LGBT seniors not seeking home-care services

Monday, January 16, 2017

Why is it that many older lesbians, gay men, bisexual men and women and trans people (LGBT) fail to seek or refuse home-care services?

Are they any less in need of such services as Meals on Wheels, transportation, homemaking, nursing and personal support services?

No. It is because they have had negative experiences with the health-care system and prefer to do without rather than face discrimination.

A study by the Coalition of Lesbian and Gay Rights in Ontario, now known as Queer Ontario, documented numerous cases of discrimination, abuse, neglect and harm experienced by LGBT people accessing health care.

In one case a woman who was having a gynecological examination was asked by the doctor if she was sexually active. When she said yes, the doctor asked if she was using birth control measures. When she said no, the doctor began a lecture on responsible sexuality. She explained that why she didn’t use birth control measures was because she has sex with other women. The doctor put down the instruments, left the room and did not return.

A friend of mine required home care following surgery. As it happens, he enjoys crossdressing and has a collection of women’s clothes and jewelry. His home care worker did not approve of this and set about disposing of it all. I have an amusing image of my friend standing in front of his closet, arms outstretched refusing to let the worker near his stuff.

I’ve heard numerous accounts of home-care workers offering to pray with the client “to be cured of this affliction” and/or leaving religious tracts behind.

Trans people regularly complain that when they encounter health-care workers, they are questioned about what surgeries they have had and what hormones they are taking, even if their ailment has nothing to do with either. Medical workers regularly question trans people about their situation by way of learning more. Trans people resent being put in the role of educator when they are patients.

People may wonder why older LGBT folk complain about these things when the gay rights movement has made so many strides in terms of human rights.

For many older LGBTQ people, the gay liberation movement came too late. The 1969 revision of the Criminal Code decriminalizing sex between consenting same-sex adults did not occur until a 72-year-old LGBT person then was 26 years old. The decision to remove homosexuality from the list of mental health conditions happened when this same person was 30 years old. It wasn’t until the person was 60 before same-sex marriage was legalized in Ontario.

Many (most?) older LGBT people have been forced to live closeted lives, appearing to be straight. Living in the closet was the only way to go if you wanted to remain in your family or be accepted by society (employers, churches, schools, choirs, bowling leagues, etc.). People who “came out” were regularly expelled from their families and lost friends, jobs, housing, careers and community acceptance.

In the situation of home care, the thought of someone coming into their home, their own sacred, safe space, is unthinkable for many. “I’d have to ‘de-gay’ my entire apartment” was one man’s response.

Older LGBT people have experienced a lifetime of homophobia, lesbophobia, biphobia and transphobia. As a result, they have developed resilience and keen senses about safe and dangerous situations. For many, a home-care worker in their space is perceived as seriously dangerous. They would rather do without care or services than expose themselves to discrimination, neglect or other forms of oppression.

What is the answer? How do we as a society provide safe, competent home care for these populations? The answers are many. The training of health-care professionals is a step along the way. I serve on a committee at the University of Toronto Medical School that is attempting to provide both safe environments for queer medical students throughout their training and to expose straight medical students to information and skills in dealing with LGBT patients. I presented on these issues to groups of medical students at McMaster University in the summer and will be at Brock University in February speaking to a class of nursing students.

Training of front line staff in home-care agencies and nursing agencies is another step. Giving staff a vocabulary to work with, insights into the lived experience of older LGBT people they may encounter is a critical. Having the opportunity to deal with scenarios featuring LGBT patients is a powerful, educational experience. Such training is equally valuable for volunteers working in the home-care field in such capacities as delivering meals, providing telephone reassurance or friendly visiting.

The leadership of organizations providing home-care services has work to do as well. Antidiscrimination policies should specifically mention sexual orientation, gender identity and gender expression as grounds for discrimination. A zero-tolerance policy for homophobic comments is another step. Complaint procedures need to be transparent and timely. New hire interviews that use scenarios dealing with LGBT clients are useful. Job postings should state that the organization welcomes diversity including LGBTQ. Job postings should be sent to places where LGBT people are likely to see them.

The “look” of the organization should present a welcoming face to prospective LGBTQ clients, staff and volunteers. Clear statements about welcoming LGBT people and rainbow graphics can appear on websites, in newsletters and brochures. The decor of an organization can be welcoming with the display of a rainbow flag, rainbow stickers, pictures of same-sex couples and LGBTQ publications in waiting rooms. These displays play a dual role in that they also help to develop tolerance in other clients visiting the offices.

With an aging population, home-care agencies are and will be providing essential services that enable older citizens to age in place, to stay in their homes and avoid costly residential care. It is important that these services be available, safe and secure for all.

— Dick Moore is a resident of Port Colborne where he sits on the city’s senior citizen advisory committee. He can be reached at

Source: St. Catharines Standard