Peak LGBTI bodies and concerned individuals have recently been involved in providing evidence, regarding LGBTI ageing issues, to current government inquiries into the accreditation process, complaints investigation mechanisms and suicide.
This document largely focuses on the implications of the legal reforms for residential aged care and associated processes. We note there are a range of issues raised in this document relevant to in-home care and other components of the aged care industry.
Understanding LGBTI Elders
The future of aged care in Australia is one in which the LGBTI face of ageing will be visible and prominent. This is in direct contrast to the current situation, where LGBTI aged care consumers are largely invisible, or ‘closeted’, as a result of a lifetime of ensuring their sexual orientation was not known by even the closest of friends.
In order to understand the specific needs of LGBTI aged care consumers, it is necessary to understand the journey of their life and the historical discrimination they have experienced. This document largely focuses on members of the same-sex attracted community, given it discusses the impact of the 2008 reforms removing discrimination faced by same-sex couples. While many of these issues are shared by members of the transgender and intersex communities, it is noted that this groups of aged care consumers often have additional and specific issues in an aged care setting that are not fully explored by this paper.
The government’s stated intention to make sexual orientation and gender identity-based discrimination illegal at Federal level is a positive indicator of change that will impact on the processes of aged care quality improvement.
The invisibility of current LGBTI consumers
As a consequence of the historical circumstances and discrimination faced by older LGBTI consumers, most current recipients of aged care services have lived lives of invisibility in regards to their sexual orientation and gender identity.
In an aged care setting, this can often lead to service providers assuming they have no LGBTI consumers – and thus no strategies, policies or procedures are developed or implemented to provide a safe and inclusive environment, beyond the notion of respect for an individual resident’s cultural heritage as outlined within the Residential Aged Care Manual.
In accordance with the views of various LGBTI organisations, we do not believe the current Residential Aged Care Manual adequately caters for LGBTI consumers. We strongly encourage the specific mention of the LGBTI community within the manual, to ensure that document adequately conveys the importance of creating a safe and inclusive environment.
Out & Proud Baby Boomers
The Australian population is ageing and it is estimated that one quarter of the population will be aged 65 years and older by 2050. The cohort aged 65 and over is currently estimated at 13% of the Australian population. This amounts to approximately 2,860,000 people within the current national population of twenty two million.
Australia lacks comprehensive data about the actual numbers of LGBTI older people. The 2003 Australian Study of Health and Relationships4 found that, while only 2% of the population identify as non-heterosexual, up to 15% have experienced same-sex attraction or had sexual contact with someone of the same-sex.
Similarly, the Australian Medical Association suggests that between 8 and 11 percent of Australians are ‘not exclusively heterosexual’. Taking this estimate, the older population of Australia which may be LGBTI or non-heterosexual may be 228, 800.
It should be noted that, as the population ages and more baby boomers who have always been open about their sexual and gender identities reach later life, it is likely larger numbers of aged care consumers may be comfortable with self identifying as LGBTI.
The 2008 Legal Reforms
The imperative to ‘come out’ to access entitlements
The 2008 legal reforms remove discrimination against older same-sex couples seeking to access residential aged care facilities. Additionally, they raise the prospect of LGBTI older people having to ‘come out’ or disclose to service providers and assessors, so that rights and entitlements are claimed and attained. This is a novel situation in relation to aged care, an area of service provision which, to date, has been somewhat oblivious to LGBTI older people’s identities as consumers of services.
Approved providers and others are facing the prospect and reality of same-sex couples disclosing their relationship status, or feeling somewhat pressured to do so, at assessment and during entry to residential care. Clearly, providers require guidance and advice around appropriate ways of responding to this significant change across the aged care sector. The Department and its agencies have an obvious leadership role to play in this process.
The impact of the 2008 removal of same-sex discrimination
Without diminishing the outstanding step forward taken by the 2008 reforms, a concern remains regarding the extent to which the aged care industry has been adequately prepared to address the anticipated increase in LGBTI aged care consumers self identifying and disclosing their same-sex partnership status.
The 2008 changes to the Aged Care Act 1997 provide a financial incentive to same-sex couples to declare their relationships. Anecdotal reports now indicate that same-sex couples are declaring their relationships to ensure they obtain the best financial situation for their relationships.
This has led to a number of concerns in key impact areas. These are outlined in the Figure on page 14 of this discussion paper.
Concerns related to LGBTI consumers in aged care
There is a plethora of overseas literature and research evidence related to LGBTI ageing and aged care. In the local sphere, there is a growing base of Australian literature reporting the experiences and expectations of LGBTI people, including same-sex couples, and service provider perspectives.
There is a growing base of qualitative evidence of discrimination against LGBTI older consumers occurring in all levels of aged care, ranging from organisational policies to abuse by staff and other residents. Data from this research is detailed in this paper and a list of the relevant literature is provided.
A culturally appropriate approach to LGBTI service provision
A culturally appropriate service model for LGBTI consumers would include interventions and approaches which serve to make clients feel comfortable and successfully convey an attitude of respect and understanding of LGBTI needs.
The User Rights Principles, Residential Aged Care Standards, Charter of Residents’ Rights and Responsibilities, Resident Agreements, and other mechanisms and instruments need to specifically refer to LGBTI consumer rights, so residents’ rights processes are explicitly inclusive.
There are currently no LGBTI-specific projects within existing aged care advocacy services across Australia. Similarly, there is currently no LGBTI community organisation resourced to provide aged care advocacy. Such projects could serve to provide LGBTI consumers with an immediate source of support, while undertaking educative programs with the aged care sector.
Options for Action
In the light of the issues raised in this paper, some options for action which could progress the process of ensuring that same-sex partners in aged care are treated in a culturally appropriate way are presented below.
We urge the government to consider the importance of these issues and engage in a broad and holistic manner with the LGBTI community. The opportunity to continue discussion of these issues and options at a Departmental and Ministerial levels would be warmly welcomed.
A range of options available to address the issues identified in this discussion paper, include but are not limited to:
- The updating of all paperwork and procedures in aged care, so all forms and information sheets are appropriate and unambiguous;
- Amendments to the Residential Aged Care Manual to specifically mention LGBTI consumers and explicitly direct approved providers to adopt non-discriminatory measures and practices;
- The recognition of LGBTI elders as a special needs group for the purposes of aged care;
- The development of an LGBTI Aged Care Plan;
- The funding of a network of LGBTI aged care advocates around Australia;
- The training of service providers in LGBTI-appropriate and competent care, including in relation to HIV / AIDS issues;
- The establishment of capacity development positions in LGBTI community organisations;
- The funding of LGBTI community organisations to provide direct care services; and
- The commissioning or conduct of research investigating LGBTI aged care issues from stakeholder and consumer perspectives. Such an examination could serve to collate existing data, while canvassing options for future approaches to program development, policy reform and other initiatives.
The Way Forward
We hope the Department and Minister find this document a useful starting point for discussion of issues faced by LGBTI aged care consumers. We look forward to continuing discussion of the points raised in this paper with the government, at both Ministerial and Departmental levels. We would welcome the opportunity to advise and assist the Department and the Minister in determining the most effective and efficient manner in which to respond to the concerns raised here and by other members and organisations from the LGBTI community.
Through a partnership approach to the identification of solution-driven mechanisms, we are certain a plan can be developed which will serve to ensure that aged care reflects the recognition and celebration of diversity in relation to sexual orientation and gender identity. Through such an approach, same-sex partners experiencing assessment for admission to residential aged care facilities will know they are protected, safe, and included.
Jo Harrison & Corey Irlam: The Removal of Same-Sex Discrimination: Implications for Lesbian, Gay, Bisexual, Transgender & Intersex (LGBTI) Aged Care
by Admin on Tuesday, 29 June, 2010
Jo Harrison & Corey Irlam: The Removal of Same-Sex Discrimination: Implications for Lesbian, Gay, Bisexual, Transgender & Intersex (LGBTI) Aged Care
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