In 2019, the National LGBTI (Lesbian, Gay, Bisexual, Transgender and Intersex) Health Alliance (the Alliance) ran a series of consultations with LGBTI elders and older people, friends, family members, allies, carers, aged care workers and representative organisations. The aim of the consultations was to collect and communicate the experiences, views and interests of LGBTI elders and older people into clearly defined issues for the attention of the Royal Commission.
We established a Royal Commission Advisory Group, made up of representatives of LGBTI communities, including older LGBTI people, which guided the development of our three submissions to the Royal Commission:
- A general submission;
- a workforce issues paper and
- one-piece scoping design of the Aged Care System.
An older gay man, aged 69, told us: “You have to assess so many things…A heterosexual person says I am going to get the care I want…I think, ‘will I get the care I need’, because I’m rainbow, or will I not?”
Access to care for older LGBTI people is impacted by experiences specific to their sexual orientation, gender diversity and/or variations in sex characteristics. Older LGBTI people have lived through a time of severe prejudice and stigmatisation, criminalisation, the HIV/AIDs epidemic, and some continue to experience systemic violence and abuse on a daily basis.
Older LGBTI people tell us that they have faced discrimination when accessing employment, housing, social welfare, basic health and reproductive services. Access to these services is exacerbated by widespread isolation, resulting in a much-reduced social capacity. LGBTI older people are often at risk of being excluded from participating in civic, political, social, cultural and community building activities, as they have been rejected by family and have lost community connection.
Exclusion from religious institutions, health providers, businesses, government, support agencies, faith, LGBTI communities, families, friends, and individuals has resulted in a tendency for older LGBTI people to remain in, or return to, the closet. They may be reluctant to even reveal their sexual orientation, sex or gender identity, and reluctant to make complaints when they experience prejudice or discrimination.
Older LGBTI people told us that aged care services do not often feel safe to access. We heard of recurring experiences including refused service, denied visitation, being prevented from displaying pictures of partners and significant others, aged care services preventing partners from participating in decision making about care, a lack of compassion after the death of same-sex partners, breaches of privacy, disrespecting a person’s wish to dress according to their gender, and daily micro aggressions including regular, casual and unchallenged negative remarks.
It’s not enough to say, “We treat everyone the same”. Treating everybody exactly the same undermines person-centred care. The needs of older LGBTI people are left unmet. Tolerance is not best practice.
The celebration of diversity must replace the rhetoric of ‘equal treatment’, which denies the reality of unequal access experienced by many in our ageing community. Our Silver Rainbow training for the aged care sector workforce and the Rainbow Tick accreditation are ways to work towards ensuring a safe, welcoming and celebratory environment for older LGBTI people accessing residential and home based aged care.Our recommendations to the Aged Care Royal Commission included making it a requirement for specific LGBTI training across the aged care sector, the primary care workforce, and auxiliary services; the development of policies and processes to ensure the inclusion of LGBTI people; robust complaint frameworks; an independent visitors scheme; the implementation of navigator systems to facilitate improved access and protections for LGBTI staff in aged care.
We presented at the special hearing that focused on diversity in aged care. We emphasised the need to shift the model of the aged care system itself, rather than delivering add-ons and additions. This will directly facilitate inclusive practice, delivery and access for the diverse spectrum of needs that the ageing community requires.
In October 2019 the Aged Care Royal Commission released its Interim Report, titled “Neglect”. The collective experience of many LGBTI elders and older people would confirm this impression of aged care services. Commissioners identified immediate action needs to be taken to provide more Home Care Packages to reduce waiting lists for higher-level care at home. Again, this raises issues specific to the LGBTI experience. The report also identified significant over-reliance on chemical restraint in aged care.
The Alliance is now embarking on a new round of consultations. We will produce submissions to address the interim report, and to review any gaps in the work we have done so far. We will be travelling around the country, prioritising LGBTI elders and older people in regional areas, and consulting separately with lesbian, gay, bisexual, transgender and intersex groups. We will be speaking specifically with First Nations people to reflect their experience, as well as people with a disability and those living with dementia.
Standard 1 of the National Aged Care Quality Standards emphasises consumer dignity, agency and choice. “I am treated with dignity and respect and can maintain my identity. I can make informed choices about my care and services and live the life I choose.” This holds the promise of positive change for all LGBTI older people who use aged care services. We hope the outcome of the Royal Commission will deliver on this promise.
We need you:
We need your views! Please come and tell us what you think about aged care. The National LGBTI Heath Alliance is collecting community views about aged care services to include in submissions to the Aged Care Royal Commission. We invite LGBTI older people, their family, friends and carers and any aged care workers to a series of consultation sessions.
General information is available here https://lgbtihealth.org.au/resources/national-lgbti-health-alliance-begins-second-round-of-consultations-about-aged-care-services/
If you can’t make it in person, you can contribute here via our surveys:
For Bisexual elders: https://www.surveymonkey.com/r/RCBisexual
For older LGBTI people: https://www.surveymonkey.com/r/RoyalCommissiongeneral
Tasmania April 7 – Working it out
Shepperton April 3 – GVPS
Just in case you are talking with partners, members or community people, here’s our program of consultations:
26 February – SA-COTA – general consultation – completed
9 March. NSW -ACON – general consultation (Teresa and Daniel)
9 March. NSW – ACON – Gay men’s consultation (Daniel and Leon)
11-18 March WA, Perth – Umbrella – CVS interviews and general consultation (Health)
19 March ACT – AIDS Action, Canberra – general consultation (Heath and Teresa)
23-27 March QLD – QuAC, Brisbane – CVS interviews and general consultation (Heath)
30 March NSW – Sydney – Aboriginal and Torres Strait Islander consultation (via BLAQ) (Teresa)
30 March NSW ACON – CVS interviews (Heath)
3 April VIC – Shepperton – general consult (Teresa and Lucy)
6 and 9 April TAS CVS interviews (Heath)
7 April TAS Hobart– general consultation (Heath)
14-16 April NSW ACON CVS interviews (Heath)
20-24 April VIC – switchboard – CVS interviews (Heath)