LGBTIQ+ Awareness in Aged Care
Published: 17 March 2024
Published: 17 March 2024
Older Australians who identify within the LGBTIQ+ community have witnessed significant social and cultural transformation over the span of their lives.
Australia’s progress on LGBTIQ+ rights has been slow and painful for the community:
(Wang 2020)
It is, therefore, safe to assume that LGBTIQ+ older adults who are ‘out’ will have experienced first-hand stigma, discrimination, criminalisation, rejection, and isolation.
The stigma around being LGBTIQ+ is still prevalent, including in the healthcare sector. For example, the Private Lives 3 survey in 2020 found that only 57.5% of LGBTIQ+ people who accessed a mainstream medical clinic felt their sexual orientation was very or extremely respected, while only 33.6% felt their gender identity was very or extremely respected (Hill et al. 2021).
Furthermore, the same survey conducted in 2012 found that roughly 34% of people who identify as LGBTIQ+ reported hiding their sexual and/or gender identity when accessing services (Leonard et al. 2012).
Unfortunately, due to discrimination, many older LGBTIQ+ Australians remain invisible in the healthcare sector and the broader community (Duncan et al. 2019).
While we may not know the exact number of older LGBTIQ+ people living in Australia, we do know that older LGBTIQ+ Australians are more likely to need aged care services because many do not have children or support structures (Duncan et al. 2019).
So, how can we support older LGBTIQ+ Australians in the aged care system?
Note: While LGBTIQ+ awareness is crucial in all healthcare sectors, this article focuses specifically on LGBTIQ+ care in an aged care context.
Statistics from the National LGBTI Health Alliance are an annual reminder that LGBTIQ+ people report poorer mental health conditions and have a higher rate of suicide than non-LGBTIQ+ Australians, with trans people continuously fairing the worst in these reports.
The most recent survey on sexual orientation in Australia found that 11 in 100 Australians may have a diverse sexual orientation, sex or gender identity (AHRC 2015).
The same survey found that gay, lesbian, bisexual and transgender people are three times more likely to experience depression than their non-LGBTIQ+ peers (AHRC 2015).
The rise of LGBTIQ+ health services, including queer-specific counselling, psychology and sexual health clinics, could signal either a knowledge gap in traditional health services; general distrust or bad experiences with traditional health services; or simply that the community demands greater attention to this facet of their identity.
The Sex Discrimination Act 1984 states that it is unlawful to discriminate on the basis of a person’s sexual orientation, gender identity or because they are intersex (AHRC 2015).
Despite this legislation and a perceived growing acceptance of the community, a 2019 news report released by The Feed shone light on the discrimination faced by the LGBTIQ+ population in aged care settings (Duncan 2019).
This article provides practical steps that care workers and their facilities can take to provide LGBTIQ+ residents with the care and respect they deserve.
The Aged Care Quality Standards state that older people’s sexual preferences and gender expressions should be recognised and respected. This is specified in Standard 1: The Person - Outcome 1.1: Person-centred care (Action 1.1.3).
The following are terms associated with the LGBTIQ+ community.
(Note: This glossary is to be considered foundational, and it provides the minimum knowledge needed to interact meaningfully with the community. This should be the starting point for your own further research.)
Term | Definition |
---|---|
Ally | A (usually) heterosexual and/or cisgendered person who actively supports the LGBTIQ+ community. |
Androgyny | Deliberately presenting or displaying characteristics typically associated with both masculinity and femininity. An androgynous person’s gender may appear ambiguous. |
Asexual | A term used to describe someone who experiences little or no sexual attraction to other people. |
Cisgender | A term used to describe someone whose gender identity aligns with the gender they were assigned at birth. |
Drag | The performance of one or more genders in a theatrical manner. |
Heteronormativity | The pervasive, society-wide assumption that heterosexuality is the default state of being and that heterosexuality is superior to other sexual orientations. |
Gender dysphoria | The experience of distress or discomfort due to a disconnect between a person’s gender assigned at birth and their gender identity. |
Gender pronouns | The words we use to refer to someone's gender in conversation, for example, he/him and she/her. Some people prefer gender-neutral pronouns such as they/them or ze/zir. |
FTM | A term used to describe a person who was assigned a female gender at birth and who now identifies as male, lives as male or identifies as masculine. |
LGBTIQ+ | A term used to identify the entire community. It stands for Lesbian, Gay, Bisexual, Trans, Queer/Questioning, Intersex and Asexual. Other terms used to refer to the community may include LGBTIQ+, LGBT, gay community or queer community. |
MTF | A term used to describe a person who was assigned a male gender at birth and who now identifies as female, lives as female or identifies as feminine. |
Non-binary | A term used by people whose gender identity does not fit comfortably within the bounds of male or female. |
Passing | The situation in which a trans person is perceived as the gender they identity as. |
Queer | A term to describe an identity which, in essence, breaks binaries and defies heteronormativity. This term was originally a derogatory slur but has now been reclaimed and celebrated by some members of the LGBTIQ+ community. It is sometimes used as an umbrella term to describe diverse genders or sexualities. |
Sexual orientation / Sex / Gender identity | Different, distinct aspects of identity that are not necessarily connected. For example, a trans person could be heterosexual, homosexual, bisexual or anywhere else on the spectrum. |
Trans | An umbrella term to describe people whose gender is not the same as, or does not sit comfortably with, the sex they were assigned at birth. |
(Dastagir 2022; NYU 2022; Stonewall 2024; Amnesty International 2023; Rosenstreich 2013; Vic.gov.au 2023; The Center 2023)
In February 2019, the Australian Government’s Department of Health released Actions to Support LGBTI Elders: a Guide for Aged Care Providers - a guide for aged care providers on how to care for LGBTIQ+ older people.
The guide is an action plan intended to be used by aged care service providers to better understand how they can advocate for and support LGBTIQ+ older people (DoH 2019).
The following six outcomes originate from the Aged Care Diversity Framework 2017 and are applied in the guide to the needs of LGBTIQ+ people. They are intended to provide you with a foundational understanding of the Framework, and it is strongly recommended that you commence further reading upon finishing this article.
While this article provides examples of how to meet these outcomes, as an ally, you are encouraged to go beyond these suggestions and think creatively of ways to support the LGBTIQ+ community.
The outcomes include:
Within your facility, LGBTIQ+ people have easily accessible information about the aged care system and services, and this information assists them in practising choice and control over the care they receive.
An example of meeting this outcome is providing LGBTIQ+ care information in an appropriate format (such as online, hardcopy, newsletter or verbal) and in a way the resident can easily understand.
(DoH 2019)
LGBTIQ+ people are active partners in the planning and implementation of the aged care system.
For example: older people are engaged in a way that is culturally safe and supportive; they are enabled to participate as active partners and can express their individual needs.
(DoH 2019)
All LGBTIQ+ older people living in rural, remote, and metropolitan areas in Australia can access aged care services and supports appropriate to their diverse characteristics and life experiences.
For example: your facility collaborates with stakeholders to identify and overcome geographical barriers in accessing the healthcare system.
(DoH 2019)
A proactive and flexible aged care system that meets the needs of existing and emerging diverse groups, requiring a diverse aged care workforce.
For example: engaging with the community and stakeholders to identify emerging needs and how service provision models can be shaped to embrace those needs.
(DoH 2019)
Services and facilities effectively meet the specific needs of LGBTIQ+ older people with diverse characteristics and life experiences, as well as their families, carers, and representatives, in a way that is respectful and inclusive.
For example: develop tools, training, and information that support the provision of care that takes into account diverse characteristics and life experiences.
(DoH 2019)
LGBTIQ+ older people are able to access high-quality and safe aged care services and supports that meet their needs, irrespective of their personal, social, or economic circumstances.
For example: provide inclusive service models to meet the needs and requirements of the most vulnerable and work with stakeholders to ensure that all of these needs are met.
(DoH 2019)
If you are interacting with a person within the LGBTIQ+ community and you want to know how they identify, ask them. Start by asking for their pronouns and proceed to listen to them openly.
Avoid making assumptions, asking invasive questions, or interrupting to draw connections to your own experience.
We are only now getting a picture of aged care facilities from an LGBTIQ+ perspective - the Royal Commission into Aged Care Quality and Safety was established in October 2018 as a response to thousands of submissions from older Australians, their families, health professionals, and aged care providers (Duncan et al. 2019).
See The Feed’s video on the abuse faced by LGBTIQ+ older adults in residential aged care:
Question 1 of 3
Educating staff of the specific characteristics of common intersex variations is a step toward meeting: