Table 3.
Summary of Results for Lesbian, Gay, Bisexual and Transgender (LGBT) Individuals’ Perspectives on LGBT Issues in Long-Term Care
| Authors | Main findings |
|---|---|
| Butler (2017) | Fear of discrimination from LTSS staff: •Although home care workers were interviewed in this study, findings focused only on perspectives of lesbians. •Participants generally did not disclose their sexual orientation to home care workers. Some assumed their sexual orientation was apparent. •Lesbians (n = 5) who reported experiencing homophobia from home care workers were able to eventually find home care workers with whom they were comfortable. •Two participants stated they had home care workers who were uncomfortable providing care to them due to religious reasons.Potential barriers and solutions to LGBT-inclusive LTSS: •Only seven lesbian participants reported they would prefer lesbian home care workers. •Having a lesbian home care worker did not necessarily guarantee improved care. •Participants felt more affordable LTSS and increasing salary of home care workers would improve overall quality of home care. |
| Butler (2018) | Concern about LTSS planning: •Most lesbians reported strong informal support networks. •Half of those not partnered reported some level of isolation. Two participants felt their isolation was related to homophobia in their communities. •Half of the caregivers (n = 3) interviewed reported they felt the home care agencies expected them to perform many tasks. Caregiving was described as physically and emotionally exhausting at times and one participant stated caregiving interfered with her work responsibilities. •One-fourth (n = 5) of participants reported experiencing homophobia from home care workers. •85% (n = 17) of participants reported good relationships with home care workers.Potential barriers and solutions to LGBT-inclusive LTSS: • Ideal qualities in-home care workers included: maturity, caring, reliable, and competent. In fact, 30% (n = 6) stated they had become friends with their home care workers. |
| Clark et al. (2010) | Concern about LTSS planning: •Most participants had planned at least one LTSS strategy, and more than half of participants had implemented at least two, including executing a will and naming a health care proxy. •There was no statistically significant about attitudes toward LTSS between sexual minority women and unmarried heterosexual women. •Most sexual minority women had spoken to their informal support networks regarding LTSS arrangements rather than their biological families. |
| Gabrielson (2011) | Fear of discrimination from LTSS staff: •Past negative experiences with heterosexism and homophobia combined with positive experiences within the LGBT community and families of choice affected lesbian’s preference for LGBT-friendly LTSS facilities. |
| Hash and Netting (2007) | Concern about LTSS planning: •Older lesbians and gay men were likely to plan ahead for LTSS. • Lesbians and gay men viewed advance directives and future plans as a means of protecting themselves and their partners.Fear of discrimination from LTSS staff: •Participants feared to disclose their sexual orientation in nursing homes. •They did not feel nursing homes would respect the rights of their same-sex partners. |
| Jackson et al. (2012) | Fear of discrimination from LTSS staff: •Both heterosexual and LGBT participants suspected LGBT older adults experienced greater discrimination in long-term care settings. • LGBT respondents were more likely than heterosexuals to feel they had less access to LTSS.Potential barriers and solutions to LGBT-inclusive LTSS: •LGBT participants were also more likely to report they believed LGBT health training would improve staff behaviors and attitudes and that LGBT-exclusive retirement communities would be beneficial for the community. |
| Jihanian et al. (2013) | Potential barriers and solutions to LGBT-inclusive LTSS: •Participants believed LTSS providers should be aware of identified sources of support for LGBT residents and other issues relevant to their care. •The importance of understanding the appropriate terms to use when caring for LGBT residents was highlighted as a way to promote inclusivity. |
| Johnson et al. (2005) | Fear of discrimination from LTSS staff: •LGBT individuals identified administration, staff, and residents of retirement care facilities as potential sources of discrimination.Potential barriers and solutions to LGBT-inclusive LTSS: •Participants believed LGBT training for staff could improve care in retirement care facilities. •They expressed a strong desire for LGBT specific or LGBT-friendly LTSS facilities. |
| Lowers (2017) | Fear of discrimination from LTSS staff: •Participants lacked confidence in the healthcare system to promote dignity and respect at the end of life. •Participants who were single worried about having individuals to advocate for their needs at end of life. •Most LGB participants were out to their primary care providers, although some felt their sexual orientation was not important to their care. • One transgender woman did not feel LTSS staff would understand her medical needs (i.e., gender-affirming hormone therapy and physical health needs). |
| Putney et al. (2018) | Fear of discrimination from LTSS staff: •Participants expressed concerns regarding safety in nursing homes, particularly they felt they would have to conceal their identities to avoid discrimination. •Participants were very concerned about potential mistreatment and social isolation in nursing homes. •They also feared psychological distress, including suicidal ideation, related to stressors of living in nursing homes.Potential barriers and solutions to LGBT-inclusive LTSS: •Preferred nursing homes to be LGBT friendly, not necessarily exclusively LGBT. •Participants believed that having out LGBT staff in nursing homes might improve care for LGBT residents. Some participants preferred to be cared for by LGBT staff. •Inclusive language on forms and organization mission statements as well as advertised training in LGBT health would increase make them aware if nursing home was LGBT inclusive. |
| Smith et al. (2010) | Fear of discrimination from LTSS staff: •Not a single LGBT participant stated they viewed nursing homes as LGBT-friendly environments. •Nursing homes were viewed as unfriendly and even hostile to LGBT residents. •LTSS cited as the single need most likely need to be unmet as participants aged. |
| Stein et al. (2010) | Fear of discrimination from LTSS staff: •Lesbian and gay participants feared being neglected or treated worse than heterosexual residents by care providers, particularly aides. •Fear of being rejected by other residents or concealing their sexuality was also discussed.Potential barriers and solutions to LGBT-inclusive LTSS: •LGBT-friendly or exclusive care environment and increased training for staff were recommended as ways to increase acceptance of LGBT residents. |
Note: LTSS= long-term services and supports.