Findings reveal that, according to staff, sexual orientation has little influence on their ability to care for residents, but dealing with homophobic attitudes and behaviour of other residents is particularly challenging.
A further key finding concerns the role of community organisations that advocate on behalf of the older LBGTI (lesbian, bisexual, gay, transgender and intersex) community; these were seen by residential care staff as a valuable resource to draw on.
“I think it is important that the expertise is out there and that aged care facilities can tap into this,” says Dr Gary Bellamy, a Research Fellow in the School of Nursing at The University of Auckland. “There is great value in making sure that staff are aware of what is available.”
Funded by the Rule Foundation, a charitable trust, the study was carried out in response to increasing awareness of the unique issues faced by sexual minorities as they age in New Zealand.
An earlier report from Western Australia had concluded that older LBGTI individuals accessing retirement and residential aged care facilities experienced high levels of unmet needs and fears of discrimination. No comparable research was available in New Zealand.
The recent study, conducted over three district health boards in the Auckland Region, involved discussion groups with 47 staff from seven residential aged care facilities. Case scenarios of older gay and lesbian residents living in aged care were used to facilitate discussion.
Registered nurses within New Zealand work within a prescribed code of conduct and have legal and professional responsibilities towards patients. However, unqualified caregivers who are involved in direct care receive most of their training “on the job”. The attitudes of medical staff, nurses and caregivers can impact significantly on acceptance and understanding of the unique perspectives of the LBGTI residents.
Staff in the study said that knowing family members, friends and colleagues who identified as lesbian or gay helped in their ability to empathise with LBGTI residents.
Participants in the study noted that individuals react differently to the transition to care. For all people, regardless of sexual orientation, this was an unsettling time and, once they had made the move into residential care, good assessment and developing relationships were crucial.
Older LBGTI people were not seen as a homogenous group, but issues of trust were fundamental as they had grown up at a time when homosexuality was criminalised and lesbianism was vilified. As a result, affording older lesbians and gay men the time to develop trusting relationships with care workers was important. Personal privacy was seen as a fundamental right for all older people in aged care, and staff acknowledge the importance of being able to help ensure personal privacy, along with partner involvement in care.
Though staff said homophobic attitudes and behaviour of other residents was a challenge, they also saw the high levels of cognitive impairment among some residents as a mitigating factor.
The findings from the study are being used to develop some practice guidelines for staff working in aged care facilities. The intention is to follow this project with a study of the views and experiences of older gay, bisexual and lesbian people and their partners regarding residential aged care.
“The project is a first for New Zealand and will help to raise awareness of the unique needs of people from sexual minorities as they age,” says Dr Bellamy.
The University of Auckland