Direct payments and lesbian and gay older people

Direct payments should transform the lives of older gay and lesbian service users but anecdotal evidence suggests that is often not the case, writes Anne Gulland

“Can you help me find a gay care worker?” This is a question that Roger Newman, a volunteer on the Alzheimer’s Society’s lesbian and gay telephone helpline, is often asked. But Newman has to disappoint: “Sometimes as a gay person you feel happier and safer with other gay people around, especially when a carer helps with personal and intimate needs. But the answer is ‘no’.”

The personalisation of social services and the introduction of direct payments were intended to help people with particular needs find the care they wanted. Newman, who has cared for two terminally ill gay partners, has a stark message for older gay people who think personalisation will help them access bespoke care.

“If you are assuming that direct payments are going to enable you to employ a gay person, that’s going to be an impossible task,” he says.

A Commission for Social Care Inspection survey last April of gay people of all ages using social care services, found three clear reasons that make direct payments popular: choice and consistency of worker to ensure positive attitudes flexibility over care tasks and times so that people could attend gay events and meet gay friends and control in deciding what to do if a worker is discriminatory.

Imprisoned with a care agency

One respondent who used direct payments said: “I would have been imprisoned with a care agency. I can’t stress that too strongly. I live at home supported by people I recruit who I am very clear with [about] who I am. They don’t change every weekLife has been a thousand times better on direct payments even with its challenges.”

But a recent policy paper by the International Longevity Centre (ILC), a think-tank on issues affecting older people, found that, although direct payments can transform people’s lives, they are not a panacea. The report said direct payments could allow some older lesbian, gay and bisexual (LGB) people to exercise choice, but many might not be equipped to handle the role of employer. It said: “It is imperative that older LGB [people] are made aware that such choices are available and that support is provided to them to ensure that their potential to use direct payments is maximised.”

Report author Primrose Musingarimi says: “With direct payments comes a lot of responsibility that people don’t want to have. A lot of us don’t have experience hiring and firing people. To be an effective user of direct payments you have to be self-confident. Looking at the type of people who use direct payments I wouldn’t be surprised if they were used by people who were educated, empowered and probably younger.”

The report warned that the fear of homophobia among care workers is so serious that it might deter people from seeking help. The report added: “The fear of having their privacy invaded, by a provider of social care who might be homophobic, may lead many older LGB people to avoid seeking access to social care services which may improve their quality of life.”

Musingarimi adds: “Direct payments are a potential tool to help older lesbians and gay people, making them feel that social care is appropriate and useful. There is supposed to be training in how direct payments work but resources are limited. People don’t get the support they need and they don’t feel they can get more information.”

Fear of homophobia

The fear of a homophobic care worker entering the home is a genuine one for many older lesbian and gay people, says Steve Pugh, a lecturer at Salford University and former social worker. He is undertaking a PhD on the statutory response to the needs of older lesbians and gay men. One lesbian told him she “degayed” her flat, removing objects that could reveal her sexuality, before the arrival of a new care worker.

“She was terrified of her home care workers establishing she was a lesbian,” he says. He believes that for older lesbians and gay men fear of homophobia is a reflection of the age they grew up in, when homosexuality among men was a crime and, even after the law was changed, society rejected same-sex lifestyles.

“It’s only in the past 10 to 12 years that things have moved apace in terms of rights and levels of acceptance,” says Pugh. “The conversation I have been having in Manchester is that the agencies have to acknowledge that there may be additional costs attached to older lesbian and gay people undertaking direct payments. The agencies have tended to look at me blankly.”

This is probably because they don’t realise what these extra costs can be: if an older lesbian or gay man does find a gay care worker, or at least a gay-friendly one, he or she might live a taxi ride away, requiring further expense. Because the gay scene is generally geared towards younger people, older lesbians and gays may have to travel further to socialise with their community, again entailing extra expense.

Although finding a gay care worker is the ultimate goal of many gay people it is up to care providers to ensure they are inclusive. Newman thinks the social care profession as a whole has to be more open.

“One of the problems is that you don’t get many professionals who are openly gay. I find when I go to conferences the gay [professionals] are happy to come and talk to me privately but they’re not known to be gay in their professional situation.

Lack of support

“Most older gay men do live alone and as you get older you have social and medical needs. In some areas there are gay outreach workers for older people but they tend to be in the conurbations, not in the country or small towns.”

Newman’s partners each died before direct payments were introduced but he would have liked the flexibility that they offered. As an older gay man who is confident, he would have been in a good position to negotiate terms and conditions that he was comfortable with. Hiding their sexuality is something that most older gay men and lesbians have become used to – and this is no different when it comes to their care needs.

The ILC report further warns of the potential for social isolation among older gay men and lesbians. They are more dependent on formal care services than their heterosexual counterparts because they are less likely to have informal carers such as children and/or partners.

Mental health needs

Gay people might talk of their “family of choice” – a network of friends – but these networks are less likely to provide care than partners or family. Older gay people are also more likely to be single than heterosexuals. Antony Smith, national development and policy officer for older gay men, lesbians and bisexuals at Age Concern, says these clients are more likely to have mental health problems, and to smoke and drink, so their care needs are greater.

“The notion of being able to pick and choose your own carer or care worker has the potential to be of huge benefit to older lesbians and gay men. It’s not about the particular care needs that gay people have that are different from heterosexuals. It’s about how that care is provided. There’s a fear that people may have to go back into the closet – in most cases that fear is probably unjustified but it doesn’t make it any less real.”

More on equality and diversity good practice

ILC policy paper