CARE OF THE OLDER PERSON
Caring for older lesbian, gay and bisexual people Ian Peate
Ian Peate is an Independent Consultant Email: [email protected]
Health needs of older LGB people The LGB community is diverse. Lesbian, gay and bisexual people are not a homogeneous group; they comprise a wide range of people from different ethnicities, age groups, socioeconomic statuses and identities. As such, they should be seen as heterogeneous. The LGB community is brought together as a group of social and gender minorities who can and do experience stigma and discrimination. They come from a number of cultural backgrounds and live as a part of each of these backgrounds. With respect to health care, there is a long history of discrimination and lack of awareness of health needs by health professionals, including nurses (Fish,
AbstracT
Ageing brings about a number of challenges for heterosexual, lesbian, gay and bisexual people. It can be a time of anxiety and concern. The expectations that many lesbian, gay and bisexual people have of how they would like to be cared for if they were to enter sheltered housing or other forms of residential care can be very different from the expectations of heterosexual people. This article considers issues that older lesbian, gay and bisexual people may encounter with regard to their health-care needs.
KEY WORDS Equity w discrimination w individuality w respect w assessment
372
2007). As a result of this discrimination, LGB people face a number of challenges in accessing culturally competent health services as well as achieving the highest possible level of health (Ard and Makadon, 2012). Older people are almost always assumed to be hetero sexual and, as a result of this misunderstanding, older LGB people are frequently invisible when it comes to service provision for older people. All older people can experience social isolation through, for example, bereavement, loss of work or ill health. For the older LGB person, these experiences are sometimes made worse by a lack of social support and a fear of prejudice that has been experienced over a number of years (Power et al, 2010).
Stonewall survey Stonewall (2011) commissioned YouGov to survey a sample of 1050 heterosexual people and 1036 LGB people over the age of 55 years across Britain, inquiring into their experiences and expectations of getting older and examining personal support structures, family connections and living arrangements. The survey identified that gay and bisexual men aged 55 years or older are nearly three times more likely to be single than heterosexual men. Forty-one per cent of LGB people over 55 live alone, compared with 28% of heterosexual people. Just over 25% of LGB people over 55 have children, whereas this figure is 9 in 10 for the older heterosexual population. Gay and bisexual men are twice as likely to have been diagnosed with depression and anxiety as heterosexual men. Three in five LGB people over 55 are not confident that social care and support services would be able to understand and meet their needs. Approximately 50% of LGB people over 55 would be uncomfortable being open about their sexuality with care home staff. As a result of these findings, older LGB people may have a greater need for health and social-care services compared with their heterosexual counterparts.
Residential care The assumption that everyone living in a residential care home is heterosexual is misguided. Age Concern (2006) estimates that 1 in 15 of the population is lesbian, gay or bisexual. Heath (2012) suggests that, in a 120-bed care home, using the data provided by Age Concern (2006),
© 2013 MA Healthcare Ltd
O
lder lesbian, gay and bisexual (LGB) people are no different from the rest of the ageing population. There are no specific lesbian, gay or bisexual diseases or conditions. However, older LGB people do have distinctive needs as they get older, and often find themselves in different circumstances from their heterosexual counterparts. Ageing can be more complicated for LGB people as they are more likely to face the prospect of being alone or to have less personal support than their heterosexual contemporaries. Little is known about the UK LGB population with regard to their physical and mental health outcomes, their use of health and social services and their experiences of health and social care more generally. There is very little data available that offer a comparison between the LGB and heterosexual populations. There is even less evidence available concerning older LGB people per se (Ward et al, 2010).
British Journal of Community Nursing Vol 18, No 8
Journal of Community Nursing. Downloaded from magonlinelibrary.com by 138.253.100.121 on November 25, 2015. For personal use only. No other uses without permission. . All rights re
CARE OF THE OLDER PERSON
© 2013 MA Healthcare Ltd
this figure would equate to 8 LGB residents. LGB people who live in care homes are generally an invisible group and those who provide care can respond to the needs of this population in a number of ways. Their responses can range from a general acceptance to overall neglect of the needs of LGB people (Price, 2010; Heath, 2012). Fish (2007) enumerates the concerns that many older LGB people have with regard to health care. One of the biggest concerns is over the possibility of them requiring residential care. Johnson et al (2005) point out that concerns centre on the lack of dedicated accommodation in the UK. There are currently no specialist housing options for older LGB people in the UK (Age UK, 2011). Issues and concerns also focus upon the possibility that some care staff and other residents may foster discriminatory attitudes toward older LGB people, which can be particularly problematic when living in close proximity. It is possible that an older LGB person could be the only non-heterosexual person living in a home. This could result in them becoming isolated, and they may resort to concealing their sexual orientation. In some residential settings, the sexual expression of residents is commonly problematised, leading to circumstances where older LGB people may be especially vulnerable to discriminatory treatment (Ward et al, 2010). The Commission for Social Care Inspection (2008) identifies that providers in sheltered and residential care often demonstrate limited awareness and understanding about sexual orientation.
be unable to make decisions about their care for themselves. Care homes should make environments more welcoming by displaying images, posters and materials depicting LGB people.
Working in partnership with older LGB people
Equality rights in the UK
Stonewall (2011) report that older LGB people can sometimes feel that those who provide services will not be able to understand and meet their needs: w Three in five are not confident that paid carers or housing services would be able to understand and meet their needs w More than two in five are not assured that mental health services would be able to understand and meet their needs. w One in six is not confident that their GP and other health-community services would be able to understand and meet their needs. The upshot of this is as follows: w Approximately 50% report that they would be uncomfortable being open about their sexuality to carehome staff w More than two in five are not assured that mental health services would be able to understand and meet their needs w One in six is not confident that their GP and other health community services would be able to understand and meet their needs. w One third would be uncomfortable with being open about their sexuality to a housing provider, member of hospital staff or a paid carer w Approximately one in five would not feel at ease disclosing their sexual orientation to their GP.
Since the introduction of the Civil Partnership Act in 2005, same-sex couples enjoy similar rights as those given to heterosexual married couples. Same-sex couples are therefore permitted to occupy accommodation together in residential care homes. Those responsible for delivering frontline services in residential care homes should apply the same polices and procedures to same-sex couples who want to live together in care homes as those applied to heterosexual couples. They must also be aware that it is important to understand that equality of opportunity means recognising difference (Opening Doors in Thanet, 2003). As is the case with heterosexual couples, same-sex couples should be allowed private time and permitted to show affection for one another. Clear policies on what is acceptable and unacceptable behaviour from patients should be developed, and care homes should deal firmly but sensitively with episodes of homophobia from patients and staff. Training should be provided to staff so that they can understand the needs and circumstances of the older LGB person and how to offer them good quality care. LGB residents should be provided with opportunities to socialise and meet other LGB people, thereby helping them to maintain social support networks. Staff should ensure that older LGB people have stipulated who should be given decision-making powers, should they
Many community nurses already work with older LGB people, but they may not be aware of this. Older LGB people can feel very vulnerable about being open when it comes to their sexual orientation. It is often necessary for LGB people to pass as heterosexual. This is a survival strategy for those who have lived through times when same-sex behaviour was a criminal act carrying the risk of imprisonment, losing one’s job, one’s children or contact with one’s family of origin (Fish, 2007). Community nurses should be aware of the fact that some older LGB people may be concerned for their own safety if their sexual preference is revealed—they may feel more vulnerable to harassment or attack. Users of older people’s services can be reluctant to ‘come out’ because other people may pass this information on to the community at large. Indeed, 36% of LGB people aged 60–91 years have been subjected to verbal abuse (Age Concern, 2006). It is also important to be aware that older LGB people may use other terms to describe themselves and their relationships. They may, for example, refer to a ‘friend’ rather than a ‘partner’. Awareness of this can help in understanding people’s needs and may encourage appropriate responses. Heaphy et al (2003) point out that only 14% of older LGB people are open about their sexuality with people who provide health care. If health-care providers continue to make the assumption that all older people are heterosexual, failing to take into account the needs of the LGB population, then it
British Journal of Community Nursing Vol 18, No 8
373
Journal of Community Nursing. Downloaded from magonlinelibrary.com by 138.253.100.121 on November 25, 2015. For personal use only. No other uses without permission. . All rights re
CARE OF THE OLDER PERSON
Commissioners and care providers The 2010 Equality Act, most of which came into force in October 2012, replaced earlier anti-discrimination laws with a single piece of legislation that had the intention of making the law simpler and more consistent. The act covers nine protected characteristics that cannot be used to treat people unfairly. The protected characteristics are w Age w Disability w Gender reassignment w Marriage and civil partnership w Pregnancy and maternity w Race w Religion or belief w Sex w Sexual orientation. The public sector duty of equality demands that public bodies consider all individuals (including their own employees) when carrying out their day-to-day work in shaping policy and in delivering services. It requires public bodies to give due regard to the need to eliminate discrimination, improve equality of opportunity and promote good relations between different people when carrying out their activities. Health and care systems help people to lead healthier lives,
LEARNING POINTS w The unequal treatment of any group of people is unacceptable and
can bring with it clear and identifiable human costs w In order to ensure that older lesbian, gay and bisexual people’s concerns and experiences are given just consideration, community nurses need to develop a deeper understanding of the needs of this community w The delivery and commissioning of services in the health and care sectors are changing w If the NHS is to deliver world class commissioning then the devolvement of decision-making processes must be taken to the people who require services w Community nurses, those who develop policy and commissioners must recognise sexual identity as a significant factor influencing access to and use of services
374
to make a positive recovery from illness and to live better and longer into old age. All people using care and support services now have more control over the services they use. Community nurses have a professional duty to work together to provide fair and equal access to high-quality services in response to patients’ individual needs and choices. The Health and Social Care Act 2012 is transforming services and putting people at the heart of all practices. The preferences of older LGB people may include support options that are not currently offered. As older LGB people are less likely to depend on family carers, they may be more likely to require services designed in such a way that their diverse networks of supportive friends are recognised and involved.
Conclusion Older LGB people have experienced, and continue to experience, unacceptably poor levels of health and social care. The needs of the ageing LGB population may be different from those of heterosexual people. Most LGB people are not seeking different services from health and social care providers—just like most heterosexual people, what they are looking for is a good service. The needs of the older LGB person are often overlooked in planning care, such as opportunities for maintaining social networks. Community nurses who are involved in the provision of care to the older population, commissioning of services and development and evaluation of care strategies have a responsibility to ensure that the needs of all members of the population are addressed and appropriate provision is made. BJCN Acknowledgements: The author would like to thank Frances Cohen for her help and support. Age Concern (2006) The Whole of Me: Meeting the Needs of Older Lesbians, Gay Men and Bisexuals Living in Care Homes and Extra Care Housing. Age Concern, London Age UK (2011) Lesbian, Gay or Bisexual, Planning for Later Life. Money Matters. Age UK, London Ard KL, Makadon HJ (2012) Improving the Healthcare of LGBT People. Fenway Institute. http://tinyurl.com/ptwp9cc Commission for Social Care Inspection (2008) Putting People First. Equality And Diversity Matters 1: Providing Appropriate Services For Lesbian, Gay And Bisexual And Transgender People. Commission for Social Care Inspection, London Fish J (2007) Older Lesbian, Gay and Bisexual (LGB) People. Department of Health, London. http://tinyurl.com/oh79ruu Heaphy B,Yip A, Thompson D (2003) Lesbian, Gay and Bisexual Lives Over 50: A Report on the Project ‘The Social and Policy Implications of Non-Heterosexual Ageing’. York House, Nottingham Heath H (2012) Supporting sexuality and intimate relationships. Nurs Residential Care 14(9): 475–7 Johnson MJ, Jackson NC, Arnette JK and Koffman SD (2005) Gay and lesbian per ceptions of discrimination in retirement care facilities. J Homosex 49(2): 83–102 Opening Doors in Thanet (2003) Equally different: Report on the situation of older lesbian, gay, bisexual and transgendered people in Thanet, Kent. http:// tinyurl.com/ojqvftw Power L, Bell, M, Freemantle I (2010) A National Study of Ageing and HIV (50 Plus). Terence Higgins Trust, London Price E (2010) Coming out to care: gay and lesbian carers’ experiences of dementia services. Health Soc Care Community 18(2): 160–8 Stonewall (2011) Lesbian, gay and bisexual people in later life. Stonewall, London. http://tinyurl.com/oj6y7pu Ward R, Pugh S, Price E (2010) Don’t look back? Improving health and social care service delivery for older LGB users. Equality and Human Rights Commission, Manchester. http://tinyurl.com/qa3ckbu
© 2013 MA Healthcare Ltd
is unlikely that these patients will be prepared to discuss their sexual orientation. The community nurse should be prepared to ask questions about relationships and, when taking a nursing or medical history, this can be done by using inclusive language. The assessment process should be sensitive to the value that older LGB people place on their identities and their community links. Increasing numbers of LGB people are living open lives, and levels of disclosure in relation to health care are expected to change in the future. The implication of this is that older LGB people will be more visible, and they will expect appropriate services. to be commissioned.
British Journal of Community Nursing Vol 18, No 8
Journal of Community Nursing. Downloaded from magonlinelibrary.com by 138.253.100.121 on November 25, 2015. For personal use only. No other uses without permission. . All rights re
Caring for older lesbian, gay and bisexual people Ian Peate
Ian Peate is an Independent Consultant Email: [email protected]
Health needs of older LGB people The LGB community is diverse. Lesbian, gay and bisexual people are not a homogeneous group; they comprise a wide range of people from different ethnicities, age groups, socioeconomic statuses and identities. As such, they should be seen as heterogeneous. The LGB community is brought together as a group of social and gender minorities who can and do experience stigma and discrimination. They come from a number of cultural backgrounds and live as a part of each of these backgrounds. With respect to health care, there is a long history of discrimination and lack of awareness of health needs by health professionals, including nurses (Fish,
AbstracT
Ageing brings about a number of challenges for heterosexual, lesbian, gay and bisexual people. It can be a time of anxiety and concern. The expectations that many lesbian, gay and bisexual people have of how they would like to be cared for if they were to enter sheltered housing or other forms of residential care can be very different from the expectations of heterosexual people. This article considers issues that older lesbian, gay and bisexual people may encounter with regard to their health-care needs.
KEY WORDS Equity w discrimination w individuality w respect w assessment
372
2007). As a result of this discrimination, LGB people face a number of challenges in accessing culturally competent health services as well as achieving the highest possible level of health (Ard and Makadon, 2012). Older people are almost always assumed to be hetero sexual and, as a result of this misunderstanding, older LGB people are frequently invisible when it comes to service provision for older people. All older people can experience social isolation through, for example, bereavement, loss of work or ill health. For the older LGB person, these experiences are sometimes made worse by a lack of social support and a fear of prejudice that has been experienced over a number of years (Power et al, 2010).
Stonewall survey Stonewall (2011) commissioned YouGov to survey a sample of 1050 heterosexual people and 1036 LGB people over the age of 55 years across Britain, inquiring into their experiences and expectations of getting older and examining personal support structures, family connections and living arrangements. The survey identified that gay and bisexual men aged 55 years or older are nearly three times more likely to be single than heterosexual men. Forty-one per cent of LGB people over 55 live alone, compared with 28% of heterosexual people. Just over 25% of LGB people over 55 have children, whereas this figure is 9 in 10 for the older heterosexual population. Gay and bisexual men are twice as likely to have been diagnosed with depression and anxiety as heterosexual men. Three in five LGB people over 55 are not confident that social care and support services would be able to understand and meet their needs. Approximately 50% of LGB people over 55 would be uncomfortable being open about their sexuality with care home staff. As a result of these findings, older LGB people may have a greater need for health and social-care services compared with their heterosexual counterparts.
Residential care The assumption that everyone living in a residential care home is heterosexual is misguided. Age Concern (2006) estimates that 1 in 15 of the population is lesbian, gay or bisexual. Heath (2012) suggests that, in a 120-bed care home, using the data provided by Age Concern (2006),
© 2013 MA Healthcare Ltd
O
lder lesbian, gay and bisexual (LGB) people are no different from the rest of the ageing population. There are no specific lesbian, gay or bisexual diseases or conditions. However, older LGB people do have distinctive needs as they get older, and often find themselves in different circumstances from their heterosexual counterparts. Ageing can be more complicated for LGB people as they are more likely to face the prospect of being alone or to have less personal support than their heterosexual contemporaries. Little is known about the UK LGB population with regard to their physical and mental health outcomes, their use of health and social services and their experiences of health and social care more generally. There is very little data available that offer a comparison between the LGB and heterosexual populations. There is even less evidence available concerning older LGB people per se (Ward et al, 2010).
British Journal of Community Nursing Vol 18, No 8
Journal of Community Nursing. Downloaded from magonlinelibrary.com by 138.253.100.121 on November 25, 2015. For personal use only. No other uses without permission. . All rights re
CARE OF THE OLDER PERSON
© 2013 MA Healthcare Ltd
this figure would equate to 8 LGB residents. LGB people who live in care homes are generally an invisible group and those who provide care can respond to the needs of this population in a number of ways. Their responses can range from a general acceptance to overall neglect of the needs of LGB people (Price, 2010; Heath, 2012). Fish (2007) enumerates the concerns that many older LGB people have with regard to health care. One of the biggest concerns is over the possibility of them requiring residential care. Johnson et al (2005) point out that concerns centre on the lack of dedicated accommodation in the UK. There are currently no specialist housing options for older LGB people in the UK (Age UK, 2011). Issues and concerns also focus upon the possibility that some care staff and other residents may foster discriminatory attitudes toward older LGB people, which can be particularly problematic when living in close proximity. It is possible that an older LGB person could be the only non-heterosexual person living in a home. This could result in them becoming isolated, and they may resort to concealing their sexual orientation. In some residential settings, the sexual expression of residents is commonly problematised, leading to circumstances where older LGB people may be especially vulnerable to discriminatory treatment (Ward et al, 2010). The Commission for Social Care Inspection (2008) identifies that providers in sheltered and residential care often demonstrate limited awareness and understanding about sexual orientation.
be unable to make decisions about their care for themselves. Care homes should make environments more welcoming by displaying images, posters and materials depicting LGB people.
Working in partnership with older LGB people
Equality rights in the UK
Stonewall (2011) report that older LGB people can sometimes feel that those who provide services will not be able to understand and meet their needs: w Three in five are not confident that paid carers or housing services would be able to understand and meet their needs w More than two in five are not assured that mental health services would be able to understand and meet their needs. w One in six is not confident that their GP and other health-community services would be able to understand and meet their needs. The upshot of this is as follows: w Approximately 50% report that they would be uncomfortable being open about their sexuality to carehome staff w More than two in five are not assured that mental health services would be able to understand and meet their needs w One in six is not confident that their GP and other health community services would be able to understand and meet their needs. w One third would be uncomfortable with being open about their sexuality to a housing provider, member of hospital staff or a paid carer w Approximately one in five would not feel at ease disclosing their sexual orientation to their GP.
Since the introduction of the Civil Partnership Act in 2005, same-sex couples enjoy similar rights as those given to heterosexual married couples. Same-sex couples are therefore permitted to occupy accommodation together in residential care homes. Those responsible for delivering frontline services in residential care homes should apply the same polices and procedures to same-sex couples who want to live together in care homes as those applied to heterosexual couples. They must also be aware that it is important to understand that equality of opportunity means recognising difference (Opening Doors in Thanet, 2003). As is the case with heterosexual couples, same-sex couples should be allowed private time and permitted to show affection for one another. Clear policies on what is acceptable and unacceptable behaviour from patients should be developed, and care homes should deal firmly but sensitively with episodes of homophobia from patients and staff. Training should be provided to staff so that they can understand the needs and circumstances of the older LGB person and how to offer them good quality care. LGB residents should be provided with opportunities to socialise and meet other LGB people, thereby helping them to maintain social support networks. Staff should ensure that older LGB people have stipulated who should be given decision-making powers, should they
Many community nurses already work with older LGB people, but they may not be aware of this. Older LGB people can feel very vulnerable about being open when it comes to their sexual orientation. It is often necessary for LGB people to pass as heterosexual. This is a survival strategy for those who have lived through times when same-sex behaviour was a criminal act carrying the risk of imprisonment, losing one’s job, one’s children or contact with one’s family of origin (Fish, 2007). Community nurses should be aware of the fact that some older LGB people may be concerned for their own safety if their sexual preference is revealed—they may feel more vulnerable to harassment or attack. Users of older people’s services can be reluctant to ‘come out’ because other people may pass this information on to the community at large. Indeed, 36% of LGB people aged 60–91 years have been subjected to verbal abuse (Age Concern, 2006). It is also important to be aware that older LGB people may use other terms to describe themselves and their relationships. They may, for example, refer to a ‘friend’ rather than a ‘partner’. Awareness of this can help in understanding people’s needs and may encourage appropriate responses. Heaphy et al (2003) point out that only 14% of older LGB people are open about their sexuality with people who provide health care. If health-care providers continue to make the assumption that all older people are heterosexual, failing to take into account the needs of the LGB population, then it
British Journal of Community Nursing Vol 18, No 8
373
Journal of Community Nursing. Downloaded from magonlinelibrary.com by 138.253.100.121 on November 25, 2015. For personal use only. No other uses without permission. . All rights re
CARE OF THE OLDER PERSON
Commissioners and care providers The 2010 Equality Act, most of which came into force in October 2012, replaced earlier anti-discrimination laws with a single piece of legislation that had the intention of making the law simpler and more consistent. The act covers nine protected characteristics that cannot be used to treat people unfairly. The protected characteristics are w Age w Disability w Gender reassignment w Marriage and civil partnership w Pregnancy and maternity w Race w Religion or belief w Sex w Sexual orientation. The public sector duty of equality demands that public bodies consider all individuals (including their own employees) when carrying out their day-to-day work in shaping policy and in delivering services. It requires public bodies to give due regard to the need to eliminate discrimination, improve equality of opportunity and promote good relations between different people when carrying out their activities. Health and care systems help people to lead healthier lives,
LEARNING POINTS w The unequal treatment of any group of people is unacceptable and
can bring with it clear and identifiable human costs w In order to ensure that older lesbian, gay and bisexual people’s concerns and experiences are given just consideration, community nurses need to develop a deeper understanding of the needs of this community w The delivery and commissioning of services in the health and care sectors are changing w If the NHS is to deliver world class commissioning then the devolvement of decision-making processes must be taken to the people who require services w Community nurses, those who develop policy and commissioners must recognise sexual identity as a significant factor influencing access to and use of services
374
to make a positive recovery from illness and to live better and longer into old age. All people using care and support services now have more control over the services they use. Community nurses have a professional duty to work together to provide fair and equal access to high-quality services in response to patients’ individual needs and choices. The Health and Social Care Act 2012 is transforming services and putting people at the heart of all practices. The preferences of older LGB people may include support options that are not currently offered. As older LGB people are less likely to depend on family carers, they may be more likely to require services designed in such a way that their diverse networks of supportive friends are recognised and involved.
Conclusion Older LGB people have experienced, and continue to experience, unacceptably poor levels of health and social care. The needs of the ageing LGB population may be different from those of heterosexual people. Most LGB people are not seeking different services from health and social care providers—just like most heterosexual people, what they are looking for is a good service. The needs of the older LGB person are often overlooked in planning care, such as opportunities for maintaining social networks. Community nurses who are involved in the provision of care to the older population, commissioning of services and development and evaluation of care strategies have a responsibility to ensure that the needs of all members of the population are addressed and appropriate provision is made. BJCN Acknowledgements: The author would like to thank Frances Cohen for her help and support. Age Concern (2006) The Whole of Me: Meeting the Needs of Older Lesbians, Gay Men and Bisexuals Living in Care Homes and Extra Care Housing. Age Concern, London Age UK (2011) Lesbian, Gay or Bisexual, Planning for Later Life. Money Matters. Age UK, London Ard KL, Makadon HJ (2012) Improving the Healthcare of LGBT People. Fenway Institute. http://tinyurl.com/ptwp9cc Commission for Social Care Inspection (2008) Putting People First. Equality And Diversity Matters 1: Providing Appropriate Services For Lesbian, Gay And Bisexual And Transgender People. Commission for Social Care Inspection, London Fish J (2007) Older Lesbian, Gay and Bisexual (LGB) People. Department of Health, London. http://tinyurl.com/oh79ruu Heaphy B,Yip A, Thompson D (2003) Lesbian, Gay and Bisexual Lives Over 50: A Report on the Project ‘The Social and Policy Implications of Non-Heterosexual Ageing’. York House, Nottingham Heath H (2012) Supporting sexuality and intimate relationships. Nurs Residential Care 14(9): 475–7 Johnson MJ, Jackson NC, Arnette JK and Koffman SD (2005) Gay and lesbian per ceptions of discrimination in retirement care facilities. J Homosex 49(2): 83–102 Opening Doors in Thanet (2003) Equally different: Report on the situation of older lesbian, gay, bisexual and transgendered people in Thanet, Kent. http:// tinyurl.com/ojqvftw Power L, Bell, M, Freemantle I (2010) A National Study of Ageing and HIV (50 Plus). Terence Higgins Trust, London Price E (2010) Coming out to care: gay and lesbian carers’ experiences of dementia services. Health Soc Care Community 18(2): 160–8 Stonewall (2011) Lesbian, gay and bisexual people in later life. Stonewall, London. http://tinyurl.com/oj6y7pu Ward R, Pugh S, Price E (2010) Don’t look back? Improving health and social care service delivery for older LGB users. Equality and Human Rights Commission, Manchester. http://tinyurl.com/qa3ckbu
© 2013 MA Healthcare Ltd
is unlikely that these patients will be prepared to discuss their sexual orientation. The community nurse should be prepared to ask questions about relationships and, when taking a nursing or medical history, this can be done by using inclusive language. The assessment process should be sensitive to the value that older LGB people place on their identities and their community links. Increasing numbers of LGB people are living open lives, and levels of disclosure in relation to health care are expected to change in the future. The implication of this is that older LGB people will be more visible, and they will expect appropriate services. to be commissioned.
British Journal of Community Nursing Vol 18, No 8
Journal of Community Nursing. Downloaded from magonlinelibrary.com by 138.253.100.121 on November 25, 2015. For personal use only. No other uses without permission. . All rights re
