“For many accessing the aged care system it is a daunting and frightening process at a time when you are even more vulnerable. A life time of exclusion because of diverse characteristics and life experiences makes it hard to trust this system. [This] is recognising that diversity is everyday business not an “add on”. It is about making the aged care system culturally safe.”

Samantha Edmonds, National Project Manager – Silver Rainbow, National LGBTI Health Alliance.

Discrimination and prejudice on the bounds of gender and sexuality have long been a reality for the older LGBTI community, who have only now seen Australia and other countries begin to acknowledge their gender identity, intersex status or sexual orientation in the provision of health care, workplaces, the legal system, religious institutions and greater society.

Formerly exposed to discrimination and harassment, their medical care was traditionally pathologised – being viewed as medically or psychologically abnormal, and requiring treatment to ‘fix’ the problem such as religious conversion therapy, medication, electroconvulsive therapy and sterilisation or normative surgery on intersex children.

As such, many of those who have lived through decades of societal and institutional discrimination against their LGBTI status experience fear in accessing aged care services.

Beyond Blue has provided statistics from studies done on aged care services for LGBTI people:

• An extensive 2011 report from the UK titled Lesbian, Gay and Bisexual People in Later Life but often referred to as the Stonewall report found that LGB people fear discrimination in aged care. This means that they often don’t access services or are reluctant to do so, and if they do, they don’t feel comfortable disclosing their sexuality.
• A US study (Fredriksen-Goldsen et al. 2011) found that more than 1 in 10 participants who identified as LGBT reported being denied care or being provided with inferior care because of their sexuality or sexual orientation.
• An Australian study titled My People which interviewed older LGBT people about their experiences of aged care in Australia gave various examples of discrimination such as older men being denied physical contact because staff believed that all gay men have HIV and they could catch it if they made physical contact.

Countless mental health resources supporting older LGBTI people from across the world report on the fear that patients live in that their identity or status will expose them to discrimination or loss within the service environment.

Coupled with the higher rates of depression and anxiety that LGBTI people experience (twice as much as the cisgender population), this data has led to the rollout of the National LGBTI Ageing & Aged Care Strategy by the Australian Government and the LGBTI community sector. It is the first of its kind in the world.

The Rainbow Tick is a LGBTI-inclusive service accreditation system measuring six core competencies required for an organisation to be listed on the national register of LGBTI accredited organisations.

The National LGBTI Health Alliance provides training on meeting the needs of older LGBTI people through the Silver Rainbow program. The Alliance works with service providers, policy makers, LGBTI people and the general community in education and policy work to further better health outcomes through inclusive practice.

The Opal Institute promotes the sexual rights of older people, through care provider education, research and awareness activities through the media.

ACON runs the Pride in Health and Wellbeing program, targeted to service providers at the beginning of their LGBTI inclusion journey.

In supporting patients choosing their care options, a range of guides are available at www.10questions.org.au which allow users to consider the questions they might like to ask when visiting residential aged care facilities. The LGBTI guide includes questions such as whether staff LGBTI inclusivity is practised; if events such as Mardi Gras are celebrated; or if patients are supported in maintaining their affirmed gender identity. Some aged care providers are upfront about their LGBTI policy and services.

Guide to LGBTI inclusive service from ACON:

• Don’t assume all service users are heterosexual and/or cisgender.
• Be aware the unique of social and emotional issues that LGBTI people face.
• Respond supportively when someone discloses they’re LGBTI.
• Challenge homophobia and transphobia and ensure your policies reflect this.
• Demonstrate that your practice is inclusive of LGBTI people.
• Develop appropriate and inclusive referral pathways for LGBTI clients.