Showing posts with label #lgbt. Show all posts
Showing posts with label #lgbt. Show all posts

Thursday, November 27, 2014

Back In The Closet?


BACK IN THE CLOSET

 November 26, 2014 10:42 am
LGBT seniors afraid they will have to go back in the closet

By Mia Sheldon  


When entering care, many LGBT seniors are afraid they will experience homophobia or discrimination because other residents or health care workers may not agree with their lifestyle.
16x9
Baby boomers have seen 12 Canadian prime ministers, the birth of the Canadian health care system and watched rights for LGBT (lesbian, gay, bisexual and transgender) people fought for, and won. But now as they age, many worry that those gains will not make it to the nursing home.


“People are not being treated the same,” says Bill Ryan, a professor of social work at McGill University. He has been studying LGBT health for 25 years and says many healthcare providers, long term care facilities and retirement homes simply do not know that some of their residents could be LGBT.

“If these places have more than 20 or 30 residents, they have people that are LGBT,” he says. “Just because someone doesn’t name their reality, doesn’t mean they aren’t there.”
When entering care, many LGBT seniors are afraid they will experience homophobia or discrimination because other residents or health care workers may not agree with their lifestyle. Ryan says some will conceal their sexuality and go back in the closet.

“…this man said when he went to visit his partner he would walk into the room and he would close the door and lock it, then he would go to the bed and he would help his partner into the bathroom and he would walk into the bathroom and close the door and lock it so 2 locked doors between them and anybody else and he would just hold him and hug him”, says Ryan. “It’s horrible not to show affection”.


Current research estimates that up to seven per cent of the senior population is openly LGBT.

The number of seniors in Canada is set to double in the next 25 years, up to 25 percent of the total population by 2036. Current research estimates that up to seven per cent of the senior population is openly LGBT. And the generation that fought for rights decades ago is set to demand the same equal treatment when their time comes for senior care.

Right now that equal treatment doesn’t always happen. Discrimination can be a dirty look from staff, a homophobic slur from another resident or facilities that do not acknowledge LGBT relationships.

“Regardless of what your policies are, regardless of what your thinking is, this is what our relationship is. This is who I am to her and who she is to me and this is how we want our relationship to be respected,” says Lorraine Sayell, 68.

Lorraine was born Lorne in 1946 and six years ago, at 62 years of age, she realized she was transgender, a woman born in a man’s body. She quickly transitioned: changed her name, got new ID, started taking hormones and came out to her wife Joyce after 47 years of marriage.

Lorraine realized she was transgender at 62 years old and came out to her wife Joyce after 47 years of marriage.
They refer to each other as “wife” and have started a new life for themselves as two women. They also want the same respect for their relationship if they enter long-term care.

According to Ryan, if they are ignored, it could become a human rights issue. “..if (homes) don’t change because it’s the right thing to do then the courts will be telling them that they’re acting in a way that’s unconstitutional.”
The answer, Ryan says, is in creating LGBT-friendly environments, where people want to come out. That includes asking residents how they identify, not assuming everyone is straight.

“It’s not that hard,” says Ryan.

Toronto’s Fudger House, a downtown long-term care facility, became gay positive in 2004. Becoming gay friendly includes training staff in diversity, creating LGBT friendly activities and programs to be more inclusive.

“In order to respond to the needs of our residents we thought we need to explore and travel the journey of improving, to make sure we are gay positive,” says Lorraine Siu, Fudger House’s administrator.


Alf Roberts, 85, is one of the 249 residents at Fudger House. Five years ago, when he moved in, he came out of the closet and admitted he was a homosexual.
It was a secret he had kept his whole life. But he finally felt comfortable enough at Fudger House to be himself.

But he is one of the lucky ones.

“I just hope that more homes across Canada will open themselves to LGBT groups,” Alf says. “As long as they feel they don’t have to go back into the closet that’s the big thing”.

16×9’s “Back in the Closet” airs this Saturday at 7pm.

© Shaw Media, 2014





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Sunday, November 23, 2014

LGBT Seniors Facing Going Back Into The Closet


Coming out all over again: Why the first gay-rights generation faces familiar challenges in old age

WENCY LEUNG
The Globe and Mail
Published Thursday, Oct. 09 2014, 12:29 PM EDT
Last updated Friday, Oct. 10 2014, 4:49 PM EDT




With the generation that led the gay-rights movement reaching retirement age, many LGBT seniors are forced to relive the struggle for acceptance, and even re-closet, as they enter care facilities populated with a generation raised to believe that homosexuality is a crime. Wency Leung reports


Ginny Lundgren, left, and Paulette Kupnicki, take a walk outside their Windsor condo with Zooki. The long-time couple had to come out all over again when they moved to a retirement condo a couple years ago, to often unenthusiastic neighbours. (Photos by Glenn Lowson for The Globe and Mail)
When Paulette Kupnicki and long-time partner Ginny Lundgren moved into a Windsor, Ont., condo for retirees two years ago, Kupnicki wanted to get to know her new neighbours. She put up flyers on the building’s bulletin board, advertising a seniors’ games group and an upcoming play about LGBT (lesbian, gay, bisexual, transgender) issues, in which she was involved.

The games group flyer was left in place, but her notice about the play was anonymously taken down. Its removal set Kupnicki’s heart pounding: The thought that some residents did not welcome same-sex couples filled her with dread.

“I just spent a lot of money to move out of my house into this place,” says Kupnicki, now 70. “Honestly, I’m walking around with a lump in my throat, thinking, ‘What the hell am I going to do?’”

Stories like Kupnicki’s are all too common. The generation that led the gay liberation movement now faces the prospect of moving into retirement communities, nursing homes, and long-term care facilities alongside more elderly occupants who were raised with the notion that homosexuality was a disease, and a criminal act.

Stories of seniors having to relive their struggle for acceptance are rife. Fearing discrimination from service providers and their peers, some even retreat to the closet when they seek health and social assistance, hiding their sexual orientations, gender identities and domestic relationships. That can be emotionally draining, and have serious consequences on their mental and physical health.

“The number-one fear we hear over and over [from LGBT seniors] is having to age out of their homes, move into care and potentially re-closet,” says Dana Parker, executive director of the Vancouver advocacy group Qmunity. She notes that middle-aged and younger LGBT individuals rarely give that future prospect a thought.

The issues around integration and acceptance have kickstarted campaigns to raise awareness and tolerance in senior-care facilities, and to educate staff members trying to welcome their first wave of uncloseted LGBT residents.

And as the number of openly LGBT individuals swells among the senior population, the need for sensitivity and inclusivity in elder care becomes more pressing. According to a discussion paper released last month by Qmunity, the number of open LGBT individuals aged 65 and older is believed to be about 6.7 per cent of the overall senior population. In the B.C. Lower Mainland alone, that translates to roughly 25,000 people.

It’s a figure that’s expected to grow to reflect a shift in demographics that will see seniors make up an estimated 19 per cent of the province’s population by 2020, up from 15 per cent today. If attitudes don’t change, Parker says, LGBT seniors will be vulnerable to loneliness, isolation and at risk of not receiving the care they need.

Deep-seated fears of discrimination are hard to shake among those who spent much of their adult lives in a world that treated homosexuality as a crime or a disease. The Qmunity paper points out that those who are 85 years old now were already 40 when homosexuality was decriminalized in 1969, and 66 at the time sexual orientation became protected under the Charter of Rights and Freedoms in 1995.

These older seniors, who may have had relationships and careers ruined because of their sexual orientation or gender identity, aren’t likely to live openly in elder care, particularly if they are housed with peers who still hold onto their prejudices. It has fallen on less reticent LGBT boomers, who spent their youth championing gay rights and are now greying themselves, to advocate on behalf of their elders and to push for change in senior care.


“I’m an activist, so I’ve never been in the closet,” says Marie Robertson, community developer of the Ottawa Senior Pride Network, which provides diversity training to long-term-care workers, volunteers and clients of senior services. Now in her 60s, she recalls marching in the streets for human rights protections when she was 19, and she continues to defend those rights. “When I do training,” she says, “I’ll say to the staff: ‘This is who we are. We’re not going back into the closet when we go into care. So here, you’d better get ready.’”

Much of the sensitivity training around LGBT seniors involves creating a safe environment in care homes by building empathy, ensuring staff and volunteers understand historic hardships LGBT individuals experienced, and making sure the language used on intake forms and in brochures is inclusive. Through her work, Robertson has heard heartbreaking accounts of the fear and humiliation LGBT seniors face in long-term care, such as the gay couple who had to visit the washroom just to hold hands, or the transgender woman whose care-worker made a scene upon discovering she had a penis.

Social exclusion is only one of the fears seniors have of being outed. “They’re afraid if the staff knows that they’re gay, that diapers aren’t going to be changed as fast, the call bell is not going to be answered,” Robertson explains. “And the reality is that those fears are justified. That’s what happens.”

Shoshana Pellman, 68, of Toronto, became comfortable enough to be openly transgender in 2005. Although she lives independently now, the idea of returning to the closet if she needs senior care in the future is unthinkable. “It’s like, which part of my body am I going to basically amputate? What part do I have to get rid of to meet your needs or your demands?” Pellman asks. “If someone is forced back in the closet, they’re denying who they are. They’re losing a part of who they are. That’s so cruel… Basically, they’re just surviving. You’re not living any more.”

Research points to positive mental health and wellness benefits linked to coming out in supportive settings, with subjects showing lower rates of depression, burnout and anxiety, and lower levels of the stress hormone cortisol. However, being openly LGBT may have the opposite effects in environments that are not supportive, says Robert-Paul Juster, a PhD candidate at McGill University’s Integrated Program in Neuroscience.

Concealment, on the other hand, has emotional and cognitive costs, says Richard Ryan, professor of psychology at the University of Rochester in New York state. “For example, to conceal, one must constantly monitor oneself, which is draining and requires a cognitive load. Concealing also has emotional costs associated with lower self-esteem, more depression and other negative states,” Ryan said in an e-mail.

Juster points out that much research in this area, including his own, has focused on LGBT youth, but he says there is growing interest in examining the mental health of LGBT seniors. “There is this feeling that they’re an under-represented portion of the population that people don’t know very much about,” he says.

Aware of the need to address a growing wave of openly LGBT seniors, some care facilities are proactively reaching out to advocacy groups for help, says Steven Little, education and training manager at The 519 Church Street Community Centre in Toronto. Although they’re willing to make changes, most seniors’ homes don’t know where to start, he says, noting that mental health resources for LGBT seniors are scarce. And for the first time, service providers may be grappling with how to care for aging clients who have HIV/AIDS.


When it comes to welcoming LGBT seniors, Toronto’s city-run long-term-care homes have taken a lead. At True Davidson Acres, for example, administrator Carlos Herrera says staff and volunteers hold a variety of LGBT-friendly programs, such as shows starring a local drag performer, and movie nights featuring films such as Brokeback Mountain. They participate with residents in the city’s annual pride parade, are careful to use the proper pronouns to address transgender residents, and they’ve made sure a rainbow flag and pink triangle, symbols of LGBT rights, are visible at the entrance to the home, signalling to visitors and residents that it is a supportive environment.

To be LGBT-positive, Herrera says, “we need to see it, we need to hear it, we need to feel it.”

The results of such efforts can be life-changing. At True Davidson Acres’s sister home, Fudger House, resident Alf Roberts, 85, finally felt comfortable enough to be openly gay for the first time in his life after moving into the home five years ago. At last, he says, he can be himself. “I hope that, eventually, more long-term-care homes will be more open so that people don’t have to worry about coming into a place like this,” he says

Back in Windsor, Kupnicki eventually summoned the nerve to address the issue of her missing flyer during a building meeting by pre-emptively thanking her neighbours for welcoming her and Lundgren, and inviting them to join her group activities. Although she made a few new friends that day, some people refused to even look at her.

Kupnicki, who is involved in a 50+ Proud group that provides diversity training on senior care, says it’s difficult to have to come out of the closet all over again. “At times, you think to yourself, I don’t think I can do this one more time,” she says, noting it’s more challenging for people to disclose their sexual orientation when in ill health.

Kupnicki, who had a Catholic upbringing, knew she was attracted to both males and females when she was in grade school, but she quickly hid her attraction to women when her parents discovered she had been kissing a girl. She did not open up about it until entering a relationship with Lundgren 32 years ago, after leaving her husband. Even so, for years Kupnicki was careful about disclosing the relationship, referring to Lundgren as her “friend” in public for fear of losing custody of her children. The process of coming out was also fraught with struggles with disapproving family members.

Kupnicki and Lundgren married eight years ago, and though they now live happily in their retirement condo, having warmed up to even those who initially gave Kupnicki the cold shoulder, the memories stay with them.

“As I talk about them, it comes back and reminds me how painful some of that stuff was,” she says, noting each senior brings his or her own struggles when accessing services or entering care. “Even if you’re out and you’ve been out a long time and all the rest of it, those experiences sit in the back of you.”

Follow Wency Leung on Twitter: @wencyleung



Thursday, October 30, 2014

Social Isolation & the Aging LGBT Community

Here's an excellent article discussing social isolation and aging. 




Social isolation and aging in place




Lifetimes of discrimination and stigmatization put LGBT older adults at risk for social isolation, generally considered to be an involuntary lack of contact with others. It may coexist with loneliness, but they are not the same.
Loneliness is the feeling that you do not have enough contact, or meaningful contact, with others. Social isolation is a lack of social contact. Loneliness can occur even if you are not socially isolated.
Staying connected is important for maintaining overall health as well as a sense of well-being. Although the exact reasons are unclear, it is believed that a lack of connection with others may have health risks similar to that of cigarette smoking.
Some experts suggest older people derive health benefits through contact with others who may encourage healthy behaviors such as adequate sleep, nutrition and exercise. Also, access to social networks may connect individuals with information and needed resources. Finally, informal networks, which consist of family, friends, neighbors and volunteers, provide valuable support and care.
The degree of social isolation is a factor in determining whether an older adult can maintain independence and “age in place.” Negative effects of social isolation frequently lead to the need for the elderly person to move to an assisted-living or nursing-home setting.
Research indicates that older adults have a strong preference for remaining in independent-living situations. In order to remain independent, older adults need a variety of services. These include support with medical, legal, housing, spiritual, family, mental-health and social needs.
LGBT older adults can experience social isolation for many reasons, such as the loss of a spouse or supportive friends, or physical or psychological disabilities.
Some LGBT older adults may be particularly vulnerable. Many rely more heavily on their “chosen families,” particularly in situations where “coming out” negatively affected the relationship with a “family of origin.” Under these circumstances, loss of a partner or a close friend may be especially problematic because there are no siblings, children or other “relatives” to provide social connection and support.
While there are supports that address the needs of the general older-adult population, many do not address the unique needs of LGBT older adults. Research indicates that LGBT older adults may fear discrimination, or may sense they are not welcome in senior centers, adult day care and other settings. Ironically, these environments are designed to increase socialization and decrease the potential negative effects of social isolation. Suggested future directions
Training is needed to ensure that existing social and other support services are competent and LGBT-sensitive. Research indicates many health-care and social-service providers lack adequate training to address the unique needs of LGBT older adults.
Advocacy efforts must be strengthened. For example, LGBT older adults are not included in the Older Americans Act. LGBT older adults must be included in this legislation as a vulnerable population. States will then be required to collect data so that funds and services are provided to our communities on a proportional basis.
Programs within the LGBT community should continue to be developed that meet the needs of the older population. Philadelphia is fortunate to have the William Way LGBT Community Center, providing a variety of social opportunities for older LGBT people. Check out MorningsOUT, Silver Foxes and Women’s Wednesdays, to name a few.
New models for supporting aging in place are being pioneered, such as the Village to Village Network that utilizes a grassroots, self-governing approach to design communities that support older adults as they age in place. Penn’s Village, East Falls Village and Mutual Mt. Airy Village are in the Philadelphia area.
Explore new communication technologies as a tool for staying connected with friends, family and your community. The LGBT Elder Initiative will present “Keeping Connected: Seniors & Technology” April 12 to help older adults use computers, smart phones and tablets as one way of avoiding isolation. While these technologies may serve a useful purpose in helping older adults access information and keep connected, experts agree that they do not substitute for direct human interaction.
There may also be a need to educate LGBT older adults on the effective and safe use of newer technologies. Of particular concern is the potential for financial exploitation. “Keeping Connected” will explore how to maintain privacy and security while using these technologies and the ’Net. Call the EI for more information about this program at 267-546-3448.
The LGBT older-adult population is growing rapidly. Most of these individuals equate a high-quality life with one in which they are able to age in place. In order to support this goal, the LGBT community will need to address issues associated with social isolation. Let’s hope that we are up for the challenge.
Michael Clark is chair of the LGBT Elder Initiative’s Advocacy and Policy Committee. The LGBTEI, headquartered in Philadelphia, fosters and advocates for services, resources and institutions that are competent, culturally sensitive, inclusive and responsive to the needs of LGBT elders in the Delaware Valley. To comment on this article, suggest topics for future articles or for more information, please visitwww.lgbtei.org or call the LGBTEI at 267-546-3448 and watch for “Gettin’ On” each month in PGN.

Thursday, September 25, 2014

Care Homes Address Touchy Subject - Intimacy


Care homes address touchy subject

 

Imagine this scenario: a woman with Alzheimer's disease moves into a residential care facility while her husband continues to live at home. He visits her regularly and as the disease takes its toll, she becomes fearful and loses the ability to make decisions about her finances and health care. Her husband wants to continue his private visits with her, but she can't articulate whether she is comfortable with this.

 
 
 
 
Care homes address touchy subject
 

Imagine this scenario: a woman with Alzheimer's disease moves into a residential care facility while her husband continues to live at home. He visits her regularly and as the disease takes its toll, she becomes fearful and loses the ability to make decisions about her finances and health care. Her husband wants to continue his private visits with her, but she can't articulate whether she is comfortable with this.

It's a dilemma faced by care home staff on a regular basis and there are no easy solutions, said Heather Campbell, director of policy and research at the BC Care Providers Association.
Intimacy in care homes - and among seniors generally - has historically been such a taboo topic that there are few best practices or guidelines for those in the industry on how to handle such situations, Campbell said.

"I think society has the misconception that seniors are asexual, don't have an interest in sex or if they are living with dementia, perhaps it's inappropriate for them to be having intimate relations," Campbell said, adding the reality is seniors need to feel love and a sense of belonging as much as anyone else.
The challenge for care homes is to strike a balance between respecting individual privacy and ensuring that relationships happen in a safe and consensual way, she said.

Many people experiencing cognitive decline have power of attorney or representation agreements in place that allow someone else to make decisions on their behalf with respect to finances or health care.
"When it comes to sex, the law is unclear in terms of what can a substitute decision maker consent to on behalf of somebody," Campbell said.
The Supreme Court has ruled that consent cannot be given in advance and must be given in the moment, she said. "If we have a husband who's living in the community and his wife is now in a care home and he comes in and wants to engage in an intimate relationship with her, the argument that 'we've been married for 40 years' doesn't have much weight because it's: 'Can the wife provide consent in the moment?'" Campbell said.

"It's not really something you can consent to through someone else."
Catherine Kohm, executive director of Haro Park Centre in the West End, has encountered such situations and says the solution is often to involve family or close friends in deciding what to do. There have been times when staff have consulted the couple's children, although it is usually the last thing they want to get involved in, Kohm said with a chuckle.

The forum discusses what can be done to respect and respond to the needs of LGBT residents, some of whom are afraid to move into a care home because they come from a generation where being gay was highly stigmatized, Campbell said. This fear sometimes results in "re-closeting" when a person enters residential care.

Staff at Haro Park have gone through training to make sure they are inclusive and don't assume heterosexuality in their language, policies and choices of activities - using the word "partner," for example.

It's important to acknowledge that there are LGBT individuals in the residential care population and that they feel welcome and included, Kohm said, adding that a group from Haro Park march in the Pride parade each year.

Outside the West End, however, things can be different. Certain activities - having to choose an oppositesex dance partner, for example - and assumptions made by staff or other residents can make LGBT seniors feel unwelcome.

There are times when bullying and discrimination are problems, Campbell said, noting that aggression is a symptom of dementia.
There are also times, Kohm said, when relationships develop between residents, "and how wonderful is that?" Philippa Ward is one such resident. She met John Hewis Smith in 2012 when he was seated at a table near hers in the dining room. He liked the way she greeted everyone and came over to introduce himself, Ward recalled. He tried to impress her with his large television and after that, they were "constant companions."

Smith had a near-death experience and was determined to get everything he could out of life, Ward recalled. He was diabetic and bored with his limited meal options at the centre, so they used to troll the West End together in search of interesting food. They also went to lectures, concerts and movies - "everything that was happening," Ward said.
Smith died in November at age 89. His large flatscreen TV found a home in Ward's room.

"I try to continue some of it still," she said of the excursions on the town "but it's a lot lonelier now."

www.bccare.ca/events/care-to-chatspeaker-series/tcarman@vancouversun.com twitter.com/tarajcarman

Friday, September 19, 2014

LGBT Eldercare


Current discussions on the unique health issues of lesbian, gay, bisexual, and transgender (LGBT) populations have prompted the healthcare professions to reexamine their mission and values. The American Nurses Association (ANA) Code of Ethics reminds us that nursing is committed to the fundamental uniqueness of the individual patient. The preamble to the International Council of Nurses’ (ICN) Code of Ethics states that nursing care should be “respectful of and unrestricted by considerations of age, color, creed, culture, disability or illness, gender, sexual orientation, nationality, politics, race or social status.”
Older adults are a vulnerable population. Besides health problems, many face ageism and sexual-orientation biases. In 2009, the National Gay and Lesbian Task Force Policy Institute estimated the LGBT community in the United States accounts for 5% to 10% of the total population. With the 65+ population projected to number 88.5 million in 2050, this means 1 of every 13 elders will be LGBT. According to the 2011 report “The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding” from the Institute of Medicine (IOM), stigma, discrimination, and violence are social determinants of health and well-being among LGBT elders. IOM’s consensus report on the state of science of LGBT health seeks to mobilize the healthcare community to address the unique health needs of LGBT persons.

Health disparities among LGBT elders

The IOM report detailed the following health needs and issues of LGBT elders:
  • Transgender elders may experience negative health outcomes from long-term hormone use.
  • HIV/AIDS affects older as well as younger LGBT individuals. However, few HIV prevention programs target older adults—a cohort that has been deeply affected by losses inflicted by AIDS.
  • LGBT elders exhibit crisis competence (a sense of resilience and perceived hardiness).
  • They experience stigma, discrimination, and violence across the life span.
  • They are less likely to have children than heterosexual elders and thus less likely to receive care from adult children.
Lack of culturally competent healthcare providers contributes to ongoing health disparities, making LGBT elders an underserved minority in an aging society. This population has the highest rate of tobacco and alcohol use. With the risks of coronary heart disease, stroke, and diabetes increasing with age, added damage from nicotine and substance abuse puts LGBT elders at greater risk for morbidity and mortality. Also, although advances in AIDS treatment are helping people live longer and more productive lives, the combined effects of drug side effects and lingering infections place them at higher risk for stroke and other cardiovascular events.
Less support or care from adult children may lead to social isolation. In this era of patient-drive care that values diversity, healthcare providers need to understand the concept of “family of choice” among the LGBT population. Given the lack of Social Security benefits to unmarried partners, one partner’s disability or death may threaten the economic security of the surviving partner, causing added hardship and stress that may have negative health effects.

Mandate for LGBT healthcare equality

Through the Affordable Care Act, the Department of Health and Human Services (HHS) promotes cultural competency training for healthcare providers, allocates resources for improving the primary-care workforce, and increases funding for community health centers to address healthcare inequity among the LGBT population. In addition, HHS now requires equal visitation rights for same-sex partners. Starting in 2011, the Joint Commission (JC) began requiring hospitals to demonstrate how they are specifically responding to LGBT patients’ needs as part of the more comprehensive provider/patient communications standards for accreditation. This mandate provides further impetus to apply best practices in LGBT health care across the lifespan.

Inclusive nursing education and practice

With most nurses and other healthcare providers likely to care for LGBT elders with multiple comorbidities, cultural sensitivity and patient-centered care are among the core competencies a nurse must possess. To a large extent, nursing faculty and nursing curricula lack adequate knowledge of LBGT health. Teaching, practice, and research on LGBT health are deficient, too. Revising and aligning the nursing curricula and increasing faculty’s knowledge base in regard to LGBT health promotes adoption of best practices, as called for by the IOM report and the recommendations cited in Healthy People 2020, an HHS program that provides science-based, 10-year national goals for improving the health of all Americans.
Also, ongoing faculty and staff development initiatives should consider covering LGBT health topics involving policy, legal rights, and social justice issues—all of which affect the health of LGBT persons regardless of age.

Promoting culturally sensitive nursing care

To provide culturally sensitive care for all LGBT persons, the JC published a “field guide” to promote inclusiveness and bridge gaps caused by healthcare disparities. Called “Advancing effective communication, cultural competence, and patient- and family-centered care for the lesbian, gay, bisexual, and transgender (LGBT) community,” it offers guidance in the areas of leadership, care provision, workforce, data collection, and community engagement. The box below summarizes its recommendations related to leadership and provision of care domain. (Keep in mind, though, that the health needs of LGBT individuals aren’t uniform.)

Practice guidelines for inclusive and culturally sensitive health care

Leadership

  • Develop or adopt a nondiscrimination policy that guards patients from discrimination based on personal characteristics, including sexual orientation and gender identity or expression.
  • Develop or adopt a policy ensuring equal visitation.
  • Develop or adopt a policy identifying the patient’s right to identify a support person of their choice.
  • Integrate and incorporate a broad definition of family into new and existing policies.
  • Monitor organizational efforts to provide more culturally competent and patient- and family-centered care to LGBT patients, families, and communities.
  • Develop clear mechanisms for reporting discrimination or disrespectful treatment.
  • Develop disciplinary processes that address intimidating, disrespectful, or discriminatory behavior toward LGBT patients or staff.
  • Identify an individual directly accountable to leadership for overseeing organizational efforts to provide more culturally competent and patient-centered care to LGBT patients and families.
  • Appoint a high-level advisory group to assess the climate for LGBT patients and make recommendations for improvement.
  • Identify and support staff or physician champions who have special expertise or experience with LGBT issues.

Provision of care

  • Create a welcoming environment that includes LGBT patients.
  • Prominently post the hospital’s nondiscrimination policy or patient bill of rights.
  • Ensure that waiting rooms and other common areas reflect and include LGBT patients and families (for instance, by showing a rainbow flag or LGBT-friendly periodicals).
  • Create or designate unisex or single-stall restrooms.
  • Ensure that visitation polices are implemented in a fair, nondiscriminatory manner.
  • Foster an environment that supports and nurtures all patients and families.
  • Don’t make assumptions about a person’s sexual orientation or gender identity based on appearance.
  • Be aware of misconceptions, biases, stereotypes, and other communication barriers.
  • Promote disclosure of sexual orientation and gender identity while remaining aware that disclosure or “coming out” is an individual process.
  • Make sure all forms contain inclusive, gender-neutral language that allows for self-identification.
  • Use neutral and inclusive language in interviews and when talking with all patients. Ask the patient what pronoun is preferred.
  • Listen to and reflect patients’ choice of language when describing their own sexual orientation and how the patient refers to his or her relationship or partner.
  • Provide information and guidance for the specific health concerns of LGBT patients.
  • Become familiar with online and local resources available for LGBT people.
  • Seek information and stay up-to-date on LGBT health topics.
  • Be prepared with appropriate information and referrals.
Source: The Joint Commission. Advancing effective communication, cultural competence, and patient- and family-centered care for the lesbian, gay, bisexual, and transgender (LGBT) community: A field guide. 2011.

Eliminating health disparities

Eliminating health disparities and enhancing efforts to improve LGBT health are crucial to helping LGBT persons lead long, healthy lives. Education for healthcare professionals should cultivate openness and inclusiveness. To achieve this, healthcare organizations and professionals should use inclusive language, welcome and normalize individuals’ disclosure of their sexual orientation and gender identity, and apply knowledge gained from professional development training in providing patient-centered care.
Nurses and ancillary staff comprise the largest group of healthcare providers in the United States. Because of our scope of practice and access to patients and families, we have both the privilege and the responsibility of providing compassionate, science-based care to LGBT elders. A basic premise in working with this population and other minority groups is to understand that historically marginalized communities don’t demand special rights butequal rights. To learn more about specific programs for LGBT elders, visit the web resources listed below:
Selected references
Benjamin LA, Bryer A, Emsley HC, Khoo S, Solomon T, Connor MD. HIV infection and stroke: current perspectives and future directions. Lancet Neurol. 2012:11(10):878-90. doi: 10.1016/S1474-4422(12)70205-3.
Eliason MJ, Dibble S, Dejoseph J. Nursing’s silence on lesbian, gay, bisexual, and transgender issues: the need for emancipatory efforts. ANS Adv Nurs Sci. 2010:33(3):206-18. doi: 10.1097/ANS.0b013e3181e63e49
Fowler MD. Guide to the Code of Ethics for Nurses: Interpretation and Application. Silver Spring, MD: American Nurses Association; 2010 reissue.
Gay and Lesbian Medical Association. Guidelines for care of lesbian, gay, bisexual, and transgender patients. 2006. San Francisco, CA: Author. http://glma.org/_data/n_0001/resources/live/GLMA%20guidelines%202006%20FINAL.pdf. Accessed November 16, 2012.
Grant JM, Koskovich G, Somjen Frazer M, Bjerk S. Outing age 2010: Public policy issues affecting lesbian, gay, bisexual and transgender elders. 2010. Washington, DC: National Gay and Lesbian Task Force Policy Institute.www.thetaskforce.org/downloads/reports/reports/outingage_final.pdf. Accessed November 16, 2012.
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Lim FA, Bernstein I. Promoting awareness of LGBT issues in aging in a baccalaureate nursing program. Nurs Educ Perspects. 2012;33(3):170-5. http://dx.doi.org/10.5480/1536-5026-33.3.170
Lim FA, Levitt N. Lesbian, gay, bisexual and transgender health: Is nursing still in the closet?Am J Nurs. 2011:111(11):11. doi:10.1097/01.NAJ.0000407277.79136.91
Meyer H. LGBT aging: Lessons from life at the edges. Aging Today. 2011:32(4):7,10.
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U.S. Department of Health and Human Services. Medicare steps up enforcement of equal visitation and representation rights in hospitals. September 7, 2011.www.hhs.gov/news/press/2011pres/09/20110907a.html. Accessed November 16, 2012.
Fidelindo Lim is on the clinical faculty, James C. Pace is associate dean of the undergraduate program, and Henrietta Jones is an administrative assistant at New York University College of Nursing in New York, N.Y. Kimberly Bailey works in the intensive care unit at Robert Packer Hospital in Sayre, PA.

This post comes courtesy of American Nurse Today.