Have you heard this one? When people get dementia, they “revert” to being straight.

It’s a homophobic myth, but it still gets trotted out by some aged care providers, say the first researchers to study the experiences of Australian lesbian, gay and transgender people with dementia.

Older people of diverse sexual orientation and gender identity should be able to access aged care services that are responsive and respectful of their care needs and consider their history and any experiences of discrimination and marginalization.

Given their experiences of discrimination and limited recognition of their needs by service providers, people who identify as lesbian, gay, bisexual, transgender and/or intersex (LGBTI) have been identified as having special needs for aged care.

Many still carry emotional scars from an era when revealing their sexual orientation or gender identity could mean arrest, imprisonment, psychiatric incarceration and attempted “cure” treatments.

But some people entering aged care also find their circumstances offer a newfound freedom, including one man who only felt safe to come out when he entered aged care, he told researchers.

One patient transitioned from male to female 40 years earlier, but was forced by her children to enter a residential aged care facility as a man or run the risk of never seeing her grandchildren again. It was actually her carers who realised what had happened and were unsure what to do.

“Your sexual orientation or gender identity is more likely to be influenced by homophobic or transphobic ideas from family or the care setting, than dementia”, Dr Barrett says.

“But you do become reliant, and this could change your opportunity to have your relationship or gender identity recognised.” Older LGBTI people should prepare their powers of attorney well in advance, and clearly document their gender preferences, she says.

It is noteworthy to mention that the lack of appropriate questions pertaining to gender and sexual identity in most national or state surveys makes it difficult to estimate the number of LGBT individuals and their health care needs. LGBT youth face a fear of coming out and discrimination because of their sexual orientation, gender identity, and gender expression.

What is diversity in the context of aged care reforms and the Aged Care
One of the key goals is ensuring diversity is catered for in the new system. Older people display the same diversity of characteristics and life experiences as the broader population. Older people with diverse needs, characteristics and life experiences can share the experience of being part of a group or multiple groups that may have experienced exclusion, discrimination and stigma during their lives.

However, they are not a homogenous group. There are some similarities within groups in relation to the barriers and difficulties they may face in accessing the aged care system but additionally, each person may have specific social, cultural, linguistic, religious, spiritual, psychological, medical, and care needs. In addition to common challenges, social differences often overlap as people identify with more than one characteristic, exacerbating already complex issues. There is no limit to the number of different characteristics a person holds and no two people’s lived experiences are the same.

Older people display the same diversity as the broader population across one or more attributes including race, religion, language, gender, sexuality, health, economic status and/or geographic location. Available information from the National Aged Care Alliance shows that:

  • There are over 100,000 older people from Aboriginal and Torres Strait Islander communities’ in Australia
  • Over 36 per cent of older Australians were born outside of Australia and one in three older people were born in a non-English speaking country
  • More than one in ten people have diverse sexual orientation, gender identity or intersex characteristics
  • Almost 15,000 older Australians experience homelessness or are at risk of homelessness
  • One in ten Australians over sixty-five lives with cognitive impairment and dementia More than 80% of older Australians report an affiliation to a religion of some kind
  • Over half of older Australians experience some sort of disability.
  • More than one in ten older Australians live in regional, rural and remote communities
  • One in twelve older Australians experience significant financial or social disadvantage
  • One in twelve older Australians have four or more chronic diseases

While a range of initiatives have been put in place to better meet the aged care needs of LGBTI elders, the strategy informs how the Australian Government supports the aged care sector to deliver care that is sensitive to and inclusive of the needs of LGBTI elders, their families and carers.

Resources
Download or print the Aged care for LGBTI elders: Getting started with My Aged Care factsheet.

Download or print the Finding LGBTI Inclusive Home Care Packages on the Service Finder factsheet.

Source: Aged Care Diversity Framework on the 31/5/18 from https://agedcare.health.gov.au/sites/g/files/net1426/f/documents/12_2017/aged_care_diversity_framework.pdf
Source: The Age. on the 31/5/18 from https://www.theage.com.au/national/victoria/lgbti-people-with-dementia-struggle-to-find-welcoming-aged-care-research-finds-20150922-gjs831.html
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