Topic Building Community Capacity 3

Creating inclusive care home environments for older LGBT+ residents

Author Dr Wenjing Zhang and Dr Paul Willis

In care and nursing homes, older lesbian, gay, bisexual, transgender/transsexual plus (LGBT+) people can often be invisible, and their personal lives, histories and relationships can be hidden behind ageist and heterosexist/cisgenderist assumptions.

The 17 May marked IDAHOT Day (International Day Against Homophobia, Transphobia and Biphobia). This is a significant day for a number of reasons. For LGBT+ groups and organisations, it’s about recognising and speaking out against the violence and discrimination experienced by lesbian, gay, bisexual, transgender, intersex and all other people who belong to sexual and gender minority groups around the world. The 17 May also marks the date when the World Health Organisation decided to declassify homosexuality as a mental disorder in 1990 (subsequently removed in 1992) – another successful challenge to institutional homophobia.

The UK government’s recent survey of over 108,000 LGBT+ respondents shows us that we still need local and international campaigns against sexuality and gender-based violence and discrimination. The survey reports that 68% of respondents with a minority sexual orientation said they had avoided holding hands in public with a same-sex partner for fear of a negative response. 40% of respondents had experienced a hostile or violent incident in the 12 months before the survey because they were LGBT+.

In the UK, LGBT+ people who are over 60 years of age have lived through decades of criminalisation (until partial decriminalisation of sex between men in 1967), pathologisation (treatment of homosexual as a mental disorder and ‘unhealthy lifestyle’) and social and moral condemnation of same-sex relationships and desires across communities. For older lesbians, their existence has only been recently recognised in law with the implementation of equal rights law over the last 18 years. For transgender individuals, the Gender Recognition Act 2004 finally enabled people with a medical diagnosis of gender dysphoria to change their legal gender and marked a shift in the state starting to protect the civil rights of trangender individuals.

Living in a hostile and oppressive climate across one’s lifetime can lead to deep mistrust and low confidence in legal bodies, institutions and helping professionals, such as mental health professionals, GPs, social care workers and housing officers. We know from Stonewall research conducted in 2011 that older LGB adults (55+) report lower confidence in health and social care professionals compared to heterosexual older adults – in turn this may prevent older LGBT+ individuals from seeking health and care support from service providers when they need it later life.

In care and nursing homes, older LGBT+ people can often be invisible, and their personal lives, histories and relationships can be hidden behind a double-layered curtain of ageist and heterosexist/cisgenderist assumptions. Organisations such as Age UK and Opening Doors London are working hard to challenge these assumptions and to create safer, more equal environments for older LGBT+ people across services, including care and nursing homes. We’ve sought to make our own contribution to creating inclusive care environments for older LGBT+ people with the creation and launch of our new online learning resource titled ‘Care under the Rainbow'.

The University of Bristol and The Diversity Trust recently jointly hosted the ‘Care under the Rainbow Launch Event’. This launch showcased a new open access online resource for care home staff and managers for making care homes more inclusive for older people who identify as LGBT+. The aim of this new resource is to provide managers and staff teams with tools for leading discussions and educational sessions about the importance of promoting equality between residents in care homes and of valuing diversity amongst staff and residents.

This new resource includes four short films on the inclusion of LGBT+ residents (care home staff talking, lesbian, gay and bisexual inclusion, creating trans inclusion and Werner and Alan’s story), case studies for use in staff training and development, top tips and things you can do for making care homes more inclusive, and legal timeline highlighting key changes in equality law and policy in England and Wales. The resource has been co-produced by LGBT+ individuals with the involvement and advice of older LGBT+ individuals and the work has been supported by a wide range of organisations, including Skills for Care and Stonewall Cymru.

Ways in which care home managers and staff might use the learning materials:

  • Staff team meeting – watch the films together and/or discuss case studies to raise discussion about the importance of respect of equality and diversity among residents.
  • Recruitment exercise – use one of the case studies in interviews with new staff members as a way of assessing applicants’ attitudes and values.
  • Induction – request new staff to view the films, read the documents online and discuss case studies together to gauge how new staff members would respond to residents from similar backgrounds.
  • Continuous professional development – organise a half-day training session for all staff. Start with watching the films together, test participants knowledge of the law with the legal timeline and finish with discussion of the case studies in pairs or small groups.

We were delighted that a diverse audience came along to participate in the launch event including care home staff and managers, and members of the LGBT+ community. Following the launch, we are disseminating the learning resource to a wider audience, including care and nursing homes across South West England and South Wales, and would like to explore future research and practice-focused collaborations.

If you would like to find out more information about the launch event and project story, please search our Twitter hashtag #careunderrainbow or visit the project website. We would also love to hear your feedback on the learning resource. Please contact:

Care Under The Rainbow

Dr Wenjing Zhang and Dr Paul Willis

Dr Wenjing Zhang and Dr Paul Willis work for the School for Policy Studies, University of Bristol.