Older gays and lesbians face a discriminatory environment when it comes to ageing and aged care services, according to gerontology researcher Dr Jo Harrison of the University of South Australia.

Dr Harrison says that the view of ageing as a negative, lonely experience is a serious barrier to overcoming discrimination on the basis of age in the gay and lesbian community. Connection to the gay community can contribute to a positive ageing experience, and many gay and lesbian people fear having to go to a nursing home in old age.

According to Harrison, aged care services operate within a dominant “heteronormative” framework in which heterosexual experience is seen as the central world view and the role of sexuality as a component of identity is not recognised.

Harrison says that heteronormative assumptions underpin many discussions of aged care practice, particularly when referring to relationships, family, household, taxation and superannuation. Terms like “never married”, “spouse carer” and “widowed” reflect the assumption that all elderly people are heterosexual.

This can lead to a situation where an older gay man or lesbian is reluctant to disclose their sexuality and it is therefore unlikely that their needs will be met to the fullest extent possible.

Harrison discusses a case in which a lesbian being admitted to a home felt unable to reveal that the “friend” accompanying her at admission was really her life partner. The partner was therefore not given the same visiting and decision-making rights as the woman’s children.

In fact, only a small percentage of the aged population ever requires nursing home care. But the fear of being “forced back into the closet” makes many gay and lesbian people reluctant to consider this as an option, and may influence their overall thinking about ageing.

A common viewpoint among health professionals is that a person’s sexuality is “private” and not relevant to their treatment. Harrison argues that this is a barrier to a full understanding of a client’s life experiences, and may also be a way of avoiding the need for change.

Harrison says that mass “outing” of elderly gay men and lesbians is not the answer, and they should not be required to overtly discuss their relationships. Gay men and lesbians who grew up prior to the advent of gay liberation may have lived their entire lives without revealing their sexuality and coming out may not be a feasible option for them.

This contrasts with mid-life gays and lesbians, who are more likely to have been through a “coming out” process and made choices about disclosure throughout their lives.
However, Harrison says the crucial thing is for aged care services to “avoid assumptions which limit opportunities for coming out, while respecting diversity around identity, life history and self-understandings”.

This includes understanding the choice not to identify as lesbian, gay, or even different. Overseas research has shown that many older lesbians, for example, do not apply this term to their own same-sex relationships or life arrangements.
There are ways that aged care services can communicate to older gay men and lesbians through language, practices and symbols that can reassure them that an environment is non-discriminatory.

For example, application forms and interviews could refer to “significant people” rather than “husband or wife”. Anecdotal evidence suggests that such subtle signals of openness have encouraged older gay clients to discuss issues and concerns that may otherwise have remained unaddressed.

Overt homophobia and abuse of gay and lesbian clients by nursing home staff are very important issues in the aged care context. Although there are no documented cases in formal complaints to government bodies, anecdotal evidence suggests that the problem certainly exists.

Harrison tells of one elderly man who had come out to the occupational therapist at a day centre after she asked whether he had a partner and what was their name. This enabled him to express some concerns that would otherwise have remained unaddressed.

However the Director of Nursing subsequently asked him to wear latex gloves while at the centre and threatened to refuse service to him if he did not comply. The occupational therapist managed to resolve the issue but it was a struggle and they had limited support from other staff.

Another elderly man was transferred from a retirement village to a psychiatric hospital because the management disapproved of his “younger male visitors”. There are other cases of nurses refusing to bathe a “suspected lesbian” and elderly people being threatened with outing if they complained about how they were being treated.

Transgender and intersex people are also particularly vulnerable to discrimination in aged care settings, to the point where they may avoid seeking assistance altogether. There is anecdotal evidence of denial of services, forcibly preventing cross-dressing and deliberate physical violence when people are revealed to be transgender.

Transgender people may also have medical issues related their original gender that emerge with ageing, such as osteoporosis or prostate cancer. These may not be addressed because they may be too intimidated to seek medical advice of any kind.

Harrison says that aged care workers must develop a better understanding of diversity around sexuality issues in order to provide quality service to future clients who have not led closeted lives and need non-judgemental care and support. There have not yet been significant advances in this area in Australia.

Education of service providers is very important, and overseas evidence suggests that initiatives based on empowerment, involving gay and lesbian professionals from related organisations and organising speakers bureaux of older educators, have been particularly successful.

A Code of Ethics was developed for the Australian aged care industry in 2001, but this did not outlaw discrimination on the grounds of sexuality.

Recent legislative changes have addressed some of these concerns, but do not necessarily cover the special situation of older people who have lived a long life of non-disclosure. Areas such as superannuation, wills, next of kin and power of attorney are still problematic in this regard.

There have been developments in the USA in relation to ageing and sexuality. These include the establishment of a National Association of Lesbian and Gay Gerontology, the American Society on Ageing’s Lesbian and Gay Ageing Issues Network, and some tertiary curricula that address gay and lesbian ageing issues. Some activist and support organisations are now also emerging in Australia.
An improvement in understanding of the needs of gay and lesbian clients of aged care services, leading to greater empowerment and self advocacy, may result in unexpected outcomes and new options for action not previously considered.