Encouraging an LGBT-friendly, or better still, an LGBT-inclusive environment needs to be higher on the agenda in care homes, argue Dr Paul Simpson and Dr Kathryn Almack. If homes were to function more along these lines, they could work more like communities than simply places to live.
What if you had lived a life as gay, lesbian, bisexual or trans person and then in later life you needed to be looked after in a care home?
On top of concerns about moving from your home into a care home, imagine how it must feel suddenly to consider having to go back into the closet after having struggled for many years to ‘be yourself’.
A recent survey we conducted indicates that older LGB&T (gay, lesbian, bisexual and trans) people could feel constrained from disclosing their sexual orientation or gender identity to staff.
The survey – a collaborative effort between the Universities of Nottingham and Manchester – canvassed the views of 189 care home staff in England concerning their views about meeting the needs of LGB&T residents in England. The sample was predominantly middle-aged, female, white British and identified as heterosexual.
Two-thirds of respondents said they were not aware of a single resident in their care home who was openly LGB or T. This was reflected in a common refrain in the survey by care home staff along the lines of, ‘We don’t actually have any at the moment.’
This indicates that staff may not recognise LGBT individuals or even misrecognise them as heterosexual or cis-gendered (presenting as consistent with the gender into which an individual was born). The study recognizes that all residents should have the option and opportunity to disclose their sexual or gender identification but should never feel forced to disclose this information.
The survey is not all bad news. Generally, care staff attitudes were positive. Just over four-fifths of respondents (82%) said they would not feel embarrassed about discussing elderly lesbian, gay, bisexual or trans issues and 83% did not consider same-sex relationships to be wrong.
But the results show – despite the goodwill of individual care home staff – there is a great deal that care homes themselves can do to improve provision for LGBT people that meets their distinct needs over and above the usual needs for mobility, nutrition and communication.
It was common to hear the phrase ‘I/we treat everyone the same’. While well-intentioned, ironically, this reinforces rather than prevents or tackles inequality. Provision needs to be appropriately differentiated in order to meet individual needs connected with sexual or gender difference.
The main problem, it appears, is that individual goodwill and knowledge of LGBT issues is not backed up by or translated into good practice at a more strategic level within care homes.
Just under one third (30%) of respondents reported that their care home policies referred to LGBT people and the same number reported that their home encourages residents to contribute to an LGBT-friendly environment.
Only a quarter of respondents thought their home monitored residents’ sexual or gender identification and the same number considered that their home encouraged open discussion of LGBT issues.
Further, only 1 in 20 respondents (5%) indicated that their care home uses images of LGBT people in promotional literature and less than 1 in 10 (9%) of respondents said that their home makes LGBT-related literature available to LGBT residents. Similarly, only 8% of respondents considered that their care home makes efforts to work with local LGBT voluntary organizations.
We conclude that LGBT-specific training may in part be an answer to the problems identified. Indeed, almost 80% of respondents said that they had never been provided with any training in LGBT specific issues at their current work place.
However, this is not the whole story, as training needs to be part of a range of initiatives as identified above on LGBT issues that need to be made central to home’s policies and embedded in everyday care practices.
It’s important to note that our study is not intending to be negative about individual staff or care homes, as attitudes appear positive. Indeed, many care workers may be struggling heroically to meet needs or else simply may not be able to recognize people who identify as LGB or T.
That, unintentionally, is likely to force residents back into the closet and deny a lifetime of experience.