Much of the news we cover here at McKnight’s isn’t exactly sexy.
Even less of it is about sex, but we know (and we know that you know) nursing homes are far from sex-less. Late in life, sex remains an important part of many individuals’ self-identity.
But for far too many Americans, sex, sexual orientation or gender identity feel like things that must be abandoned when they move into long-term care settings.
“Something we see a lot is LGBT elders going back into the closet when they go into a nursing home,” Sydney Kopp-Richardson, director of the Services & Advocacy for LGBT Elders (SAGE) National LGBT Elder Housing Initiative, said during a Tuesday roundtable discussion.
SAGE’s motto is: “We refuse to be invisible.”
Yet, a large share — 78% — of Americans who identify as lesbian, gay, transgender or bisexual still report hiding away this most intimate and true part of themselves when they enter care for fear of being discriminated against or mistreated.
Imagine going to a healthcare facility to recover from surgery, to heal, and feeling that you can’t invite your same-sex spouse to visit. Imagine packing to leave your home and deciding not to bring your favorite outfits, the ones in which you feel most comfortable or happy, because others might think only members of the opposite sex deserve to wear them.
Imagine you’ve spent your life’s savings and must rely on Medicaid to fund your long-term stay. You have few choices when it comes to location but need support, and so you accept a bed even when you overhear staff (or maybe a roommate) make off-color comments about your community. You invite your “friend” for visits, but sex becomes a memory rather than a meaningful part of the life you’re still living.
For LGBT seniors, these are all-too-common scenarios.
Riding the Rainbow Tsunami
Currently, there are about 3 million Americans over 50 who identify as LGBT, and that number is projected to hit 7 million by 2030, Kopp-Richardson said.
If you look at today’s youth and a culture where gender fluidity is increasingly common and relationships less defined by traditional expectations, it’s likely those numbers will only continue to climb. Call it a Rainbow Tsunami, if you will.
So even as some providers are doing better, the industry must continue to push toward accepting and embracing residents whose orientation is different than that of the majority of staff or their fellow residents.
“It’s been a lot of years and work, and we’re still not at a place where (seniors housing and healthcare providers) are welcoming and affirming on a regular basis,” said Jacqueline Boyd, co-chair of One Roof Chicago, an intergenerational LGBTQ+ focused housing project. “If you don’t see people’s identity and you don’t understand the barriers they face, then you can’t really meet their needs.”
That’s pretty much the crux of patient-centered care, is it not?
Here’s why it matters: If you’re in long-term care to provide care, seniors who identify as LGBT may need as much or more of it than any other patient you could imagine.
According to Boyd, LGBT seniors are three to four times less likely to have children to help support them; twice as likely to age alone; and tend to live in isolation and report heightened loneliness compared to straight peers.
LGBT people may also be less familiar (twice as much so) with palliative care or hospice, and Boyd often spends twice as long care planning with LGBT clients to help them navigate those settings and establish expectations.
In the spirit of the law
Of course, it also matters because discrimination is against the law.
On Monday, the Biden administration said it will provide protections against healthcare discrimination based on gender identity and sexual orientation, reversing a position taken by the Trump White House. The shift pertains to all healthcare providers funded by the Department of Health and Human Services, whose Office for Civil Rights previously stripped such protections and allowed institutions and insurers to deny services to transgender people in favor of protecting others’ religious freedoms.
It’s critical that the nursing home industry, especially facilities that are religiously affiliated, ensure staff are trained not only in the letter of the law but in its spirit (which has remained more generous in states such as Illinois, for instance).
Participating in SAGE’s Long-Term Care Equality Index is one way providers can figuratively open their arms to the LGBT community. Membership shows a commitment to caring and provides easy access to best practices, educational resources and inclusive marketing materials.
If your nursing home is truly inclusive, be loud and proud about it. If you’re not invisible, our LGBT elders won’t have to be either.
Kimberly Marselas is senior editor of McKnight’s Long-Term Care News.
