Diversity in aged care into the future?

Diversity in aged care into the future?

One night in the early 2000s, I was having a drink at my favourite gay bar in Collingwood when another patron came up to me and asked me to leave. ‘We don’t want your type here,’ he proclaimed with all the invective he could muster. I didn’t ask what he meant, even though I was particularly shocked by his comment.

My media profile as an HIV-positive person asking for greater acceptance of people with HIV in the broader community was, I knew, the reason for his vitriol. I had coped with many negative comments online by that time, mainly on dating sites when I declared my status, but I'd never been confronted so openly in a social situation in front of many other people. To the great credit of my friends there that night, Mr Nasty got a massive pushback that I wasn't going anywhere on their watch.

It is a sign of those turbulent times, in the ’80s, ‘90s and even the 2000s, that some people thought it was okay to stigmatise people with HIV and expect general support for their actions. The community was frightened of HIV (thanks to hysterical politicians and the Grim Reaper TV ads in 1987), and that turned to taking out their feelings on people living openly with the virus.

It was also a sign of the changing climate that the sensible cohort of friends I had there that night was happy to push back, knowing that I was no threat to anyone there, that casual transmission of HIV was not a thing, and that compassion and support for people like me were necessary to bring the gay community, at least, as together as possible.

I raise this incident in an article about ageing as it is difficult to separate the myriad of emotional challenges that both the lesbian, gay, bisexual, transsexual, intersexual and queer (LGBTIQ) community and the broader Australian community have gone through with the HIV epidemic and, more recently, the COVID pandemic.

As the ‘baby boomer’ generation (like me) gets into that over-65 age bracket and begins to need aged care services, it’s no surprise that those prejudices will follow us into the environments we now live in, which include residential aged care facilities and in-home settings with carers.

It is one thing to live in a relatively cosseted social world of LGBTIQ friends and allies, away from such ignorance, but it’s quite another for us to live openly about our sexuality—and for some of us, our serostatus—if we have to live with people and carers who don’t understand our life experiences. It becomes a real challenge as we start to take up aged care services.

This is not a new issue, of course, with a number of reports already highlighting the need for the aged care sector to account for diversity in their clients and for workers in the sector to be educated about it. One of the most thorough was a 2008 Victorian report, My people, written by Dr Catherine Barrett for the Matrix Guild and Vintage Men.1

In its interviews with LGBTI seniors, the report documents numerous examples of neglect by carers in aged care facilities, including one account where carers deliberately ignored a resident’s requests once he disclosed that he was gay.

Likewise, Anne, a lesbian aged care resident, said she experienced much conflict about whether she should disclose her sexuality and, when she did, had to stand up against a staff member from a conservative religious background, who questioned her right to have pornography in her room or even to watch gay TV shows such as Queer as folk. Often, in these instances, staff have breached residents’ privacy by simply walking into their rooms unannounced.

The report also found that even when staff were well educated about sexual diversity (which, in itself, is not all that common), LGBTI residents were often quite unhappy about the lack of ‘buddies’ in their facilities with whom they could be completely open about themselves, their sexuality or their HIV status. In My people, nursing home resident Tom spoke about fearing rejection by other residents for being both gay and HIV-positive. He kept quiet about these details, and the only time a spark came back into Tom’s life was when he got to meet gay peers or was allowed to go out to bar to have a drink and maybe watch a drag show.

The report concludes that the best outcomes would be to establish LGBTIQ-specific aged care facilities and to continue extensive education of aged care staff about the cultural and personal needs of their LGBTIQ clients. This includes education that most gay men are not HIV-positive and that those who are, cannot pass on the virus to others when they have an undetectable viral load (which the great majority do when on HIV treatments). There should also be an acknowledgement that like their heterosexual counterparts, LGBTIQ clients have sexual needs and that intimacy with a partner or private sexual expression should be allowed.

There have been improvements in the LGBTIQ aged care services provided in a number of Australian states, which should be lauded. We now have services like Older People’s Advocacy Network (OPAN) and a range of elder rights and elder abuse organisations across the country that can hear accounts of aged care services failing the LGBTIQ community and take action to address it. Some of these services are listed at the end of this article.

After all, it is illegal in many states for aged care services to discriminate against someone who is LGBTIQ in terms of provision of services, although proving this can be a challenge for people who feel the system is not their friend.

I have talked to other gay and lesbian friends about what they would choose to do about their aged care when it becomes necessary. Everybody I’ve spoken to wants to have carers in their own home if they need them and hopes that there will be sensitive carers available, maybe from the LGBTIQ community. In Victoria, people have lauded Thorne Harbour Health for looking after our vulnerable community members during COVID, keeping in touch and not allowing them to feel overly isolated when face-to-face services were less available. Similar programs are run by the Bobby Goldsmith Foundation in Sydney, among others.

Possibly the most hopeful story I heard was from a lesbian friend who said to me, ‘My group of friends are not going into aged care. We’re going to purchase a large block of units and have a common space where we can socialise and look after each other when necessary, with onsite carers from our community if required.’

While some of us have close relationships with our families, who will also help, it is not always the case for LGBTIQ folks who might have become estranged from disapproving family members over the years. As the contributors to the ‘My people’ report attested, it is often your peers who will be with you at the end of your life, and keeping them close, if you can, even through bouts of illness, is a great blessing.

Author: David Menadue

If you or someone you know needs help tackling elder abuse, start at compass.info or call 1800 ELDERHelp (1800 353 374).