Key messages

  • Many older people who are LGBTI do not disclose their sexual orientation, gender identity or intersex status to aged care service providers. 
  • Aged care services can make a positive difference in the lives of older people who are LGBTI by being LGBTI inclusive.
  • Aged care services should recognise the diversity and needs of individuals who are LGBTI.
  • When providing services to older people who are LGBTI, services should support connections with LGBTI networks, support people to maintain gender roles and appearance, support people’s rights to be safe and the right to cultural and sexual expression, intimacy and privacy.
  • Services should deliver respectful, informed and non-heterosexist assistance, protect clients who are LGBTI from discrimination and support HIV positive clients.

Aged care

As LGBTI people age, they may have less access to support from family or carers compared to the rest of the population. This may mean people who are LGBTI may have less ability to stay in their own home as they age. Aged care services can make a positive difference in the lives of older people by being LGBTI-inclusive. Being inclusive can help address a range of issues that people who are LGBTI currently experience. For example, older people may not disclose their sexual orientation, gender identity or intersex status, for fear that disclosure will result in negative attitudes towards them. Social isolation and invisibility may also be an issue. Older people who are trans, gender diverse and intersex may avoid seeking assistance from services because they are particularly vulnerable to discrimination. It is therefore important for the health and wellbeing of LGBTI people to recognise their diversity and specific needs in aged care facilities, and in community and home based care. 

Mental health issues and age-related illnesses such as dementia can compound issues facing people who are LGBTI as they age. For instance, people may find it more difficult to make, or give effect to, their own arrangements on property ownership and guardianship if their mental capacity is reduced. Even though same-sex relationships are recognised under various state and territory laws, ‘proving’ a relationship with a partner with dementia can still be problematic.

Services that already struggle to support the sexuality of heterosexual clients in residential aged care often also fail to recognise the sexual or gender diversity of their clients. People who are LGBTI may find it particularly difficult to express themselves in an aged care facility. For instance, these clients may not feel comfortable or safe to come out as LGBTI or talk about their needs as a person who is LGBTI. By enabling people to express themselves, services may minimise the risk of clients becoming socially isolated. This may also have positive impacts on their physical and mental health.

For people who are LGBTI, the effect of discrimination can be acute, particularly for LGBTI people in aged care facilities. They may also experience heterosexist attitudes from service providers, family members and other residents. This reduces both their quality of care and their everyday freedoms (Harrison, 2005; Barrett, 2008). If people are, for instance, ‘desexualised’ their opportunities for intimate, caring relationships, including sexual relationships, may be severely compromised. Furthermore, this may result in them losing their connection to the LGBTI community and support networks. If the residential aged care service is predominantly heterosexual, this may leave them feeling invisible. This return to the ‘closet’, in which people are forced to hide their LGBTI status, is a particular risk for people receiving home based care and people in residential aged care facilities.

Responding to the needs of people who are LGBTI

Strategies to better respond to the needs of older people who are LGBTI include:
  • support connections with existing LGBTI networks (which could include LGBTI media such as television, radio, newspapers, community events and outings and community visitors)
  • support transgender people who may have difficulty maintaining gender roles and appearance
  • support people who are intersex who may have experienced inappropriate normalising surgeries as children and who may find an institutional health setting stressful
  • support the rights of people in their care to be safe and for cultural and sexual expression, intimacy and privacy (given that not everyone will be comfortable being ‘out’)
  • provide additional care for seniors with dementia and with limited cognitive ability who may not have the capacity to understand when and where it is safe to disclose their sexual orientation, gender identity or intersex status
  • deliver respectful, informed and non-heterosexist assistance for personal activities, such as bathing
  • protect clients who are LGBTI from discrimination from other staff, clients, visitors and families, and respond if and when discrimination is experienced
  • support HIV positive clients so they are not quarantined or mistreated by other staff, clients or visitors.

References

Barrett, C., 2008, My people: Exploring the experiences of gay, lesbian, bisexual, transgender and intersex seniors in aged care services, Matrix Guild Victoria Inc & Vintage Men Inc, Melbourne.

Birch, H., 2009, Dementia, Lesbians and Gay Men, in: Paper 15 (A. Australia, ed.), Alzheimers Australia.

Fredriksen-Goldsen, K. I., Kim, H. J., Barkan, S. E., Muraco, A., and Hoy-Ellis, C. P., 2013, Health Disparities Among Lesbian, Gay, and Bisexual Older Adults: Results From a Population-Based Study, American Journal of Public Health 103(10):1802-1809.

Harrison, J., 1999, A lavender pink grey power: Gay and lesbian gerontology in Australia, Australasian Journal on Ageing 18(1):32-37.

Harrison, J., 2005, Pink, lavender and grey: Gay, lesbian, bisexual, transgender and intersex ageing in Australian gerontology, Gay and Lesbian Issues and Psychological Review 1:11-16.

Panich, E., Maynard, N., Margery, M., Chandler, M., South, C., and Newsome, M., 2005, The lion, the witch and the wardrobe; ageing GLBTIs (gay, lesbian, bisexual, transgender, and intersex people) and aged care: a literature review in the Australian context , Geriaction 23(4):15.

National LGBTI Health Alliance, 2010, National LGBTI Health Alliance submission to the productivity commission inquiry into the aged care system in Australia ‘Caring for Older Australians’ .