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July 10, 2013

LGBT Senior Living: Challenges and Change in Nursing Home Settings

Written by Anila S. Venkat, this post was originally featured on the ElderBranch blog. ElderBranch provides unbiased information on senior care providers. 

BlogpostlivingfacilitiesAs described in ElderBranch’s initial piece on LGBT senior living, elder care facilities and other health care settings are often unwelcoming towards LGBT older adults or insensitive to their needs and circumstances.

As a result, LGBT elders generally tend to delay seeking health care for fear of discrimination and mistreatment. At the same time, they are less likely to rely on family members for caregiving for a variety of reasons. Unfortunately, together, this may lead to LGBT older adults needing institutional care more frequently, or sooner in their lifetimes, as they may find that their health deteriorates more rapidly.

ElderBranch interviewed Hilary Meyer and Aaron Tax of Services & Advocacy for GLBT Elders (SAGE) to explore this issue and discuss SAGE advocacy efforts aimed at encouraging system-wide change.

Hostile Health Care Environments

In its report, LGBT Older Adults and Inhospitable Health Care Environments, SAGE details how health care settings are often challenging environments for LGBT elders. These seniors may face outright discrimination, or it may be that the staff in these settings is not trained to deal with this population of elders.

Though some health care environments are starting to change, the scars of previous negative experiences leave many seniors reluctant to pursue care unless absolutely necessary. In fact, the SAGE report quotes a 2006 study that found that less than half of lesbian and gay Baby Boomers were strongly confident that health care professionals would treat them with dignity and respect.

However, in delaying the pursuit of health care, LGBT older adults often find themselves in a position where their health deteriorates more suddenly and sooner than expected, and then they end up requiring institutional care – such as nursing home care.

Challenges in Nursing Home Settings

In nursing home settings, LGBT seniors often face discrimination not only from staff members, but also from other residents and residents’ family members. Hostility from a variety of angles can lead to LGBT elders keeping to themselves and limiting interaction with others.

Staff members have been known to deny same-sex partner visitations, prevent same-sex couples from sharing rooms and even refuse the participation of a same-sex partner in the medical decision-making of the resident.

When faced with harassment by other residents and their family members, nursing homes are often ill-equipped to confront these situations. Staff members sometimes react by isolating the LGBT individual – which can be devastating for that resident when he or she is already withdrawn and isolated socially.

Effecting Change – SAGE Advocacy

SAGE is very deeply engaged in advocacy efforts to support the needs of LGBT older adults. Though it is difficult to target long-term care settings more generally (assisted living, retirement communities), due to lack of one governing body or set of rules, facilities that accept Medicare or Medicaid funding – such as nursing homes – are more easily addressed.

SAGE advocates on a number of key issues pertaining to care in nursing home settings, which begin to address some of the challenges described above that arise when LGBT seniors access nursing home care.

Cultural Competency Training

It is critical that nursing home staff appreciate the specific needs of LGBT older adults, including recognizing diverse family structures and providing medically appropriate care for transgender people.

In this regard, Aaron Tax explains, “We and our LGBT-aging allies are currently working with CMS [Centers for Medicare & Medicaid Services] on an LGBT cultural competency training for employees in long-term care facilities, targeting nursing facilities certified by CMS for Medicare and/or Medicaid and state-licensed residential care facilities. We also believe there are places where LGBT curricula can and should be added to staff trainings or integrated into existing trainings for care providers.”

To this end, SAGE offers comprehensive cultural competency trainings through its National Resource Center on LGBT Aging, for staff at nursing homes and other aging service providers. Interested parties can request a training through the SAGE website.

Updating Forms and Broad Definitions of Family

LGBT people and their families often have difficulty ensuring access for partners and children who do not have legally recognized relationships. For example, LGBT elders should be allowed to list their partners on forms where heterosexual couples list spouses, list their non-biological and non-adoptive children as well, and be permitted visitations from their partners and non-biological/non-adoptive children.

“We and our LGBT-aging allies have recommended that CMS and AoA [Administration on Aging] review and revise existing regulations, as appropriate, to incorporate inclusive definitions of family. We and our LGBT-aging allies have also urged that CMS and AoA take actions to encourage state agencies to review and revise their own regulations and forms as needed,” details Aaron.

The LGBT movement’s efforts in these arenas are evidently paying off. On June 28, 2013, CMS issued amemorandum to State Survey Agency Directors, reiterating resident rights surrounding access and visitation.

The memo states that long-term care facilities must ensure that all visitors be given full and equal visitation privileges. Most significantly, the memo states that residents must be notified of their rights to have visitors on a 24-hour basis, who could include, but are not limited to, spouses (including same-sex spouses), domestic partners (including same-sex domestic partners), other family members, or friends.

While many challenges remain ahead – for example, LGBT older adults need to be able to feel comfortable reporting violations to their rights – these changes represent significant steps in the right direction.


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