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Blog Posted in avatar   Sarah Lucas's Blog

The Forgotten Elderly in Britain

By Sarah Lucas
Posted Oct 12, 2011 in Politics
Ageing can be more difficult for lesbian, gay, bisexual and transgender (LGBT) individuals. Recent studies suggest that perceived or experienced discrimination can deter elderly LGBT people from accessing health, housing and social services that are vital in later life. As the population ages, there is a mounting need to listen to the voices of these people, and address their specific concerns.
“Older LGBTs face a number of very specific problems in terms of accessing suitable housing, healthcare, and the stress of living in a minority group”, says Dr Dylan Kneale of International Longevity Centre (ILC-UK), the UK’s leading think tank on longevity and demographic change.
The UK government estimates LGBT people comprise 5-7 per cent of the population. The Office of National Statistics projects by 2031 there will be between 1 and 1.4 million LGBT people aged 60 and over in Britain.
As is the case for all people, LGBT aged over 60 have higher need for healthcare services. LGBT additionally have specific health issues, including being more likely to suffer from mental illness and substance abuse.
However, their potentially greater need for health services is set against a lesser willingness to access the formal health system. Fear of discrimination and disclosure of their sexuality can deter older LGBT from accessing healthcare that may be vital to their wellbeing.
A significant number of older LGBT have experienced discrimination based on their sexual orientation during their lives. Those now aged over 80 were at least 35 years old when homosexuality first became legal in the UK. They were young adults in societies almost entirely hostile to them.
Discrimination carried over into the health system. Homosexuality was considered a mental illness (and in fact was only declassified as such by the World Health Organization in 1992). A substantial proportion of the older section of LGBT people may have undergone shock and aversion therapy to “cure” them. Previous bad treatment may have left some with a negative association with the healthcare system, and potentially an aversion to accessing health services provided by formal institutions.
Furthermore, for those older LGBT who do utilise the health system, the quality of care may be compromised by the “heterosexist” nature of provision of health services. A patient’s sexual orientation may be directly related to his or her health needs. Yet while healthcare providers regularly question patients directly about whether they smoke or have allergies, the onus is generally on the LGBT individual to disclose his or her sexual orientation.
“The doctor makes an assumption”, says Kneale. “Older LGBT have lived for years hiding their sexuality. Healthcare professionals assume heterosexuality”. This means that if there is not a positive environment in which the patient feels comfortable volunteering it, doctors may not be made aware of relevant information. Some LGBT people may avoid care altogether. Lesbian and bisexual women, for instance, have been shown to avoid routine care and screening (King and McKeown, 2003).
As individuals grow older, they are increasingly dependent on family for their care. According to a study by the Brookdale Center on Ageing in New York, 90 per cent of LGBT individuals are childless. 80 per cent grow old as single people, without a life partner or “significant other”. This means that LGBT are comparatively more dependent than heterosexual people on residential institutions and in-home care.
But both these alternatives to family care raise issues for eldery LGBT. A recent study (Croucher, 2008) found that, similar to heterosexual older people, older LGBT express a preference to live in their own homes for as long as possible. This desire was directly related to concerns about possible homophobic attitudes among staff and other residents in residential care institutions. Older LGBT are especially concerned about how staff and other members of a residential community might react when same-sex friends visit. They are also worried that they will be “found out” if staff see their personal objects and photos.
Elizabeth, who moved into a care home in north London five years ago, remembers feeling distressed in the lead-up to her move. “I knew the first thing the others would ask me is are you married and do you have kids. And when I said no, they’d think “you’re gay”. Then I’d have to spend all my time living with people who were judging me”.
In-home care provides an alternative to residential institutions, but LGBT may equally be worried that their carer could be homophobic. A lower proportion of older LGBT “come out” relative to the young. Some may have experienced negative consequences from revealing their sexual orientation in the past, such as rejection by family. According to the report “Aging in Equity”, conducted by LGBT Elders in America, the individual’s home “may be the only place that the elder is truly able to be out and express their gayness”. An LGBT individual may be concerned that having a carer in the home will violate the only space where he or she feels comfortable to be his or herself.
It appears there is significant room for improvement in health, housing and social care services for older LGBT. “Missing services are hard to pinpoint, the needs are difficult to quantify”, says Kneale. “But we can assume they’re pretty serious”.
One element currently lacking is residential institutions dedicated to older LGBT. A survey (Hubbard and Rossington) found that 83 per cent of 117 questioned would prefer specific accommodation for LGBT individuals.
Although she has been settled in a residential institution for five years now, Elizabeth shares the majority preference. “I would like to be in a home for gay people. Everyone here knows I’m gay, and accepts it more or less, but I’d feel more comfortable living with others like me so I didn’t have to worry all the time”. There are very few such facilities in the UK.
Currently available institutions could be improved were care providers made aware of LGBT needs. One research project (Thanet, 2008) interviewed 149 care providers in Sheltered Housing Schemes and found that 43 per cent thought they had never had an LGBT individual in their establishments and a further 25 per cent were unsure. This indicates that these establishments do not create environments where LGBT feel comfortable being open about their sexuality. In addition, the limited research that has been undertaken suggests that care providers consciously or unconsciously discriminate against LGBT residents. For instance, most would react positively to expressions of intimacy amongst older heterosexuals, but negatively to the same behaviour amongst older LGBT.
For social service provision, Direct Payments, a system whereby service users are given choice over which services they commission, has had success in empowering users to select healthcare professionals they feel they can be open with. However, many elderly people are currently not aware that such choices are available to them. It would be beneficial to reach out to older LGBT to inform them of existing opportunities under the Direct Payments system.
According to Dylan Kneale, some solutions may exist in promoting inter-generational relationships within the LGBT community. “We’ve been working at inter-generational relations between LGBT people. The older are in need of care and support, and the younger are sometimes looking for older role models. So there’s a real need to bring older and younger people together”.
Older members of the community generally feel they cannot relate to younger members.
ILC-UK and Age UK have been working in partnership to explore the role inter-generational projects could play in supporting the LGBT community. Three projects aimed to foster communication amongst older and younger members, by bringing them together to participate in a range of activities. In Leicester, for example, younger participants interviewed older participants to gather and record their personal histories.
One positive outcome of the projects was the exposure young LGBT had to older role models. Many parts of the training and practical skills were carried out by LGBT who had been successful in their career or life. For some younger members, this was the first time they had realised that being LGBT is not a barrier to success.
Contact with younger members was also beneficial to older members in the development of social skills and confidence. “It has certainly given me a lot of confidence as well, working in a group and with younger people and other older people, different gender people”, assessed one participant in the Camden project.
Given older LGBT are a large and growing demographic group that has expressed serious concerns, further work is needed to understand how their needs can best be assessed. There is very likely a need for government investment in healthcare and housing services for older LGBT. Recent cuts under the 2010 Spending Review in funding to Local Authorities, and thereby funding to services for older people, do not indicate this will happen.

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