Having suffered profound discrimination in their youth, many older LGBTI people are fearful of mainstream care services. Here, home care organisations share their strategies for successfully adopting inclusive practices.
Noel Tovey was just 17-years-old when he arrested and imprisoned for the “abominable crime of buggery.” Noel had gone to a party one night, but the fun ended abruptly when police carried out a raid.
Noel is just one of the “extraordinary and yet relatively commonplace” stories that older lesbian, gay, bisexual, trans and intersex (LGBTI) people have shared with Dr Catherine Barrett, coordinator of the sexual health and ageing program at La Trobe University and a long-time researcher in the needs of older LGBTI people.
Dr Barrett has heard stories of people who disclosed their sexual orientation and were sent to psychiatric institutions and given shock therapy. She heard from gay men who were entrapped by undercover police officers and put in prison. She heard from people who had been disowned by family and friends; people who had lost their jobs. And she spoke to people who lost partners to suicide.
Key societal structures during that period – such as psychiatry, medicine and the law – reinforced that discrimination against LGBTI people.
It is unsurprising, then, that many of the current generation of older LGBTI people are mistrusting and fearful of mainstream care services.
In recognition, a growing number of community and aged care services are availing of the plethora of resources and programs available to help their services become LGBTI inclusive, a process which ultimately strives to make LGBTI people feel welcome and safe.
At the inaugural LGBTI Ageing and Aged Care Conference in October 2014, community and aged care organisations shared their strategies for becoming LGBTI inclusive.
The conference was organised by Dr Barrett and her colleagues at Val’s café, a project that provides training and resources to support agencies in becoming LGBTI inclusive.
The rainbow tick
Chief among the strategies to enable community services to become LGBTI inclusive is the Rainbow Tick, a system of accreditation against national standards for LGBTI inclusive practice, developed by Gay and Lesbian Health Victoria (GLHV).
The Rainbow Tick is an external process of accreditation, where services are assessed to show both they are both LGBTI friendly and competent, according to Sunil Patel, manager of training and information at GLHV.
GLHV also provides the How2 training program, a series of four workshops delivered over six months, for organisations that might be preparing for Rainbow Tick accreditation.
Patel said that GLHV worked with Quality Innovation and Performance from 2009 to 2012 to develop the Rainbow Tick standards and accreditation process. They also developed a self-assessment audit tool for services.
In 2013, the first two agencies in Australia received the Rainbow Tick, one of which was City of Stonnington Aged Care.
A three-year process
According to Angela Clarebrough, assessment and services coordinator at City of Stonnington Aged Care, it took three years of “hard work and staff passion and commitment to LGBTI inclusiveness” for the organisation to achieve the Rainbow Tick.
The journey began in 2009 when an organisational survey provided feedback that services needed to be more responsive to LGBTI people’s needs. An action plan to identify key issues was developed, Clarebrough said.
Initial research into needs of LGBTI was conducted, and staff participated in the How2 program.
Clarebrough said that the provider’s assessment service was a key point when communicating a message of welcome to all clients. “We realised that most LGBTI people contacting the service were invisible to the service and therefore we needed to make a special effort to communicate a message of welcome regardless of whether they chose to disclose” [their sexual orientation or gender identity].
Staff soon recognised the importance of maintaining awareness of LGBTI health and wellbeing, she said. “LGBTI inclusive practice cannot just rest in our hearts and minds; the promotion and provision of a safe service needs to be conveyed in an authentic manner and at all points along the service continuum.”
Within the provider’s brochures, handbook, website and emails are subtle messages of welcome. Nonetheless, Clarebrough added that it was human interaction that made intake and assessment crucial; if this failed, the LGBTI person may not feel confident or welcome and decline to access services.
“Our assessment services continue to explore new ways of achieving best practice directly with LGBTI clients… The team has developed LGBTI inclusive practices for both intake and in-home assessment, which includes discussions around diversity and LGBTI inclusivity as part of their everyday interaction with clients.”
Driven by staff
Staff meetings provide ways for teams to share ideas and information to develop their individual practice. Regular opportunities for peer learning have facilitated a commitment and passion which is evident in personal accounts of how LGBTI inclusive practices are being integrated, Clarebrough said.
The wearing of a rainbow pin and LGBTI inclusive badges by staff has demonstrated “public acknowledgement of inclusion”. Care staff have reported that wearing the rainbow pins provides a daily reminder to maintain their awareness regarding LGBTI inclusivity, while assessment officers have found that wearing a rainbow pin can initiative a conversation about inclusivity, she said.
“To maintain awareness, the organisation utilises a range of resources and programs. New resource information, LGBTI publications and newsletters are made readily available for all staff.”
There has also been the emergence of “LGBTI champions” who are facilitating ongoing awareness and education, she said.
City of Stonnington Aged Services also celebrates days of LGBTI awareness; this year it marked the international day against homophobia and transphobia with a rainbow themed morning tea, with proceeds going to Gay and Lesbian Switchboard.
Clarebrough said the organisation also promoted LGBTI awareness among its stakeholders and community networks, encouraging other community agencies to embed LGBTI inclusive practices within their services.
“Stonnington Aged Services continues on the journey of integrating LGBTI inclusive practices,” she said. Keeping the issue on the agenda created ongoing opportunities for staff to build capacity to further integrate inclusive practices into their interactions with clients.
“Developing and embedding inclusive services requires ongoing dedication and commitment with many rewards along the way.”
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Tips for an inclusive service
Pauline Crameri from Val’s Café at LaTrobe University provided the inaugural LGBTI Ageing and Aged Care conference with some examples of the standards for LGBTI inclusivity in practice:
Standard 1- Organisational capability: Make sure everyone in the organisation is part of the journey; articulate to all staff the vision and commitment to LGBTI inclusive practice.
Standard 2 – Cultural safety: Ensure everyone in the service understands LGBTI people’s history, how this has influenced the visibility of older LGBTI people; understanding this history will bring the service closer to meeting their needs.
Standard 3 – Professional development: Develop an education program that moves beyond a once-off training session; embed messages into other educational opportunities; keep it on agenda to ensure LGBTI inclusive practice is lived.
Standard 4 – Consumer consultation: Older people may not wish to out themselves to the service so provide safe opportunities for them to participate in the conversation; be clear about what you want to know and how you will use it; be patient.
Standard 5 – Documentation and disclosure: Ensure all stakeholders are aware that disclosure is not the aim of LGBTI inclusive practice, rather it is providing safe and inclusive service; develop and communicate procedures around documentation and disclosure; if someone discloses their sexual orientation or gender identity, clarify with that person who the disclosure is to be shared with.
Standard 6 – Access and intake process: The essence is really around creating a welcoming environment; communicate commitment to LGBTI inclusive provision in as many ways as possible; LGBTI seniors will be looking for signs so be explicit in your communication and provide welcome they need and deserve in all points in the service journey.
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- Val’s Café has a range of research, resources and initiatives to support organisations and staff. These include the HACC Pack, for home and community care workers, and the CAC Pack, for community aged care services. It also has the aged care specific self-assessment and planning tool (SAP Tool)
- The National LGBTI Health Alliance has information on training and the national LGBTI ageing strategy.
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This report first appeared in the January 2015 Community Care Review