Analysis: as the number of older LGBTQ+ people in care settings increases, organisations need to ensure they feel welcome and safe
By Megan Oglesby and Sinéad Hynes, NUI Galway
There has been and continues to be a significant rise in the number of older people in Ireland. At the same time, more people than ever are revealing their gender or sexual orientation later in life. Here we outline five key things older people have said that they want you to know.
Assumptions can be harmful
We all know that stereotypes are harmful, but sometimes stereotyping can be insidious and go unnoticed by the person using them. Saying something as seemingly harmless as "will your husband be picking you up today?", when there has been no mention of a husband or opposite-sex partner, can be very uncomfortable, and puts the responsibility of coming out on the LGBTQ+ person.
Similarly, care systems often assume a heteronormative lifestyle, where heterosexuality is the default, and often (explicitly or implicitly) the preferred expression of sexuality. Many though not all older LGBTQ+ people are single and may not have great relationships with their family of origin, so rely on a network of other LGBTQ+ friends.
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From Age & Opportunity/Bealtaine, trailer for Where Do All the Old Gays Go?, a documentary short directed by Cathy Dunne and produced by Maggie Ryan about the experiences of the older LGBTQIA+ community in Ireland
But in care contexts, the family of origin is often assumed to have the patient's best interest at heart. Who makes the care decisions when a trans man gets dementia, for example? Is it his closest friends, or his daughter who hasn't spoken to him for years because she doesn't recognize his gender identity?
The simple solution is to just ask a question like "who would you like to help with care decisions when your dementia progresses?" Forward planning with trusted people gives agency to the person with dementia in their decision-making. In general, ditching the assumptions is the way to go.
Many older people anticipate disrespect in care facilities
Although Ireland has made progress in recent years, we must not forget that homosexuality was a criminal offence here less than 30 years ago. Older people in the LGBTQ+ community in Ireland came of age at a time when it was both illegal and dangerous to be open about sexuality or gender identity. Countless people left the country for fear of their safety or stigmatization. Some returned in later life, many did not.
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From RTÉ Six One News, the Bealtaine festival looks back at LGBTQ life in Ireland
As people age, they often feel more vulnerable, relying on others in ways they have never had to in the past. This vulnerability is especially present for older people from the LGBTQ+ community because of past experiences. They have stated that they anticipate disrespect in the form of homophobia, transphobia, isolation, or humiliation. Research has found that people avoid engaging with health services as a result of this.
Older LGBTQ+ people can return to the closet in care
Because of fears of safety and disrespect, many older LGBTQ+ people conceal their sexuality or gender identity if they move into a nursing home or need full-time care. This can be very distressing for people who have lived a very different life up until that point. The fact that people feel the need to suppress or deny their identity in care settings is worrying and has many knock-on mental and physical health consequences.
Older LGBTQ+ people can stop friends from visiting because of this fear, increasing their isolation. Many may have strong support from non-nuclear structures and friend networks and reducing this contact reduces overall social support and increases the experience of loneliness.
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From RTÉ Radio 1's Ryan Tubridy Show in Sep 2021, a look at an exhibition in EPIC on Ireland's LGBTQ diaspora
LGBTQ+ people want and need safe care
People looking for long-term care want somewhere that they feel safe and accepted. LGBTQ+ people are no exception to this, but sometimes they may have to second-guess whether a care facility or a carer will be accepting of their identity.
Organisations need to take the initiative to make sure LGBTQ+ people are welcomed and feel safe in their facilities. This includes making sure employees are willing to be supportive towards all LGBTQ+ people during the recruitment process, training all staff members in LGBTQ+ care, and making sure that LGBTQ+ affirmation is visible across the organisation.
Organisations could use markers of acceptance such as pictures of same sex couples, statements of support on their website and leaflets, or symbols such as rainbows in order to demonstrate to LGBTQ+ people looking for a care-facility that they will be accepted and safe. Employees who have taken part in training processes could be given rainbow badges which could identify them to LGBTQ+ service users as someone they can trust, though training should be mandatory for all.
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From RTÉ 2fm's Jennifer Zamparelli show, sex and relationship therapist Rachel Cooke on what coming out means these days
We need to do more
The entire country was shocked at the recent murders of Aidan Moffitt and Michael Snee, as well as the alarming number of homophobic attacks on the LGBTQ+ community in recent months. We need to do more to keep the LGBTQ+ community safe. People of all ages from the LGBTQ+ community should feel safe in Ireland, be that on the streets or in care and nursing home facilities.
We congratulate ourselves on being the first country in the world to legalise same-sex marriage by popular vote, but these changes are not enough. We need to make active positive changes for the LGBTQ+ community. Specifically, we should listen to older people from the LGBTQ+ community who request that all care staff should be trained in LGBTQIA+ affirmative care.
Medical, nursing and allied health professionals should be provided with specific trans and intersex training to enable them to work safely with unfamiliar bodies. LGBTQIA+ specific services for older adults and people with dementia should be introduced and a service's LGBTQIA+ inclusiveness and training should be auditable by a relevant health authority.
No excuses. We need to do more.
This piece is based on an article by the authors for HRB Open Research
Megan Oglesby is a Research Assistant at the School of Health Sciences at NUI Galway, who has worked on research projects involving dementia in the LGBTQIA+ community, and multiple sclerosis. Dr Sinéad Hynes is a lecturer in occupational therapy at NUI Galway whose research focuses on improving the daily function and quality of life of people with neurological conditions. She is an Irish Research Council awardee.
The views expressed here are those of the author and do not represent or reflect the views of RTÉ
