By Dr Trish Cain, Prof Davina Porock, A/Prof Eyal Gringart*
Centre for Research in Aged Care, Edith Cowan University
*Trish Cain, Davina Porock and Eyal Gringart are academic scholars and allies - not members of the LGBTI community
For many people, thoughts of needing aged care services are unnerving. For lesbian, gay, bisexual, transgender, and intersex (LGBTI) people, these thoughts can be especially daunting and complex. While facing many similar reservations as heterosexual and cisgendered communities, LGBTI older people must navigate a space shaped by historical legal, structural, and social exclusion. A fear of discrimination and biased care means that many Australian LGBTI older adults have negative expectations of service quality and are reluctant to engage with the aged care system. [1, 2]
While Australia may be considered a rapidly changing society with respect to LGBTI rights, many advances have been relatively recent [3] and for the current generation of LGBTI older adults, have occurred late in their lifetimes. Someone now aged 83, would have been 58 years old when homosexuality was decriminalised in Tasmania, 73 years old when their rights and needs were recognised by the LGBTI Ageing and Aged Care Strategy, and 78 years old when they could marry their partner. In the words of one LGBTI older adult: ‘I used to be illegal and now I’m a priority.’ [4]
Recent years have seen federal government-commissioned strategies [5] and targeted consultation [6] designed to foster inclusion and equity of care. However, the recent Royal Commission into Aged Care Quality and Safety highlighted many ongoing and unresolved issues. Extracts from publicly available witness statements and hearing testimony reveal several key concerns. For many LGBTI people, fear of discrimination remains, and as a result, some opt to hide their sexual identities. For example, ‘LGB people receiving home care services speak about the need to “straighten up their home” for fear of discrimination of poor care.’ [7] Concealing a part of one’s identity leads to being hidden in the system and needs remaining unmet.
To protect themselves, many will then hide or modify their identities, bodies, experiences, relationships, and/or attractions, rendering themselves invisible. This can lead service providers to assume they don’t have any L, G, B, T, or I clients and, therefore, that they do not need to consider their needs in service provision, planning and practice. [7]
Where there are attempts at inclusion, testimony suggests that while these may be well meaning, they are not always enough. ‘There is often a lot of goodwill around staff wearing rainbow badges or putting up welcome rainbow signs or stickers without actually doing anything to ensure the service is inclusive.’ [7]
The Royal Commission reports acknowledge that more work in this space is required. Fortunately, the way forward is relatively clear as ‘best practice approaches to LGBTIQ inclusive health and aged care service delivery are well understood in Australia, though they are not consistently implemented.’ [7] Changes in policies cannot ignore history. What is needed now is broad cultural change and a commitment to workforce training and education at all levels. It is only when everyone feels safe that Aged Care Quality Standard 1—’I am treated with dignity and respect and can maintain my identity’—can be said to be achieved.
*The views and opinions expressed in Knowledge Blogs are those of the authors and do not necessarily reflect those of ARIIA, Flinders University and/or the Australian Government Department of Health and Aged Care.