Who are older LGBT People
Long overlooked and invisible in society at large, older lesbian, gay, bisexual, transexual and transgender (LGBT) people are beginning to emerge as a distinct community. While LGBT seniors share many of the same aging-related issues as their heterosexual counterparts, they also confront special challenges as well. LGBT seniors may face social discrimination due to their age as well as their sexual orientation or gender identity. Older LGBT people often experience homophobia or transphobia when trying to access health care or elder care services, and they also frequently confront age discrimination within LGBT community organizations.
Managing Stigma and Discrimination
Many older LGBT people have to cope with the impact of a life-long exposure to stigma. During their life span, homosexuality was defined as both a crime and a mental disorder (as well, many trans people still live with the stigma of the diagnosis of Gender Identity Disorder), and early life experiences often included harassment, verbal and physical assaults. They may have been imprisoned or had treatment imposed on them. Their relationships were not legally recognized until recently, and many older LGBT people have spent much of their lives hiding their sexuality or gender identity.
Serving LGBT Seniors: Removing barriers, improving healthcare
Guide to serving LGBT seniors: An introduction for staff who are unfamiliar with LGBT people and/or LGBT communities, increasing sensitivity and knowledge in working with seniors from the Lesbian, Gay, Bisexual and Trans (LGBT) Communities. LGBT includes gay, bisexual, lesbian, transgender, transsexual, intersex, 2 Spirit, queer and questioning.
- You may have grown up being taught that LGBT people are sinful, immoral,mentally ill or dangerous. These attitudes have been recognized as part of a system of prejudice and discrimination. They are no longer acceptable in Canada or in Toronto's public services.
- As a care provider, you are expected to learn about the specific needs and issues of this population and to treat them with dignity and respect. There are reading materials and training sessions that you can access here at Hamilton Health Sciences.
- Try to use the same language the resident/patient uses to describe his/her sexual orientation or gender identity.
- Don't assume you can tell whether a resident/patient or family member is LGBT by the way they look or act. Be open to the fact that about 10% of the population is believed to be gay, lesbian or bisexual. In large urban areas such as Toronto, the numbers are higher.
- Trans identities are less common but not as rare as many people imagine. There is a wide range of gender expression that involves clothing, grooming, roles and interests but not body modification as well as the more permanent changes achieved through hormone therapy or body-modifying surgeries.
- Confidentiality is very important to LGBT people. Often their safety depends on it. Individual may have experienced violence, threat and trauma due to their sexual orientation and identity. If someone discloses that they are LGBT it is important to ask who else knows and who else they would like to know. There may be particular people such as family members who are not aware of their identity or with whom it is not discussed openly.
- You may have to tread carefully in relating to someone who is not out but who you know to be LGBT. Offer a safe and supportive environment by affirming the existence of all LGBT and being knowledgeable about LGBT culture and history. This can help individuals to disclose their identity when they feel safe and affirmed.
- Not being open and out is more than keeping quiet about your sex life or your gender identity. It means hiding your most meaningful relationships and experiences, your social history, your friends and partners, your hobbies and interests, etc. Being closeted prevents the development of authentic relationships and reinforces social isolation.
Transgender and Transsexual People
Most trans people feel particularly vulnerable when undergoing a physical exam and need extra reassurance and support. They may be unwilling to take off their clothes until they are feeling much safer. Protecting the identity, dignity and bodily integrity of the trans person is paramount.
- Use the appropriate pronouns (usually the pronouns that correspond to the person's felt gender) When in doubt, ask "What is your preferred pronoun?"
- Continue to follow desired dressing and grooming routines that help the person to live in their felt gender. Again, when in doubt, ask!
- Recognize that many trans people have a mix of male and female anatomical characteristics. Not all trans people want sex reassignment surgery and the majority are unable to access it. Don't be surprised to see a trans woman (MTF) who has breasts and also male genitals, or a trans man (FTM) who has had chest surgery or binds his breasts (chest) with a tensor bandage but still has a vagina. It is extremely important to deal with these differences in a supportive and matter of fact way, without showing shock, disgust or too much curiosity. Ask the questions that are needed to deliver care and educate yourself further on your own.
- It is important not to assign rooms based on genital anatomy alone since many trans residents/patients fully identify as members of their chosen gender even though they have not had genital surgery. This issue may require sensitive and creative problem-solving with staff and other residents. To assume that anyone with a penis must be placed in the male rooms and dressed as a man or that anyone with a vagina must be placed in female rooms and dressed as a women is to condemn the trans resident to a highly disorienting and humiliating experience
- For trans people who are taking hormones, it is important to reassure them that their hormone therapy will continue to be prescribed and administered (oral or injection) as usual. These medications are central to this person's identity.Contact the person's family doctor or endocrinologist to get details of his or her hormone regimen and ongoing monitoring strategies.
- If a resident has had sex reassignment surgery there may be short or longer term post-operative caare needs as with any surgery. Agian, the family physician or surgeon should be consulted in this regard.
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