By Dr Jolie Keemink, Postdoctoral Research Fellow, University of Kent
There are around 14,200 residential care homes in England alone, set up to provide accommodation and personal care and support to the elderly and others who may find it difficult to manage daily life at home and provide a safe place where residents can be looked after. But peoples' experience of living in a care home is not always the same.
People who identify as lesbian, gay, bisexual, transgender, queer, and other identities (LGBTQ+) regularly face a range of different inequalities when engaging with health and social care services. Care providers often disregard LGBTQ+ identities and relationships, as well as their relevance for care needs. Because of this, older LGBTQ+ individuals have become invisible, are hesitant to access services and face poorer health outcomes than their heterosexual (sexually or romantically attracted to people of the opposite sex) and cis-gender (someone whose internal sense of gender corresponds with the sex of the person was identified as having at birth) counterparts.
All too often, assumptions are still being made that people will have a partner of the opposite sex. And, terms such as 'husband' and 'wife' are used, instead of the more neutral word 'partner'.
People’s relationships are not always taken as seriously as those of heterosexual and cis-gendered people. For example, partners are not always involved in care plans to the same extent, or health and social care workers repeatedly refer to 'partners' as ‘friends’.
It's a sad reality that older LGBTQ+ people are still experiencing overt types of discrimination including: verbal abuse, being told their identity is wrong, being mocked, or in some cases experience physical abuse. There have also been reports of care staff offering to ‘pray away the gay’.
And, for many LGBTQ+ people engaging with health and social care services, they often have to consider whether it will be a safe environment to disclose that part of their identity, or decide to stay ‘in the closet’ to protect themselves.
However, what's become apparent is that these inequalities are mainly being driven by a lack of knowledge and understanding by health and social care staff that then lead of poorer health outcomes for LGBTQ+ individuals. That, despite some progress being made for example, by offering binary male and female options for gender, this is clearly not enough. Many staff who work in this field, lack the adequate training of using inclusive language.
Furthermore, a report published last year, by Compassion for Care revealed how, of the 423 care homes that they received complaints of LGBTQ+ abuse about, almost all (99%) had received a 'good' or 'outstanding' rating from the Care Quality Commission (CQC) - who are responsible for the regulation of adult social care in England. In other words, the lack of LGBTQ+ inclusion seems to go unnoticed, with no clear consequences for care providers.
But we have been making some progress. We were very pleased to welcome the CQC, to one of our recent research meetings to listen to LGBTQ+ elders' experiences of care homes and reflect on the CQC's role in promoting LGBTQ+ inclusion within adult social care.
I believe that regulation can play a vital role in tackling these inequalities - by setting clear and explicit standards and using evidence on LGBTQ+ inclusion.
However, in order for this to be effective, it is also essential that care providers are supported to deliver LGBTQ+ inclusive care. The willingness is often there; we just need to provide the tools, policies, training, and systems to realise actual inclusion.
Further information:
Dr Jolie Keemink is the Lead Researcher of a study called ‘Creating Inclusive Residential Care for LGBTQ+ Elders (CIRCLE), funded by the National Institute for Health and Care Research (NIHR) Applied Research Collaboration Kent, Surrey and Sussex (ARC KSS).
The view expressed in this blog are those of author and not necessarily those of the NHS, the NIHR or Department for Health and Social Care.
The CIRCLE study aims to examine how providers of residential care for older people can be best supported to improve their LGBTQ+ inclusive care offer. As part of the study, the researchers set up a Community of Practice that meets online quarterly to support care providers and other with an interest in this subject to engage in ongoing learning on LGBTQ+ inclusion in care.
The next Community of Practice meeting takes place on 16 April, sign up here. In this meeting, we are hosting Dr Mark Wilberforce, Social Care Researcher at the University of York, who will speak about value-based recruitment of care staff. We will consider how we can ensure in the recruitment process that new care staff are LGBTQ+ inclusive.
If you want to know more about the CIRCLE project, please contact
A glossary of LGBTQ+ terms can be found here.
Dr Jolie Keemink will be presenting the CIRCLE project at the NIHR ARCs national seminar on health inequalities in later life on Wednesday 10 July 2024.
Further information and sign up here.
