The rainbow connection: Making your facility LGBT friendly

Many of today’s lesbian, gay, bisexual or transgender (LGBT) seniors grew up in an era in which they had to hide their true selves. Moving into a long-term care (LTC) facility can be a particularly difficult transition for them, as they are forced to become more dependent on people who may not accept them.

There are a few LTC facilities around the country designed to welcome LGBT people, but some have struggled financially. Also, experts say that some LGBT people don’t want to choose such options because they may only be “out” to a limited number of people—for example, someone who was in a heterosexual marriage for many years and has kids, but now identifies as gay. Moving into such a facility could be seen as the equivalent of coming out completely.

For “mainstream” facilities, creating a welcoming environment and providing good care for this population is not only the right thing to do, but it can be good for business. Many LGBT people do not have children to care for them or they may be alienated from some family members. In fact, most facilities already have LGBT residents, whether they know it or not, says Tim Johnston, manager of education and training at Services and Advocacy for GLBT Elders (SAGE). 

Experts have outlined several ways that facilities can become more welcoming to the LGBT population. Many of their suggestions can be applied to any minority resident group

Staff training

As Chair of the Board of Director for the National Center for Assisted Living, Pat Giorgio gives presentations at the state and national level about the importance of staff training surrounding the LGBT issue. She stresses that the needs of aging LGBT people are mostly the same as any other aging person. “Just like anyone, they want person-centered care,” says Giorgio, who also is owner, president and CEO of Evergreen Estates, which operates three residential care communities in Cedar Rapids, Iowa. “Accept them as they are. Get to know them and their personal history and find out what their needs and concerns are. Don’t attach a label to a person and assume his or her needs will be different from a heterosexual person. We can’t make that assumption.”

Giorgio has seen people who were “out” in their younger years decide to go back “in” when entering an LTC facility because they worry about what others will think of them and whether they will be discriminated against. “It’s very sad but it’s a reality we have to recognize,” she says. “It won’t be the same for residents entering in 10 to 20 years but it is real now.”

Over time, she notes, some LGBT residents may come back “out” again as they feel respected and confident about their rights. “We need to respect their right to confidentiality,” she says.

Managers at LTC facilities need to make it clear to the staff that if they have any beliefs that conflict with their ability to provide respectful care; they need to check their biases at the door or leave, according to Giorgio. “We do not tolerate any form of discrimination.”

SAGE offers resources for staff training, and is available to consult with LTC organizations on becoming LGBT friendly. “A lot of care providers want to do the right thing and create a welcoming environment, but they don’t necessarily have the resources or experience to do it,” Johnston says. “We can help.” For example, some people are afraid they will use improper words with LGBT people. Training can help them learn preferred terminology (see info box).

Put out the welcome mat

Johnston encourages facilities to be proactive about letting LGBT residents know they are welcome. “[Facilities] should offer explicit messages to communicate that it is a place where people can openly identify as LGBT,” he says. These would include using images of same-sex couples in advertisements or on the website. Display prominently a policy stating that it is a nondiscriminatory facility, such as a sign in a lobby or a statement on its website.

Bruce Williams, a former executive director of a continuing care retirement community in Texas, now lives in Florida and works for the Pride Center, an organization that seeks to empower the LGBT community, has witnessed facilities that did not welcome prospective LGBT residents. Six years ago, on behalf of the Pride Center, he reached out to many area facilities to see if they were welcoming to potential LGBT residents. The results were disappointing. “I got so many negative reactions,” he recalls. “Some didn’t want us to visit their facility. Many others hung up on me.”

Williams believes those attitudes have changed dramatically in recent years. For example, in his work for the Pride Center, he organizes a health fair designed for companies to tell the local LGBT community about their services—from home care to hospice. The health fair sells out annually. Many of those same companies also sponsor weekly coffee-and-conversation events for local LGBT seniors. The events started with about 25 attendees, but now up to 200 people attend.

“I want to help people find facilities that will provide them good care with respect,” Williams says. “It is not appropriate for people in need of long-term care to have to fight this battle. We need to fight it for them.”

Specialized housing

For some LGBT seniors, choosing a facility that is designed especially for them is a good fit. Gary King, RN, is the executive director of Stonewall Gardens in Palm Springs, Calif. Stonewall Gardens, which has 24 units and opened in late 2014, was designed to be welcoming to LGBT people. “We are open to everyone. I don’t ask people what their orientation is. Frankly, it is not my business,” he says. “I just explain who we cater to and leave it at that.”

King sees specialized housing like his being a growing market as the baby boomers age. “We offer understanding of their lifestyles and their needs, and compassion without judgment,” he says.

The aging LGBT’s community biggest need is acceptance. “One of my residents recently told me it’s such a relief to move into a facility where every single female in the place isn’t pouncing on him,” King says. “The males are really outnumbered out there.”

Other welcoming advice

Language to avoid

Tim Johnston of SAGE provided several examples of preferred terminology when interacting with the LGBT population:

  • Using the word “transgender” as a noun is disrespectful. It should only be used as an adjective, i.e., “a transgender man.”
  • While younger LGBT people may embrace the word “queer,” older people are likely to associate it with taunting from their youth.
  • “Homosexual” may seem like a neutral word, but to older people who remember when it was considered a diagnosis of a mental health disorder, it can be unwelcome. Instead, Johnston counsels people to use words such as gay, lesbian or bisexual.

Legal issues. Do not assume a blood relative is the right person to make medical decisions for any resident. Since many of today’s LGBT seniors came out later in life, they may have a spouse/former spouse and children, but would prefer to have their key decisions made by a current partner. Since they may not be legally married to that person, encourage them to spell out these desires through a power of attorney or other documents, Johnston says. This can be particularly important if estranged family members are reappearing at the end of a person’s life and expressing an interest in reconciling and/or getting an inheritance.

Johnston also recommends residents be explicit about who is in charge of their burial, which can be problematic for transgender people. They may be worried that a family member who does not accept their new gender and/or name could bury them in clothing from their previous gender under a tombstone with their previous name. Clarifying who they want to make such decisions gives them peace of mind at the end of life, he says.

Cohabitation policies. Have a policy that allows consenting adults to live together—same sex or opposite-sex couples, Johnston advises. “Marriage equality is not an option everywhere. If a facility has a policy that says people must be legally married to live together, that can be discriminatory,” he explains. This can also benefit heterosexual couples who may choose not to wed because they could lose some benefits.

Handling complaints. If an LGBT resident feels like he or she is being treated poorly by the staff or other residents because of sexual orientation, his or her concerns should be given the same weight as would any other complaints—for example, a resident who feels treated poorly because of skin color. “Residents should know the staff has been trained and they do not need to fear retaliation for speaking up,” says Johnston.

Staff diversity. Having LGBT employees is a good idea. “They bring a unique perspective, which is why it's important to have a diverse staff that reflects the community you serve,” Johnston says.

Beth Thomas Hertz is a freelance writer living in the Akron, Ohio area.

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