Back in the closet

Older lesbian and gay people who have been
“out” for many years can find that ageing brings problems in the
form of adverse reactions from care staff and other service users.
Anabel Unity Sale looks at what must be done to confront these
attitudes.

After a lifetime of openness about their
sexuality, lesbians and gay men face a new enemy: their age.
Despite spending decades being out and proud, many older lesbians
and gay men are having to hide their sexuality when they need care.
And there is evidence that many are being forced back into the
closet because they fear homophobic reactions from care staff and
other service users if they come out.

Older
people’s charity Age Concern was so concerned about the needs of
older lesbians and gay men that it organised the first national
conference on the subject last month (News, page 12, 9 May).
Conference speakers and delegates revealed the difficulties this
group face when deciding to use care provision.

Age
Concern director general Gordon Lishman says many older lesbians
and gay men are frightened about not being able to cope with going
into care. “Many fear being with staff and other users who are
homophobic, and it is an understandable fear,” he says.

Molly
Dunn, older lesbian development worker at the Lesbian and Gay
Foundation health and community charity, agrees. “I’ve heard
anecdotal evidence that staff whisper about gay users behind their
backs in a ‘nudge, nudge, wink, wink’ way,” she says.

It can
be daunting for lesbian and gay service users if care staff have
not had sexuality awareness training, says Fran Springfield,
assistant director and head of care at Hill Homes housing
charity.

“If
staff have not been appropriately trained to act and react with
older lesbian and gay residents in appropriate ways, they will not
understand their cultural needs and issues.”

It is
not only the fear of other people’s reactions that stops older
lesbians and gay men being open about their sexual identity. Martin
Green, chief executive of Counsel and Care, says the experiences of
older lesbians and gay men can sometimes make them reluctant to
reveal information about themselves. He says: “For the generation
going into care now, homosexuality was a great taboo when they were
younger.” Sex between men was illegal until 1967 when the Sexual
Offences Act decriminalised it between two consenting men aged 21
or over. Green suggests that older lesbians and gay men are more
cautious about being open about their sexuality compared with their
younger counterparts.

So
what effect does this all have on older lesbian and gay people
receiving care? Springfield says staff failure to consider the
needs of older lesbians and gay residents disempowers these service
users: “All older lesbian and gay men’s ability to be themselves,
and to behave in a way they normally would, is taken away from them
if staff treat them inappropriately.”

Dunn
says homophobic responses from care staff and other service users
can also have a profound impact on older lesbians or gay men: “They
can become isolated, depressed and suicidal.”

The
invisibility of older lesbian and gay people in care homes has
meant they been unable to say what their needs are, says Lishman.
“Many older lesbians and gay men are used to hiding their sexuality
and don’t expect those providing services to be understanding about
it, or to have knowledge of their care needs.”

Another consequence of staff
failing to accept or acknowledge an older person’s lesbianism or
homosexuality is that their partner becomes excluded from their
care. “With gay relationships, the partner is not always assumed to
be the first carer in line,” Green says. Also a lesbian or gay
partner who is not classified as the primary care giver will miss
out on respite support.

Roger
Newman was spurred on to found the Lesbian and Gay Carers’ Network
(LGCN) within the Alzheimer’s Society after his partner David was
diagnosed with dementia eight years ago. They had been together for
30 years. David spent the next six years in residential homes
before his death in 2000.

During
this time, Newman regularly visited David and reminded the staff of
the significance of their relationship. But he says: “I had to
teach staff what we were all about and tell them I had to be the
first line of contact. As time went on they happily accepted the
fact that it was David and I and not just David.”

Two
years on, the LGCN has four volunteers providing a telephone
befriending service to lesbian and gay carers of people with
Alzheimer’s in England, Northern Ireland and Wales.

Clearly, older lesbians and gay
men’s experiences of care homes and home care services are not the
same as those of heterosexual people. The former group’s sexuality
affects how professionals and service users interact with them and
their partner.

Springfield says: “People make an
assumption when you are going into care that you are straight. This
is where problems occur, because it leads to judgements being made
about what is appropriate for you.”

She
adds she is aware of one case when a residential home manager
called two lesbians walking down the corridor holding hands “dirty
pervs”. He had not known that one of the women was feeling unwell
and needed her partner to steady her.

So
what has to be done to ensure reactions like this are not
commonplace, and to meet the needs of older lesbians and gay
men?

Anchor
Homes director Barbara Laing says her organisation is looking at
developing forums for older lesbian and gay residents in its 97
residential homes across England. These would operate in the same
way as the company’s forum for lesbian and gay staff.

She
admits getting older lesbian and gay residents to come out may be
tricky, but stresses they would be completely supported by the
provider if they did.

Springfield urges organisations
should have robust equal opportunities policies applicable to all
staff and residents. If older lesbian and gay residents suffer
homophobic abuse, the provider should not hesitate to act against
the perpetrators.

She
says she leads by example at Hill Homes: “I am an out lesbian, and
because I do all the equal opportunities training for the
organisation’s staff and residents, they see a positive image of
lesbianism.”

Professionals need to be aware if
residents are receiving only same-sex visitors, or none at all,
according to Newman. “If an individual has not come out yet, it
could be appropriate for a professional to say some warm and
accepting words to enable them to feel safe and come out if they
want to,” he says.

Green
says simply asking older people about the most important
relationships in their lives will reveal more about their care
needs. He warns this must not be done in an intrusive
way.

Glenys
Jones, chairperson of the Association of Directors of Social
Services’ older persons committee, says social work principles of
respect for the individual, valuing a person and maintaining
confidentiality should apply to all service users, regardless of
their sexuality. She says the ideal place to ensure these are
adhered to is within councils’ Better Care, Higher
Standards agreements.¹ The charters on long-term
care should contain shared standards for dealing with older
lesbians and gay men receiving care services.

Little
effort is required by providers to meet the needs of their older
lesbian and gay service users, argues Lishman. “Organisations may
not have to start doing new things – they must simply change what
they do now to make it more inclusive.”  

¹Department of Health, Better
Care, Higher Standards: A Charter for Long Term Care, DoH,
2001