LGBTQ+ Precarity in Nursing Homes

LGBTQ+ Precarity in Nursing Homes

Discussions regarding the care of elderly LGBTQ+ populations have been recent developments. The global visibility of non-heterosexual populations with political gay rights activism has contributed to the increasing relevance of this topic. Public and privatized healthcare systems throughout the world are influenced heavily by the concept of heterosexual aging. Heterosexual aging refers to the assumed heterosexual and cisgender norms in geriatric care (“Transforming the Invisible” 2). For elderly LGBTQ+ individuals, whose care is dependent on a small handful of nursing staff, the cis-heteronormative system leads to the repression of sexual or gender identity (Silva Jr. et al. 2). Some documented acts of homophobia and transphobia by health professionals and other residents of nursing homes include the delegitimation of stable unions, separation of couples, loss of autonomy in the dressing and treatment of patients with neurological issues, restrictions on displays of affection, and prohibitions on bathing with other residents of the same gender (Silva Jr. et al. 6).

Structural violence is a form of violence in which one or more social structures or institutions contribute to silencing and harming vulnerable populations by creating disadvantages that prevent them from meeting their basic needs. Elderly LGBTQ+ adults are impacted by the aftermath of the HIV/AIDS epidemic as the same political leaders remain in power, which impacts the public health response to COVID-19 (Faas et al. 416). Ageism and ableism dominated public discourse about COVID-19 as statistics were shrugged off as only impacting older adults and those with preexisting conditions. Furthermore, institutional violence is a subset of structural violence that reveals itself in the heteronormative organization of healthcare and nursing homes. Institutional violence refers to the structural oppression by institutions that normalize covert violence against stigmatized or marginalized groups. This constitutes violence as neglect and ignorance contribute to poor care for an already vulnerable population. LGBTQ+ individuals have unique health risks and complications that add specificities to their care compared to heterosexual cisgender populations. To demonstrate, older homosexual men are recommended to undergo screening for anal cancer, and HIV-positive individuals are advised to undergo yearly anal Pap smears (“An Approach” 53). Given the lack of comprehensive sexual education, STI prevention measures and screening must be discussed with older adults. Poor sexual health, while caused by insufficient knowledge, reinforces stereotypes about the prevalence of AIDS amongst LGBTQ+ residents. These stereotypes may add to lower self-esteem and social participation due to the stigmatization of those with HIV or STIs.

Additionally, complications of hormone treatments regarding the transitioning process may produce harmful effects and health risks that require nursing home staff to take preventative measures, considering LGBTQ+ populations are at risk for certain ailments. For example, those who have taken hormones, are at greater risk of developing osteoporosis, requiring bone density screenings in residents over the age of 65 years. Likewise, older cisgender lesbians may have higher rates of obesity and nulliparity compared to heterosexual peers, which places them at an increased risk of developing breast cancer (“An Approach” 52). Nulliparity refers to people who have not given birth and is linked to the development of reproductive cancers. Nevertheless, the culture of inaccessibility and fear surrounding those labeled as gender or sexual minorities contribute to few adults disclosing their sexual or gender identity to health professionals. Commonly cited reasons were fear of negative reactions, lack of confidence in the healthcare system, and concern over worse quality of care after disclosure (“An Approach” 52). In this situation, the stress of concealing one’s identity or sexual practices can negatively impact quality of life and active aging. As nonheterosexual individuals show higher rates of depression, suicidal ideation, substance abuse, and hypertension, models of heterosexual aging do not encapsulate their health risks and complications (“Transforming the Invisible” 2). Professionals in noninclusive nursing homes are currently unequipped to intervene in unsafe situations of bullying and oftentimes reinforce discrimination against perceived minorities (Silva Jr et al. 3). 

Likewise, long-term care institution residents have been known to have a lower quality of life with LGBTQ+ elders facing the isolating effects of institutionalization, the stigmatization of aging bodies, and prejudice in regards to their gender or sexual identity (Fasullo 1087). LGBTQ+ elders are more likely to live alone, be socially isolated, and have a lack of familial support as many have been disowned for their identity. Due to the significant correlation between higher quality of life for the elderly and their relationship status, where partnered individuals have the highest quality of life, this lack of relationships reinforces loneliness and negative health outlooks (Figueira et al. 122). In general, older adults are perceived through a lens of asexuality that characterizes any expressions of sexual desire to be non-normative, which can contribute to the further ostracization of non-cisheterosexual relationships. With the personalized aspect of this care, untrained staff are situated to commit microaggressions from using the wrong name to breaching confidentiality guidelines. 

Addressing the care of LGBTQ+ elderly, there are two emerging approaches, which are the separate-but-equal model and the together-but-different model (“An Approach” 54). Without healthy support networks, LGBTQ+ elderly are at risk for high levels of stress, depression, and suicidal ideation. The creation of segregated safe spaces for LGBTQ+ older adults would further otherize them from the heterosexual cisgender population, which would be especially damaging to LGBTQ+ elderly placed in noninclusive spaces by unsupportive family members. Instead, all nursing homes should employ staff sensitivity training and LGBTQ+ specific informed care to create a safer environment where older adults feel comfortable exploring their sexuality and gender if they so desire. Geriatric sensitivity can be broadened to include developing the skill to recognize and empathize with LGBTQ+ elderly. Likewise, staff must have an awareness of how stigmatization can play out in medical contexts, such as the harm of screening residents for HIV, AIDS, and STIs on account of their sexual or gender identity. This impacts the quality of treatment for LGBTQ+ individuals and increases self-perceptions of a negative health status. An approach recommended for nursing staff to make a safe and comfortable environment in nursing homes is active listening (“An Approach” 53). Active listening is a communication skill that emphasizes making a conscious effort to hear, understand, and retain the information shared. In geriatric care, this is expanded further to include demonstrating interest and empathy, asking questions, and using the same descriptor words as the resident for relationships and identities (“An Approach” 53). Nursing homes can be used to build community amongst residents and facilitate beneficial social interactions. Full social inclusion should not be limited to cisgender and heterosexual residents.

Works Cited

Crenitte, Milton, et al. “An Approach to the Peculiarities of Lesbian, Gay, Bisexual, and Transgender Aging.” Geriatr Gerontol Aging, vol. 13, no. 1, 2019, pp. 50-56.

Crenitte, Milton, et al. “Transforming the Invisible into the Visible: Disparities in the Access to Health in LGBT+ Older People.” Clinics, vol. 78, 2023, pp. 1-7.

Faas, A. J., et al. "Aging Queer in a Pandemic: Intersectionalities and Perceptions." Disaster Prevention and Management, vol. 31, no. 4, 2022, pp. 411-424. ProQuest, http://mutex.gmu.edu/login?url=https://www.proquest.com/scholarly-journals/aging-queer-pandemic-intersectionalities/docview/2698596621/se-2, doi:https://doi.org/10.1108/DPM-06-2021-0196.

Fasullo, Katherine, et al. “LGBTQ Older Adults in Long-Term Care Settings: An Integrative Review to Inform Best Practices.” Clinical Gerontologist, vol. 45, no. 5, 2022, pp. 1087–102, doi:https://doi.org/10.1080/07317115.2021.1947428.

Figueira, Olivia, et al. "Quality of Life in Brazilian Elderly: An Analysis of Healthy Aging from the Perspective of Potter's Global Bioethics." Global Bioethics, vol. 32, no. 1, 2021, pp. 116-129. ProQuest, http://mutex.gmu.edu/login?url=https://www.proquest.com/scholarly-journals/quality-life-brazilian-elderly-analysis-healthy/docview/2621818771/se-2, doi:https://doi.org/10.1080/11287462.2021.1966975.

Silva Jr. et al. "Health Care for LGBTI+ Elders Living in Nursing Homes." Revista Brasileira de Enfermagem, Suppl. 2, vol. 74, 2021, pp. 1-9. ProQuest, http://mutex.gmu.edu/login?url=https://www.proquest.com/scholarly-journals/health-care-lgbti-elders-living-nursing-homes/docview/2531366000/se-2, doi:https://doi.org/10.1590/0034-7167-2020-0403.