Older trans people have an ‘absolute fear’ about entering aged care

Australian-first research into older trans people’s experiences of ageing and aged care has revealed trans people are often living in fear of aged care services, and has led to the development of a evidence-based guide to inclusive care.

Australian-first research into older trans people’s experiences of ageing and aged care has revealed trans people are often living in fear of aged care services, and has led to the development of a evidence-based guide to inclusive care.

The study, conducted by the Australian Research Centre in Sex, Health and Society at La Trobe University, in partnership with FTM Shed, Transgender Victoria and The Gender Centre NSW, aimed to capture the experiences of older trans people and understand their aged care needs. A group of 15 older trans people were interviewed, as well as six service providers.

One trans woman, Caren*, said that if she could not find an aged care service that would allow her to live as a woman, she would commit suicide “without a hesitation”.

Researcher Catherine Barrett of La Trobe University said that, like Caren, many of the older trans people interviewed spoke with an “absolute fear” about entering aged care, having already encountered profound discrimination throughout their lives.

“There’s a real sense of trans people just having to battle on so many fronts,” said Dr Barrett. “Every other service that they’ve accessed over the course of their ageing has pathologised them, has discriminated against them and now they’re about to hit aged care and they’re absolutely terrified.”

The study found that many service providers, from acute to aged care, knew very little about trans ageing and physical needs of older trans people, including the effects of long-term hormone use. Dr Barrett said this often meant that it was up to trans people themselves to educate providers and other professionals about their own health, which created power imbalances and sometimes led to issues such as hormones being withheld if they had lost capacity to advocate for themselves.

Service providers were also found to often be prejudiced against trans people or focused on their trans identity at times it was not necessary or relevant, such as one trans person who had their gender identity brought up when they were experiencing acute chest pain.

Providers as advocates

One of the main recommendations of the study was for trans people to make advance care plans to document their health needs and preferences. Dr Barrett said this would allow them to not only educate providers, but allow providers to advocate on their behalf.

The research documented the story of one trans woman with dementia, who was told by her children to enter residential aged care as a man or she would never see her grandchildren again. The woman, who had transitioned 40 years earlier, agreed. Dr Barrett said that when the staff in the facility later realised she was trans, they were uncertain of how to advocate for her. An advance care plan in this case would have given staff legal means to challenge her family, she said.

Other common experiences brought up in the research were funerals or burials conducted in a trans person’s birth gender, not in their identified gender. Advance care plans would also help to avoid this, Dr Barrett said.

Sending the right message

While many providers were taking positive steps to become LGBTI inclusive, they often focused primarily on gay and lesbian issues, said Dr Barrett. She said there were often issues around documentation and gender-exclusive activities within aged care.

“People talked about accessing a range of services, including aged care services, where there was a real binary segregation of male and female and there was a sense of them not fitting in,” she said.

Dr Barrett emphasised that trans-inclusivity didn’t mean identifying trans people, rather it was about sending a message that gender diversity was valued.

“It’s not about understanding, it’s about respecting where someone’s coming from,” she said. “It’s that sense of relating to a trans person as a person first, as one human being to another.

“We want aged care service providers to really take notice of this, because we think, when they get it, when they understand, they are so powerfully placed to be advocates… being trans-inclusive is not just the right thing to do, it’s also something that can be enormously rewarding; you’re making a difference to someone’s life,” said Dr Barrett.

Trans Ageing and Aged Care: An Evidence-based Guide to Inclusive Services was announced at this week’s LGBTI Ageing and Aged Care Conference in Melbourne. It will be released by Val’s Café in November, along with additional narrative resources for aged care providers.

*Name has been changed

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Tags: advance-care-planning, Australian Research Centre in Sex Health and Society, dr catherine barrett, FTM Shed, la-trobe-university, lgbti, The Gender Centre NSW, Transgender Victoria, Val’s Café,

4 thoughts on “Older trans people have an ‘absolute fear’ about entering aged care

  1. This is fantastic research and well overdue! I am an openly trans woman and have recently been employed by an aged care facility as a carer. I am the first trans person they have knowingly employed, I have found all the staff very supportive, although I have had some strange questions, but the questions are more curious than anything and I don’t find them offensive.
    At nearly 60 years old, this issue is close to my heart. I see my role as an educator and the facility has allowed me to embrace this role. I recently facilitated a staff training session on trans issues and it was very well received from all staff from the CEO down.
    We are planning more!
    Keep up the good work!!

  2. Hi Rikki It is wonderful to read and visualize how much of a difference you are making.Kudos!!!

    At Home Care Assistance we provide in-home care services for seniors to ensure safety and independence. We have developed two programs, the Balanced Care Method, which promotes healthy mind, body and spirit, and the Cognitive Therapeutics Method, which engages clients in activities designed to slow cognitive decline, to enhance the quality of life of older adults.

    Please spread the news around that due to pressing demand, we may provide employment to some great caregivers such as yourself to connect with folks who chooses to continue living in heir own home.
    WE ARE CHANGING THE WAY THE WORLD AGES

  3. There are a number of wonderful training courses delivered by organisations across Australia, such as GLHV, ACON and QAHC for example. I am a trans woman who delivers Inclusive training for ACON in NSW. Such training is a great place for organisations to start.

  4. As an ageing transgender woman, 85 years of age I have long ago paid for my funeral, with instructions on everything to do with the whole show. Now, I wish to enter the fiery furnace as Elizabeth, a fitting finale. I think I ought to check on the funeral director’s policy on funerals for trans ladies. I’d like to be in the coffin wearing my best frock.

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