Person-centred long-term residential care for 2SLGBTTQI+ elders, seniors and older persons
The Senior Pride Network (Toronto) asserts and advocates for the human, economic, social and cultural rights of 2 Spirit, lesbian, gay, bisexual, transgender, transsexual, queer, intersex and other (2SLGBTTQI+) elders, seniors and older persons. We envision a series of communities of 2SLGBTTQI+ elders, seniors and older persons that are affirming, supportive, safe and healthy. In keeping with that vision, the Senior Pride Network believes that person-centred models are the best options for long-term residential care for 2SLGBTTQI+ elders, seniors and older persons. We set out below the specific issues and concerns of 2SLGBTTQI+ elders, seniors and older persons in regard to long-term residential care and recommendations – a call to action -- that we believe would be best addressed by embedding them in person-centred approaches to residential care in all types of care facility, whether government-run, not-for-profit or for-profit.
2SLGBTTQI+ Diversity and Intersectionality
2SLGBTTQI+ elders, seniors and older persons are an exceptionally diverse group. The life and aging experiences of 2SLGBTTQI+ elders, seniors and older persons vary significantly because of their race, gender, sex and other identities. Many 2SLGBTTQI+ elders, seniors and older persons, including 2SLGBTTQI+ elders, seniors and older persons who identify as Black, Indigenous, people of colour, lesbians, transgender and persons with disabilities, or who came to Canada as immigrants or refugees, live at the intersections of two or more of these identities. The life experiences and present realities of elders, seniors and older persons found under the broad, rainbow coloured umbrella of 2SLGBTTQI+ have been shaped not just by being 2SLBTTQI+, but also by their other identities -- as are their needs and concerns in regard to residential care and access to health and social services in general.
2SLGBTTQI+ elders, seniors and older persons face a number of issues that have impacted their lived experiences and may have affected their mental or physical health and their overall well-being. Gaining an understanding of those issues and addressing them by adopting an intersectional approach are critical to providing appropriate policies, programs and services, and positive, caring environments for older 2SLGBTTQI+ persons. Recognizing and positively responding to the diversity of 2SLGBTTQI+ elders, seniors and older persons would be best addressed by adoption of intersectional, person-centred approaches to residential care.
Adopting intersectional, person-centred approaches requires shifting away from a strictly one-dimensional approach to 2SLGBTTQI+ elders, seniors and older persons -- one that has been focused on viewing them as a relatively homogenous group which differs from heterosexual seniors in respect of sexual orientation or gender identity and for whom the unique or particular needs, challenges and concerns are primarily or solely linked to the historical, sociocultural context of bias and discrimination against 2SLGBTTQI+ people. Intersectional, person-centred approaches, while continuing to recognize and address the effects of such bias and discrimination as significant factors in the lives of 2SLGBTTQI+ elders, seniors and older persons, also would take into account and address the multiple identities and experiences – not just being a member of the 2SLGBTTQI+ community -- that have shaped their lives and that influence their needs and concerns when in residential care and when accessing other aging services.
Life Experiences of 2SLGBTTQI+ Elders, Seniors and Older Persons
Throughout their lives, 2SLGBTTQI+ elders, seniors and older persons have had to cope with stigma and discrimination in various forms that have negatively impacted their wellness and their economic and social well-being. Many have been or have risked being discriminated against in employment, housing and access to services, denied the right to have custody of their children, or denied legal and societal recognition of their same-sex spousal relationships. Some 2SLGBTTQI+ elders, seniors and older persons have been convicted of criminal offences, or perhaps even imprisoned, for engaging in consensual sex. Others have had treatment imposed on them for “sexual orientation disorder” or “gender identity disorder”, or otherwise have been subjected to therapies and treatments purported to cure, suppress or change their sexual orientation, gender identity or gender expression. Depression, anxiety, abuse of drugs and/or alcohol, and suicidal thoughts or attempts, are common among 2SLGBTTQI+ populations because of discrimination, inequality, social stigma and social isolation. Many 2SLGBTTQI+ elders, seniors and older persons have experienced prolonged poverty or financial insecurity, especially lesbians, bisexual and trans women, 2 Spirit persons and LGBTTQI+ people of colour. HIV positive 2SLGBTTQI+ elders, seniors and older persons who survived the HIV/AIDS health crisis of earlier decades are now at high risk for HIV/AIDS-related co-morbidities and depression. More than a few older 2SLGBTTQI+ elders, seniors and older persons have experienced multiple losses and are coping with significant grief.
2 Spirit elders, like all Indigenous peoples, have experienced higher rates of personal trauma, such as assaults and abuse, incarceration and systemic racism. They have lived with the horrific legacy of colonization, attempts by Christian churches to deny or suppress Indigenous spiritualities and the residential school system in Canada.
2SLGBTTQI+ elders, seniors and older people, and their partners or spouses, often face discriminatory or inequitable treatment from medical, social service and home care providers and as residents of long-term care facilities. 2SLGBTTQI+ seniors fearing discrimination or ill-treatment will often avoid seeking social services and healthcare support when they need them.
2SLGBTTQI+ elders, seniors and older persons, especially those experiencing dementia/Alzheimer’s, are often in vulnerable or risky situations because of their use of chosen names, preferred pronouns, how they express themselves or converse with other 2SLGBTTQI+ persons, how they dress or accessorize, or how they act or interact (e.g. campy) with other people.
Social Isolation and 2SLGBTTQI+ Elders, Seniors and Older Persons
Social isolation and lack of support systems are other significant factors that may negatively impact the health and well-being of 2SLGBTTQI+ elders, seniors and older persons. Opportunities to meet other older 2SLGBTTQI+ people for social and cultural interaction are limited. Programs, activities and events specifically geared toward 2SLGBTTQI+ elders, seniors and older persons are rare. Many 2SLGBTTQI+ elders, seniors and older persons have experienced rejection from family, spouses and children and increasingly rely on chosen families to provide care and nurturing relationships and to build support networks. In general, 2SLGBTTQI+ elders, seniors and older persons are more likely to lack adequate social support, in particular emotional support, than elders, seniors and older persons who identify as heterosexual.
Specific 2SLGBTTQI+ Issues and Concerns Regarding Long-Term Residential Care
Many older 2SLGBTTQI+ elders, seniors and older persons lack access to 2SLGBTTQI+ inclusive long-term care facilities and retirement homes. They may experience, or have a fear of experiencing, discrimination and harassment from residents and staff in homes. To avoid this, they may choose to conceal their sexuality, gender expression or gender identity. A concern expressed frequently by 2SLGBTTQI+ elders, seniors and older persons is that they will have to go back into the closet when receiving care or when residing in long-term care facilities. Many 2SLGBTTQI+ elders, seniors and older persons have reported a desire for inclusive housing environments, including long-term residential care facilities.
The specific issues identified by 2SLGBTTQI+ elders, seniors and older persons in regard to long-term residential care are:
Fear of being forced back into the closet
Perception that long-term care facilities’ approaches to care are based on assumptions that everyone is heterosexual and heterosexual norms and social interactions are applicable to and appropriate for everyone
Perception that long-term care facilities are “illiterate about sexuality”, and are ill-equipped to address sexual orientation, gender identity and gender expression and the particular needs and desires of diverse 2SLGBTTQI+ elders, seniors and older persons
Fear of being rejected, neglected, mistreated or abused by healthcare providers because of 2SLGBTTQI+ identity/ies
Anxiety about health care aides who assist with daily life activities who may not be comfortable with 2SLGBTTQI+ people, have biases or negative attitudes (including homophobia, transphobia and biphobia) or whose behaviours and actions are motivated by judgmental or condemnatory religious beliefs
Fear of being maltreated, ostracized, stigmatized, abused or rejected by roommates or other residents because of being 2SLGBTTQI+
Concerns about end-of-life decision-making rights
Lack of guidance for the care of 2SLGBTTQI+ elders, seniors and older persons experiencing dementia/Alzheimer’s, especially transgender seniors
Fear of being alone or isolated and/or not being able to talk about their lives, partners, life experiences, etc., or to display or express grief after loss of their partners
Lack of residential care staff who are open about their own 2SLGBTTQI+ identities
Concerns about limited definition of “family” in legal and medical settings and lack of recognition and acceptance of surrogate families or chosen families (e.g. partners, close friends, other caregivers)
Couples are often separated in long-term care facilities, especially couples who are 2SLGBTTQ+.
Recommendations and Call to Action
Recent studies in Canada and internationally have identified various types of support that are important to 2SLGBTTQI+ elders, seniors and older persons in residential care. The Senior Pride Network recommends that these supports be embedded in person-centred residential care in all types of long-term care homes.
Policies against discrimination based on sexual orientation, gender expression and gender identity
Develop and implement 2SLGBTTQI+ inclusive policies and practices that recognize the diversity of 2SLGBTTQI+ communities and individual residents and that adopt person-centred, intersectional approaches tailored to positively responding to the unique issues, needs and concerns of individual 2SLGBTTQI+ elders, seniors and older persons
Provide 2SLGBTTQI+ intersectional inclusion/cultural competency training for staff, residents and community members in residential care
Recognition and affirmation of, and respect for, 2SLGBTTQI+ relationship status – whether partnered/coupled, single or polyamorous
Respect for 2SLGBTTQI+ partners showing or expressing affection/intimacy
Recognition of and respect for same-sex partner(s)/spouse(s) as main caregiver(s)
Recognition of and respect for surrogate or chosen families of 2SLGBTTQI+ residents
Recognition of and respect for powers of attorney held by others for 2SLGBTTQI+ residents
2SLGBTTQI+ resident allowed to share suite/room with partner/spouse or another 2SLGBTTQI+ person
Someone on staff to approach if 2SLGBTTQI+ resident is feeling excluded, disrespected or mistreated
Having support groups available for issues specific to or services provided for diverse 2SLGBTTQI+ elders, seniors and older persons
Social activities specifically for 2SLGBTTQI+ elders, seniors and older persons or at least that make 2SLGBTTQI+ elders, seniors and older persons feel welcome, safe and included
Promotion of an environment in which there is not a presumption that every resident is heterosexual nor a presumption that gender identity and gender expression equate with the sex or gender assigned at birth
Allow 2SLGBTTQI+ residents to have and display photographs, decorations, mementoes, etc. that reflect or celebrate their identities and lived experiences
Encourage intergenerational activities and interactions with 2SLGBTTQI+ youth, including liaising with Gender and Sexuality Alliances in high schools to help address the social isolation of 2SLGBTTQI+ elders, seniors and older persons and provide 2SLGBTTQI+ youth with role models
Establish Gender and Sexuality Alliances within residential care homes
Recognition of and respect for chosen names and preferred pronouns.
Senior Pride Network (Toronto), May 2019