Lifetime of Discrimination Affects Care Decisions
Many LGBTQ+ older adults grew up in times when their identities were heavily stigmatized. This history of discrimination impacts their willingness to seek care later in life. Fear of discrimination in various care settings is a significant concern for many. This fear can lead to delaying care planning or concealing their identity to avoid potential hostility. Returning to the closet in later life causes emotional distress and a sense of losing one's identity.
The Manifestation of Discrimination in Care Settings
Concerns about discrimination in care settings can include:
- Reluctance to Disclose: Fear of judgment or denial of rights for partners or chosen family.
- Mistreatment and Neglect: Worry about substandard care or disrespect from staff. Transgender older adults have heightened safety concerns regarding personal care.
- Social Exclusion: Fear of being ostracized by other residents.
Social Isolation and Diminished Support Networks
Historical discrimination has also resulted in fewer traditional support networks for many LGBTQ+ older adults. They are less likely to have children who can act as caregivers and a significant number report family rejection. While chosen families are vital, they may not be legally recognized in healthcare systems. Those in rural areas may have less access to affirming care. Loneliness is a major health risk, and these factors increase isolation, leading to poorer health.
The Importance of Intersectionality
The challenges faced by LGBTQ+ older adults are often compounded by other identities, such as race or ethnicity. This intersectionality can increase health disparities and avoidance of care due to navigating multiple forms of bias.
Finding Affirming Care and Reducing Risk
Steps can be taken to find affirming care and reduce risks:
- Researching Inclusive Facilities: Look for explicit non-discrimination policies and inclusive marketing.
- Seeking Certified Providers: Identify providers with certifications in LGBTQ+ inclusive care, like those from SAGECare.
- Inquiring about Staff Training: Ask about staff education on LGBTQ+ issues.
- Advocating for Change: Support organizations like SAGE, which advocate for LGBTQ+ elders' rights. More resources are available at the SAGE Advocacy and Services website.
Comparison of Affirming vs. Non-Inclusive Care Settings
| Feature | LGBTQ+-Inclusive Care Setting | Non-Inclusive Care Setting |
|---|---|---|
| Anti-Discrimination Policy | Explicitly includes sexual orientation, gender identity, and expression. | May have no policy or a generic one that lacks specific LGBTQ+ protections. |
| Staff Training | Regular cultural competency training on LGBTQ+ history, language, and healthcare needs. | Little to no specific training on LGBTQ+ issues. |
| Environment & Culture | Visible signs of inclusivity (e.g., rainbow flag), diverse marketing, and resident-led LGBTQ+ groups. | Homogenous imagery, potentially unwelcoming or hostile social environment. |
| Partner/Family Recognition | Explicitly recognizes and includes chosen family in visitation and care planning. | May deny visitation rights to partners or exclude chosen family from decisions. |
| Intake Forms | Includes gender identity, preferred name, and pronoun fields, with inclusive relationship status options. | Standard forms that may misgender residents or fail to recognize their family structure. |
Conclusion: Fostering Safety and Dignity
The most significant concern for an older LGBTQ+ adult is the threat to their safety and dignity due to fear of discrimination in care settings. This can lead to isolation and health issues. Understanding these challenges is key to creating more welcoming environments where all older adults, including LGBTQ+ individuals, can age with respect.
