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Is nobody’s business everybody’s excuse?
Making care services inclusive of older people who are lesbian, gay, bisexual or trans

Sally Knocker explores recent developments in supporting older people who are lesbian, gay, bisexual or trans and why it’s everybody’s business to get support right.

 ‘Is it really our business to know what people do in the bedroom?’
‘We don’t have any gay people here, so it is not really an issue for us.’
‘We aren’t prejudiced, we treat everyone the same.’

All of these comments have been heard in recent years by care managers in a range of settings. They are sometimes offered as an excuse for why looking at the particular needs of older people who are lesbian, gay, bisexual or trans (LGBT+*) are not considered a priority.

Behind these attitudes are, of course, many underlying misunderstandings and assumptions.
For people who are LGB or T, what ‘they do in the bedroom’, ie people’s sex lives, is only a part of what is integral to people’s core identity. Being LGBT+ shapes many aspects of a person’s life, interests and experiences, and especially whom they feel able to trust.

For an older generation of LGBT+ people who have lived through a time when they were criminalised, seen as ‘sick’ or had to hide who they were for fear of losing family, jobs, homes or even their children, trust is a huge issue.

Some LGBT+ people can feel genuinely fearful about contacting care services when they need support. Most research evidence suggests that older LGBT+ people are more likely to be single and less likely to have children and, therefore, potentially more likely to be isolated and in need of support services.

Yet in Stonewall’s 2011 survey, six out of ten lesbian, gay and bisexual people said they weren’t confident that social care and support services would understand or meet their needs.

In data collected by the Commission for Social Care Inspection (now Care Quality Commission) in 2008, only 7% of care homes and 8% of homecare providers reported carrying out specific work around equality for LGBT+ people.

Added to this, there was no specific reference to LGBT+ issues in the National Dementia Strategy published in 2009.

The second statement that there are ‘no gay people here’ stems from an ageist assumption that sexuality is generally perceived as a ‘non-issue’ for older people. Yet, as people become grey, do we become any less gay?

If people are still having sexual and romantic relationships into their 70s, 80s and beyond, it is seen as unusual and ‘sweet’ at best and ‘distasteful’, ‘unthinkable’ and ‘wrong’ at worst.

There is also a danger that people who have been married to someone of the opposite sex in their earlier lives, as many lesbian, gay or bisexual people were, are automatically assumed to be heterosexual.

When initial information is gathered about a person, many forms do not have open enough questions to enable people to talk about the important people in their lives, whether a lover or LGBT friends. ‘Family’ may mean very different things to LGBT+ people than conventional family constructs. Many assessment forms are also very gender specific, which can be excluding and difficult for trans people.

All this means that at a time when people are at their most vulnerable, many find themselves feeling guarded and afraid to be open about themselves with care professionals.

There are an estimated 1.2 million older LGB people, and an estimated 300,000 to 500,000 trans people in the UK, though there are no official statistics available for trans people and both numbers are guesses. This is a significant population, and the next generation, currently in their 50s and 60s, who might need care services are much more likely to be open about their LGBT+ identity and to want these services to be equally open about how they might recognise and support them as they age and/or develop a dementia.
This brings us on to the final excuse; ‘We don’t discriminate, we treat everyone the same’, which fails to capture what truly person-centred care is about.

As the recent guide produced by Age UK and Opening Doors London (ODL) Safe to be Me explains, ‘It is through recognising and giving regard to difference in a positive way, that services can distinguish themselves.’

Positive change is happening

The encouraging news is that there is a definite current wave of interest in the sector in raising the profile of the needs of LGBT+ older people and translating this into positive action. In terms of dementia, Alzheimer’s Society, the Dementia Action Alliance, the National Care Forum and ODL all have focused strands of work to identify specific areas in which practice could be improved.

This work is still in progress, but the idea is that there will be some action areas which might be taken forward, for example in positive publicity initiatives, staff training and support for LGBT+ people who are affected by dementia.

With over 1,600 members, ODL is the largest organisation providing a wide range of services and support to the older LGBT+ community in the UK. Its monthly afternoon Rainbow Memory Café is well-attended by LGBT+ people with dementia, their partners and friends, as well as people with concerns about memory loss and cognitive decline.

One of the gay men caring for his partner with dementia said at the first meeting he had a huge sense of relief and feeling as if he had ‘come home’ in the group without having to explain himself as he might in a generic dementia support group. Another Rainbow Café has recently been launched in Brighton.

There is still work to be done in reaching and including older trans people, who are often more immediately visibily identifiable as trans and so can face even more prejudice and ignorance.
More generally in health and social care services, there is an increasing interest in how care providers might positively identify and prove themselves as an inclusive and welcoming service to older LGBT+ people.

ODL has just started to pilot a Pride in Care Quality Standard, which would enable services to sign up to implementing a range of clearly identified steps to ensure they were LGBT+ aware and inclusive.
Once these steps have been taken, the service will then be assessed by trained ODL ambassadors and if successful, given a quality assurance certificate which will be monitored and renewed annually.

Be proactive

The starting point, as with any change initiative, is an inspiring manager in any care service who has a genuine interest in making sure that any trans, lesbian, gay or bisexual person who contacts their service will feel safe and comfortable. They cannot just assume this will happen as they need to ensure their whole staff team is proactive and committed, not just ‘tolerant’.

This is starting to happen, and it was particularly heartening at the ODL LGBT+ Rainbow Café consultation event last year to meet so many heterosexual colleagues keen to show their support.
At the end of the day, it must surely be ‘everybody’s business’ to get this right?

*The term LGBT+ is used to recognise inclusion of those who are not exclusively lesbian, gay, bisexual, or transgender, encompassing spectrums of sexuality and gender.

Sally Knocker is Rainbow Memory Café Coordinator at Opening Doors London and Consultant Trainer at Dementia Care Matters. Email: sally@dementiacarematters.com Twitter: @SallyKnocker

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