News outlet PinkNews held its first annual Ageing Summit yesterday 14th May, welcoming Elder as the care company championing LGBT+ rights.
The summit was the first of its kind in the UK, and focused on a range of issues facing the elderly LGBT+ community, bringing together academics, regulators and business leaders.
Elder CEO, Pete Dowds, participated in a panel discussion focusing on social care. Central to the discussion was the inherent unsuitability of the care home for older members of the LGBT+ community.
As a live-in care provider, Elder has fought to draw attention to the issues older LGBT+ individuals face – being forced to uproot their lives and move into a care setting where, as Independent Age says: ‘homophobia is alive and kicking’.
Care facilities are often built from a heteronormative outlook, which can lead to LGBT+ adults concealing or avoiding disclosure of their sexual identity for fear of discrimination. This is exacerbated by the fact many have already spent much of their early adult years in social, political and medical environments in which homosexuality was illegal or considered a mental illness.
After participating in the social care panel discuss at the summit, Elder CEO and co-founder, Pete Dowds commented: ‘As a sector, we need to do a lot more on LGBT+ rights. It’s a fundamental question of equality that has been largely unreported, and unaddressed. for too long. Credit to PinkNews for starting the debate.
‘This summit has made me realise we need to be closer to the recent struggle of LGBT+ history. That carers need to be provided with the practical skills to understand the nuances of caring for someone from the LGBT+ community. And that it’s completely apparent the care home sector, as it stands, is not fit to serve the whole of society. At Elder, we’re looking to provide an inclusive alternative that gives people, from all walks of life, the support they deserve in their later years. This summit gives us, as a business, real impetus to zero-in on LGBT+ rights.’
The total population of people over the age of 55 living in the UK is 17,421,000 (based on 2009 mid-year statistics) and 5–7% of this are LGBT+, between 871,045 and 1,219,470 people (roughly equivalent to the population of Birmingham).
Elderly LGBT+ people are much more likely to live alone, suffer from loneliness, which leads to poor health decisions such as heavy drinking and smoking. A shocking 33% of over 65 LGBT+ drink every day. Both are becoming increasingly linked to dementia.
Older transgender adults are at higher risk of poor physical health, disability, depression, and perceived stress. Evidence suggests that older LGBT+s are more likely to live alone in old age, with fewer links with younger generations, thereby increasing their risk of isolation.
The UK care home sector is struggling. That has a knock-on effect on its ability to deliver specialised care, suitable for LGBT+ people. As the report highlights, the UK is struggling, in contrast to other OECD countries, to provide specialist options for LGBT+ people. This failure may be symptomatic of the wider system, but it disproportionately impacts LGBT+ people.
Going into a care home
Residential care facilities are often built from a heteronormative outlook, therefore the most difficult of life transitions is made ever more difficult. Having spent much of their early adult years in social, political and medical environments in which homosexuality was illegal or considered a mental illness, some older LGBT+ adults conceal or avoid disclosing their sexual identity for fear of discrimination.
Being closeted again
One of the issues of moving into a care home is the potential for elderly LGBT+ people to feel the need to go ‘back into the closet. On this, Pete Dowds said: ‘Imagine, you’ve lived through the most transformative period in LGBT+ history. You’ve seen the legalisation of homosexuality in ‘67, you’ve seen the repeal of section 28 in the early 2000s (2003), you’ve seen civil partnerships and then the legalisation of gay marriage. All of this makes you happy, out and confident in your own life.
‘Then you get moved into a care home. Conservative attitudes and cohabited rooms, along with uncomfortable introductory conversations. It makes you contract, look inwards and live out those precious final years of your life back in the closet.‘
Having to come out again
Alternatively, there’s the option of coming out again. ‘Coming out’ is an ongoing, dynamic process. Every unfamiliar person and place (such as a hospital or nursing home) demands yet another decision about disclosure. While this may be completely fine for a select few, this is likely to only exacerbate feelings of anxiety and depression felt by LGBT+ people of all ages. We know, for example, that half of LGBT+ people (52%) said they’ve experienced depression in the last year, with 61% experiencing anxiety. Why should people we know are more vulnerable have their mental health subjected to the potentially traumatic experience of uprooting their life?
And that’s uprooting their life to face the homophobia that Independent Age says ‘alive and kicking in the care industry’. As the report notes, and Stonewall identified, homophobia is much more prevalent among the elderly. This makes facing a whole residential home of new people even more nerve-wracking.
Person-centred care provision is the future. Whether in an institution or in the home, it’s the direction the sector is travelling. For our Elder Magazine, we recently spoke with Professor Brendan McCormac, Head of the Division of Nursing and Associate Director at the Centre for Person-centred Practice Research at QMU.
He defined person-centred practice simply: ‘It’s a way of practising, or engaging with service users that is focused on their beliefs and values – and I always add into that their wants, needs, hopes and dreams – in deciding on care, and deciding on how best to deliver care.
It’s a relationship-based, partnership model where the person is at the centre of the decision making, and the elements of the system fit around that, rather than the other way around.
’1. Embrace new models of care – Live-in care is an important part of the mix to transition to a more person-centric approach. Obviously, as a live-in care company, Elder is always going to be proponents of live-in care. We’re very happy to hear the mood music from government, with hints that a ‘big shift’ towards home care is going to be included in the long-awaited forthcoming green paper. However, for LGBT+ people, it’s not a silver bullet, and there are still many challenges associated with it.
2- Teach, train and develop inclusivity – Staff need to be aware of the particular issues facing LGBT+ people. As an introductory agency, Elder is not permitted under Care Quality Commission (CQC) regulations to provide training. We only work with care professionals who have one years’ experience, so have already done their training. It’s clear that an understanding of the history of LGBT+ people living in the mid-twentieth century would be an important addition to social care teaching, training and development, working towards person-centred care. But so are the more practical elements, such specific care requirements of post-operative trans people. It will need a collaborative public affairs effort from a group of key industry, academic and activist stakeholders.
3. Create a positive workforce – As the National Audit Office (NAO) has identified, staff turnover is unacceptably high. That impacts LGBT+-friendly care provision. As the report notes, without a positive, happy workforce, we’ll struggle to engage care professionals to be open minded around the issue. Staff turnover is still too high, at 28% in 2017. Pay across the sector is still too low, with the NAO finding half of care workers in England were paid £14,625 or below per year. This is while staff are working long hours in trying conditions. The result is they feel under-valued and less engaged in learning best practice. Ultimately that can lead to closed minds, and less experienced staff.