclusive services to many “special needs” groups, including members of the LGBTI community.
But she says more can be done, including acknowledging LGBTI status, calling out inappropriate behaviours and making sure staff understand the impact of their beliefs and attitudes on LGBTI people.
Eldercare has developed LGBTI policies, is training all staff and volunteers for Rainbow Tick accreditation and is trialling an LGBTI advocate service.
Aged care service provider Helping Hand last year launched an LGBTI position statement, is about to train staff through COTA’s Silver Rainbow program, is providing 10 LGBTI-specific home care and residential care packages and has produced a booklet, All people are welcome and included.
“While legislative reforms have helped to promote and ensure equality, many older LGBTI people continue to fear or expect prejudice from the people around them, including health professionals and aged care service providers,” Helping Hand executive manager of residential services Syd Farrell says.
“So they hide their identities and are less likely to access services and this concealment and fear has had a detrimental impact on the health and wellbeing of many older LGBTI people,” he says.
“We need to change this.”