Making Elder Homes More LGBT-Friendly
A nonprofit trains care staffers to be more sensitive to LGBT residents
In 2016, the New Jewish Home in New York City sponsored what may be the first-ever float by a nursing home in the city’s annual Gay Pride Parade.
Five residents and 25 staff members participated, says Tammy Marshall, the nursing home's chief experience officer, including one older man who had marched in the original parade in 1970. Marshall says the most fun was decorating the bus for the parade. Other residents and staff of the New Jewish Home came out to cheer them on.
The Gay Pride float was an outgrowth of two years of staff training to make the nonprofit New Jewish Home and its related services for older adults more LGBT (lesbian, gay, bisexual, transgender) friendly.
Working with a cultural-competency program developed by Services and Advocacy for Gay, Lesbian, Bisexual & Transgender Elders (SAGE) called SAGECare, the New Jewish Home has trained more than 500 of its 2,300 employees, including the organization’s leadership team.
A Needed Change of LGBT Residents
Only 22 percent of respondents in a 2011 national survey of LGBT older adults in long-term care felt such older adults could be open about their identities with facility staff. (Survey respondents included residents themselves as well as family, friends, social workers and other professionals). Eighty-nine percent predicted that staff would discriminate based on LGBT residents' sexual orientations and/or gender identities, and 43 percent reported instances of mistreatment.
“It is quite common for LGBT older adults to be subjected to discrimination and ill-informed approaches to care and services,” says Michael Adams, CEO of SAGE (and one of Next Avenue’s 2016 Influencers in Aging).
To address this problem, SAGE, with support from the U.S. Administration on Aging, offers training, tools and technical assistance to aging service and long-term care providers. The goal is to help them give culturally competent care to LGBT elders. Since 2011, SAGE has trained more than 13,000 individuals who work in more than 1,600 senior service agencies and long-term care settings.
At the New Jewish Home, says Marshall, “We realized we weren’t as welcoming as we could be to LGBT individuals.” The training gives employees a safe space to ask basic questions — everything from “Can AIDS be spread by kissing” to “How do you become gay?”
Considering Our Language
As a first step, the group talked about language and the importance of making sure the staff identified individuals in their preferred way. For example, one resident appears to be a male, but identifies as a female who wants to be called Doris and referred to as “she.” Another resident wants to be dressed in the nightgowns his partner brings him — a choice once ignored but now honored.
The home is now working towards becoming credentialed by SAGECare as a community whose employees have received LGBT aging training.
“Our overall goal is for staff and leadership at agencies to understand the needs of LGBT older adults and to enhance their services to those communities,” says Hilary Meyer, SAGE chief enterprise and innovation officer, who heads up SAGECare. “To that end, we work to help people understand the experiences and historical significance of LGBT older adults and how that affects them in the present day.”
No Gay People Here?
Long-term care facility staffers often assume they do not serve any LGBT individuals, Meyer says. But after undergoing the training, they learn otherwise.
A residential activities coordinator reported that before the training she did not think there were any LGBT residents in her community. But within two weeks after hanging her training certificate on her office wall, says Meyer, “two community members came out to her as LGBT. They appreciated that she was creating a safe environment for them.”
A secondary benefit of the training is the message that it sends to LGBT employees. “Folks who identify as LGBT on staff are very appreciative and voice that in the trainings,” says Meyer. “They feel really good that the agency has invested in getting the staff trained on these issues.”
Others Offering LGBT Training
Trade associations representing long-term care providers also offer such training for employees, often in collaboration with SAGE. The largest association, the American Health Care Association (AHCA) and National Center for Assisted Living (NCAL), represents 9,500 nursing homes and 3,500 assisted living facilities. AHCA/NCAL leads train-the-trainer workshops at conferences and through webinars. Participants return to their organizations and spread what they’ve learned.
“It’s important that the staff understands [LGBT bias] because it impacts our residents,” says Lindsay Schwartz, NCAL’s senior director of workforce and quality improvement. “There are disparities in health care for LGBT individuals. We make sure staff understand that and help residents overcome those disparities and help them find LGBT-friendly physicians. We talk about things communities can do to be culturally competent — asking about families of choice rather than families of origin, and having diverse marketing materials that show the different faces of aging.”
Older Peers Are Often the Problem
Although the training is focused on employees, Adams says often, non-LGBT residents exhibit biased behavior.
“In our experience, the two biggest challenges are other elders, who may demonstrate hostility or ignorance or discrimination towards LGBT elders in a care setting,” he says, “and the other is professional staff who don’t know how to navigate the problem when that happens.”
Pat Giorgio, president and CEO of Evergreen Estates in Cedar Rapids, Iowa, and immediate past president of NCAL, says residential communities must have “zero tolerance” for discriminatory behavior.
“You cannot allow it to exist or it will poison the community,” she says. In her homes, residents sign a contract that delineates both their rights and their obligations, including treating others with dignity. “It doesn't get them off the hook just because they’re older,” Giorgio says. “They have to respect others.”
In one case, a male resident was verbally cruel to another resident, who was a lesbian. When the behavior did not stop, the man was asked to move out. “Ironically, once I asked him to leave, the behavior changed,” says Giorgio. He was allowed to stay.
In Some Corners, Acceptance
But some long-term care facility executives say they have been impressed with how accepting older residents can be.
“In Oklahoma, a provider talked about a staff member who was transgender and transitioning and how supportive the residents were,” says Schwartz. “They really embraced the staff member and made the person feel comfortable. I think sometimes we don't give people credit that they can be accepting.“
To Giorgio, who helped lead the LGBT initiative for NCAL, this is a social justice issue. “I’ve watched residents and coworkers and friends suffer a great deal of pain trying to hide their sexuality,” she says.
In 2009, when NCAL began working on the issue, Iowa had become the first state to legalize same-sex marriage and LGBT concerns were front and center in the news. The time seemed right to help long-term care organizations address these issues, says Giorgio.
Early Resistance by Staff
Of course, not all staffers are happy being told they must be open and accepting of LGBT people. But, says Schwartz, “Regardless of what a provider’s beliefs are, you are there to care for someone. Your focus is person-centered care.”
Giorgio had a Catholic employee who came to her after the training to express religious objections to homosexuality. After talking it through (“I asked her what would Jesus do?”) the employee seemed more comfortable about providing care to LGBT residents, says Giorgio.
“The key to discussing LGBT issues is to root it in person-centered care,” she says. “The training must be done in a very compassionate manner, so that the presenters leave themselves open to hearing different points of view — you can’t trample on people’s beliefs and feelings. It has to be done with compassion and love and the ability to deal with any conflicted feelings. There are some religions where this is anathema, so you have to remember when you’re talking about person-centered care, that also means accepting the cultures of people who are hearing this and may not agree.”
Reason for Optimism
Having made presentations on becoming LGBT-friendly to many long-term care provider groups over the last five years, Giorgio says she has witnessed a shift in thinking that makes her optimistic.
“I’ve seen it evolve from discomfort to much greater understanding and acceptance,” she says. “I truly am hopeful.”