Lesbians and gay men face barriers when they make long-term care decisions, TCU researchers report

Fort Worth, TX

5/27/2008

Lesbians and gay older adults face serious problems when they consider entering long-term care facilities, reports a team of social work and nursing professors at TCU. 

“Older lesbians and gay men often feel they must go back into hiding when they become ill, vulnerable and dependent on others,” says Harriet Cohen, professor of social work at TCU. “It is troubling when these women and men decide they must hide a critical part of their identity in order to feel physically and emotionally safe in nursing homes, assisted living facilities or retirement communities.”

Dr. Cohen and four TCU colleagues call on long-term care facilities to develop statements of non-discrimination that include sexual orientation. They also advocate cultural competence training for long-term care staffers, residents and their families.

The recommendations are made in a paper titled “Older Lesbians and Gay Men: Long-Term Care Issues,” published in the February 2008 issue of Annals of Long-Term Care. The co-authors are Linda Cox Curry, professor of nursing; David Jenkins, professor of social work; Charles A. Walker, professor of nursing; and Mildred O. Hogstel, professor emerita of nursing. All work through the Center for Healthy Aging at TCU.

Based on the common gauge that between three and five percent of the older population uses long-term care facilities, they estimate that by 2030, between 120,000 and 300,000 lesbians and gay men will access these services across the U.S.

Fear of homophobic attitudes among long-term care staff and residents could keep that number from being higher, they say.

“Examples of homophobia among nursing home staff include refusal to bathe ‘the lesbian’ and workers threatening to reveal a resident’s lesbian identity to other residents and to staff,” they write.

Lifelong relations can be negated during a medical crisis when gay couples are separated into different nursing homes, without regard for their long-term relationship.

“Lesbians and gay men agonize about accessing long-term care services because they worry that their quality of care may be compromised by homophobic and heterosexist attitudes and practices among staff, other residents and residents’ families,” Dr. Cohen says. “As a result, older lesbians and gay men worry about the loneliness and vulnerability, as they are not able to display pictures or keepsakes or to reflect on their shared life experiences with significant others and friends.”

“Same-sex partners are often denied visitation privileges in hospitals and long-term care facilities. In fact they may not be contacted when there is a change in their loved one’s health status or their loved one dies. ‘Chosen families’ are often excluded from making decisions about an older lesbian or gay man’s care.”

This leads to situations where people are prepared to die at home with insufficient care rather than go back into the closet.

“Cultural competence training for…staff, residents and their families can assist long-term care facilities to provide an environment where older lesbians and gay men do not need to fear or to hide, but can experience the same quality of life as older adults in general,” the authors conclude.

For more information contact Dr. Harriet Cohen at 817-257-5230 or h.cohen@tcu.edu.