Transcript LGBT Aging: The Do*s and Don*ts of Working with Older LGBT People

LGBT Aging:The
Do’s and Don’ts of
Working with Older
LGBT People
Weston Donaldson, Ph.D.
OBJECTIVES
Increase awareness of issues that are
important for older LGBT people
 Increase knowledge of the unique life
experiences and needs of older LGBT
people
 Provide recommendations for ways to be
sensitive and supportive of older LGBT
people.

Describe each of these individuals
with 3 to 5 words or phrases.
What are their personalities?
 What do they do?
 How do they generally feel?
 What is their relationship history?
 What is their current relationship status?
 Who cares for them when they’re sick?
 Who do they rely on for support?

Demographics of Older Adults

Population Projections:
◦ 2030: 1 in 5 people in the US will be 65 or
older
◦ 2-7 million LGBT older adults in the US by
2030
Case Example

Maria is a 71 year-old Latina transgender woman who is
admitted to a nursing home. She is a Vietnam-era Veteran
who served in the Army for 3 years. Maria was previously
married, but divorced 15 years ago. She has three
children, two of whom live out of state. Currently, she
lives with Silvia, her partner of 5 years. Prior to admission,
Silvia told facility staff that Maria has had more trouble
remembering things, and has needed more assistance
with paying bills, cooking, and taking her medications
correctly. She had been recently hospitalized following
two consecutive falls at home, with Maria complaining of
dizziness and confusion. Maria is generally compliant,
although she tends to be anxious, which results in her
being irritable with staff. Silvia visits periodically but
appears unsure how to interact with staff in relation to
Maria’s care.
Sexual
Identity/Behavior/Orientation

Sexual Orientation
◦ Whom we are innately attracted to, and with
whom we innately desire to form intimate
relationships

Sexual Behavior
◦ Whom you have sex with and how

Sexual Identity
◦ How you identify based on your orientation OR
behavior OR cultural expectations
◦ Your personal sense of yourself as a sexual being
Gender Identity

Each person has a gender identity
◦ “Gender” defined as ways that a person
enacts their sense of gender along the
spectrum of masculinity and femininity
◦ Transgender / Gender non-Conforming /
Gender-Variant / Gender Fluid
Intersecting Identities

Sexual orientation and gender identity
don’t exist alone – they intersect with
other personal characteristics, including
AGE, race, ethnicity, disability, religion,
national origin, socioeconomic class
◦ Older LGBT people may also have personal
experiences of racism, classism, discrimination
based on disability
◦ As they become older, older LGBT people
may also face AGEISM
Generational Cohort

Older adults share common life
experiences based on the time they were
born and grew up
◦ Great Depression
◦ Baby Boomers
◦ Civil Rights Movement
◦ Pre-Stonewall Generation
of LGBT people
Generational Cohort

Life experiences of sexual and gender
minority older adults may lead them to
mistrust medical and mental health
providers

Older LGBT individuals are likely to have
lived through discrimination and
victimization in their life
An “Invisible Minority”
LGBT older adults often called an
“Invisible Minority”
 Reasons for invisibility:

◦ Self-protection
◦ Internalized homophobia
◦ Fear of discrimination and violence
Resilience of Older LGBT People

Older LGBT people may have
◦ Increased resilience in the face of adversity
◦ Increased crisis competence
◦ Ability to cope with negative effects of aging,
including ageism
◦ Greater gender role flexibility
◦ Self-advocacy skills
Older LGBT Support Networks

LGBT older adults tend to rely on a
“family of choice,” which may consist of
current and former partners, friends, and
blood relatives
Older LGBT Adults in Long-Term
Care
Residents in long-term care facilities are as
diverse as the general older adult
population
 Residents come to facilities with life
histories that have been impacted by their
intersecting social and cultural identities

POP QUIZ

Due to their fear of being discriminated
against or mistreated in a nursing home,
what percentage of LGBT older adults
would go “back in the closet”?
(Johnson, Jackson, Arnette, & Johnson, 2005)
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◦
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10%
25%
33%
50%
POP QUIZ

Due to their fear of being discriminated
against or mistreated in a nursing home,
what percentage of LGBT older adults
would go “back in the closet”?
(Johnson, Jackson, Arnette, & Johnson, 2005)
◦
◦
◦
◦
10%
25%
33%
50%
What can we do?

We can “be the change we want to see in
the world” by effecting changes at each of
the following levels:
◦
◦
◦
◦
Personal
Professional
Institutional
Systemic
Personal: Attitudes Toward Older
LGBT Adults
•
•
Increase self-awareness of your own
attitudes about older adults
Ageism: Biased attitudes that disempower,
desexualize, and demean older adults
•
•
•
•
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Stereotypes
Discrimination
Jokes
Avoidance
“Elder speak” (slowing or exaggerating speech)
Infantilization (treating them like children)
Personal: Don’t Assume!
Examine homophobic / biphobic /
transphobic attitudes
 Heteronormativity: attitudes and
behaviors that privilege heterosexuality
above non-heterosexual sexualities
 Cisnormativity / Binary Gender:
assuming that individuals fall in two
discrete gender categories, and that natal
sex and gender identity always align
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Personal: Check yourself!

Staff can increase their cultural
competency with older LGBTQ residents
by examining their own attitudes and
beliefs about gender roles, gender
expression, sexuality and aging, same-sex
sexual contact, etc.
Personal: Be Aware
LGBT Older Adults have an increased risk
of:
◦ Poverty
◦ Social Isolation
◦ Decreased access to medical and mental
health care
◦ Elder Abuse
 Transgender older adults and LGB people
of color are at highest risk

Professional: Working with
Older LGBT People

Asking is the antidote to assuming:
◦ “How do you identify?”
◦ “Do you date men, women, or both?”
◦ “Who do you rely on for support right now?”

Offer cues that show an LGBT-affirming
stance
◦ “partner, significant other, or spouse”
◦ “marital status” vs “relationship status”
Professional: Working with
Older LGBT People
NEVER force someone to self-disclose –
open the door and allow them to walk in
if they so choose
 Use the person’s words instead of trying
to guess or using a word that you believe
is appropriate.
 Be trauma-sensitive, but look for
resilience

Institutional: Build a Culturally
Affirming Environment

Like many people of
minority/marginalized status, LGBT
people are typically sensitized to the
behavior of others and the environment
around them, in order to distinguish “safe
places” and “safe people.” Try the
following to indicate you are a “safe
provider” that works in an affirming
setting:
Institutional: Build a Culturally
Affirming Environment
Wearing a rainbow pin on a lanyard
 Allowing for (but not requiring) selfidentification for non-binary gender and
sexual orientation on forms
 Placing LGBT-oriented magazines or
publications in waiting areas (e.g.,
OUTFront, the Advocate)
 Posting non-discrimination policies that
include gender expression and sexual
orientation

Institutional: Build a Culturally
Affirming Environment

Displaying LGBT-affirmative symbols and
signs in office space (e.g., SafeZone,
rainbow flag)

Offer cultural competency training to staff
LGBT Cultural Competency Training
Staff desire training in LGBT cultural
competency
 LGBT cultural competency trainings with
LTC staff are effective:

(Donaldson & Vacha-Haase, 2016; Johnson & Federman, 2014)
◦ Increased knowledge, skills, and behavioral
intention to challenge discrimation
◦ Increased knowledge, skill, and positive
attitude toward LGBTQ people
◦ Increased awareness and comfort with
LGBTQ LTC residents
(Porter & Krinsky, 2014)
(Leyva, Breshears & Ringstad, 2014)
(Gendron et al., 2013)
Systemic: Advocate for LGBTAffirmative Policies
Be aware of discriminatory policies that
disproportionately impact LGBT
individuals and same-sex couples
 Become familiar with local and national
resources that are available to older
LGBT people

Summary and Conclusion
LGBT older adults have unique needs and
concerns
 Providers can be trained to be more
knowledgeable and be better skilled to
help this population
 Change must occur at multiple levels to
create settings that are LGBT-affirmative
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OLGBT Advocacy and Resources
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Services and Advocacy for GLBT Elders (SAGE)
http://www.sageusa.org/
Gen Silent:
http://stumaddux.com/GEN_SILENT.html
LGBT Aging Project:
http://www.lgbtagingproject.org/
Old Lesbians Organizing for Change (OLOC)
http://www.oloc.org/
National Resource Center on LGBT Aging:
http://www.lgbtagingcenter.org/
Transgender Aging Network: http://forgeforward.org/aging/
THANK YOU!!!!!

Contact information:
◦ Weston Donaldson, Ph.D.
◦ 303-923-6930
◦ [email protected]