Rev Dorothy McRae, Uniting Church: Cultural sensitivity and ageing in health care services

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Rev Dorothy McRae – McMahon, Co-Editor South Sydney Herald, Former National Director – Mission, Uniting Church delivered this presentation at the 2013 LGBTI Aged Care Forum. The two day event offers a platform for discussion on national policy issues, mental and physical health and implementing sensitive quality care and service delivery.
The forum brings together LGBTI community leaders plus senior researchers on LGBTI issues in the aged and health care sectors, to share perspectives on good practice insights for real needs as well as strategies to build community and sector capacity. For more information about the event, please visit the conference website: http://www.informa.com.au//lgbtiagedcare

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Rev Dorothy McRae, Uniting Church: Cultural sensitivity and ageing in health care services

  1. 1. LGBTI AGED CARE FORUM June 2013 Like most of us, I tend to mix with people who are “one of us” in their sexuality or gender identification. That sometimes gives me a false perception of the level of acceptance we have in the community at large. Then I move around a bit, especially in churches, and am reminded that there is still a significant amount of prejudice and homophobia in the wider community. For a while, I assumed that this related mostly to my generation – people who would not have even dared to say the word homosexual in our earlier years. Then I was Patron of Twenty Ten, the agency for young LGBTI people at risk, and I had to face that, especially in the rural areas and outer-suburban areas, there is still lifethreatening hate and prejudice and that possibly as many as a third of youth suicides are due to this. In mentioning all of this, I am affirming that forums like today and working groups to advise governments involved in human services are still very necessary. It is all too easy to have general policies in any services, perhaps especially in aged-care, without regularly checking whether they are actually being carried out. It only takes one prejudiced person in a facility to have a huge impact on the lives of the often vulnerable people in care. I want to suggest, also, that it is often hard to describe and pin down what people are experiencing. The prejudiced staff person concerned doesn’t come into a room and say “How are you today? I hate lesbians!” or refuse to properly dress or toilet a gay man, or say “I love Fred Nile.” It is usually much more subtle than that. Most of us would have experienced that subtlety in all sorts of situations and relationships – a cold or disapproving face or voice, small but important prejudiced attitudes and behaviours and little punishing activities behind the scenes in which we live and work. As those who have a level of independence and power over our own lives, we can at least usually make some choices about who we relate to, or even face into the persons concerned and challenge what they are saying or doing. Obviously, these possibilities are not often available to those in aged-care. Most of us haven’t the confidence or competence to do that at that stage in our lives and, seeing it is often hard to get into an aged-care facility, people daren’t risk offending staff and possibly losing their place there. Even the family and friends of the person concerned may feel anxious about raising any concerns in case they jeopardise the placement. I speak as a person who will be 80 years old next year and who now has friends in aged-care, quite apart from having visited many people in these facilities as part of my work as a member of the clergy.
  2. 2. Seeing my partner died last year, I now live alone and am very conscious that I need to do some research relating to where I might go if I need aged-care, so I don’t land my family and friends with that. Moving into any sort of care facility is obviously a huge change in anyone’s life and I have many experiences relating to that and hearing those involved saying “Please! I want to go home! Will you take me home?” I have a friend saying that to me when I visit her now and it breaks my heart, even though I know she is in a good spot. When the facility really becomes “home” for the one concerned, you know that the culture is right and is warm, caring and accepting. So, what is “home” for people like us? If my partner was alive and I was in care, I would want opportunities to snuggle up in bed with her. I suspect that many agencies would find that hard to deal with, most especially if we were a male gay couple. My experience is that, probably because people have mostly taken the sexual activities of women less seriously, they can cope with physical connections between us, but with men, it is different. When I was young, if two women lived together, people would say how nice it was that they had a friend to live with, given that they hadn’t had a chance to marry. However, if two men lived together, the attitudes were very different. I think that prejudice would be quite hard to bring to an end in many aged-care facilities. It must also be very difficult to find a culture where all staff treat transgender or no gender people with respect and encourage other residents to do the same. Making a place “home” involves having around you all sorts of things which remind you of those you love and of your previous real home. For us, that must include images and symbols of our partners and/or companions in life. I guess some people may propose that we have dedicated facilities for LGBTI people. This may be a temporary solution to existing prejudice, but I would hope that it would remain temporary. We are not odd people. We are part of the ordinary diversity of human beings from the beginning of time and, in my view, our goal is to create communities which express that in every way. So, how would we recommend that care facilities develop a culture which is open and respectful to LGBTI people? How can we institute change? Over the years, I have had to try to do that in many church and community contexts and, in every case, I have found that the most effective way is to have those concerned meet up with LBGTI people and listen to their stories about their recognition of their sexuality and then how that has played out in life and relationships. I have no doubt that we have two sorts of opponents – those who disagree with our lifestyles and people who are phobic in their hatred of us.
  3. 3. Those who simply disagree can be changed, in my experience. Those who are phobic usually can’t be changed. Their attitudes are really pathological and are often connected with things deep in their own lives. If you get staff of an agency together to listen to LGBTI people and talk with them, you can usually discern what sort of people you are dealing with on your staff. Phobic people find it hard not to reveal themselves, even if they remain largely silent during the discussion and wait until after the group has dispersed to say what they are feeling. I have usually suspected that I know what they think in their body language, even if they say nothing directly. I learned to use story-telling in changing the views of people when I related to people in the church, here and around the world. It was fascinating to watch what happened when the people taking part realized and affirmed that we were all human beings and that they liked us, rather than our being some strange creatures who they couldn’t possibly like. When they heard the stories, they realized the hard journey which many of us had travelled in facing our sexuality or gender – how we had worked with that ourselves. Often they could see that we had needed to take risks in doing that – risks with our relationships and our work, both present and future. They could see that no-one would do that unless it meant everything to them. I will never, ever, forget when I came out publicly and put at risk not only my ordination as a member of the clergy but also a number of very senior international positions. At the time, I was the first woman in the world to be Moderator of the World Council of Churches Worship Committee. We had been working together for 5 years. I had no idea what would happen when I turned up to chair our next meeting in Geneva because I knew that those involved would already know about my sexuality. I waited a few minutes for everyone to arrive, then walked in to take the chair. There was a silence and I could feel all the Church Presidents, Bishops and Patriarchs looking at me very carefully. Then it was as though they said to themselves “Oh! She hasn’t changed. She’s the same person we have been working with over all these years!” Then someone said, “Ready to get started, Dorothy? Let’s go for it!” Some of them talked with me about things afterwards and others didn’t, but we were reconciled and went on happily doing our work. It was interesting to see the responses from non-LGBTI people when Bishop Gene Robinson, the Anglican gay Bishop from the United States visited recently. I could see on people’s faces an expression which said “Oh! He is a really nice person!” Clearly, some of them hadn’t expected him to be that. There are so many stereotypes of LGBTI people floating around that we must assume that we need to give people evidence that we are normal – some of us nicer than others, just like heterosexual people.
  4. 4. If I share this story, it is to affirm that many unexpected people can change their minds about us, if they get to know us, and that story-telling can be one of the best and gentlest ways of doing that. Also, if leaders of an agency are watching carefully the responses of their staff to such story-telling, they can usually pick the phobic people present and then face the decisions required in knowing them. In my experience, it is a much more productive way of working with the culture of a facility, than simply giving rules and lectures. After the sharing of personal stories, the way is then open to have those concerned reflect with the staff on possible issues which may emerge for people in their care. It may even be related to differing views on sexuality within their own families, or longings for time with the one they love which they find hard to express. Many older people in care would have already experienced so much prejudice and rejection that they can’t trust those around them. There are obviously ways around that – again in the telling of stories, rather than staff asking direct questions. Not that this needs to be discussed by every person in care, but sensitive staff can often pick up loneliness or alienation which may suggest some particular situation. When I mention the telling of stories again, it is something like “An elderly friend of mine in care was telling me that she longed to have a particularly close woman friend of hers to visit and maybe even stay the night with her. I could see how much that meant and I told her I would see if I could help her make that happen. Do you have all the people that you love around you?” Etc ect. Of course, every agency needs to decide on its ground rules and make them clear to the staff at the time of employment so that it has something to point to if a staff person is found to have oppressive and discriminating attitudes later. In all this, I am suggesting that any agency needs to have a clear set policy and then take action in inviting change in its staff and training them to be sensitive and respectful of all those in their care. They also need to respect those who relate to the person in care, those who assess how she or he is experiencing living in the facility. Obviously, I have already made reference to situations which involved religious people. However, now I want to concentrate more directly on religion and aged-care facilities. I haven’t the statistics on this, but I would say that the vast majority of aged-care facilities are owned and run by various religious groups. Some of them, like Mission Australia, are not directly related to any particular church, but they still have a religious underpinning. If you look at the rules and beliefs of the various religions or churches in this country, the only one which has a firm national doctrine of acceptance of LGBTI people is the Uniting Church. In fact, the churches around the world which take that view are very likely to either be a one of the three churches which created the Uniting Church in Australia (the Congregational, Methodist and Presbyterian Churches) or another union of those churches.
  5. 5. I can mention that the Uniting Church probably has more aged-care services than anyone else, under its department called Unitingcare. It recently won the Not for Profit Charity Award for “Pride in Diversity” as a LGBTI employer and carer and it has a special group to encourage LGBTI people to enter its services. I should also include the Quakers as being inclusive, but I don’t think they have any aged-care facilities. The Anglican church varies around the world – hence the appointment of Bishop Gene Robinson. It is a mix of radicalism and conservatism in Australia too. Then there are the very conservative churches like the Salvation Army, the Churches of Christ or the Pentecostal (Hillsong) type churches which would try to “heal” us of our sexuality. Baptist Churches vary in their attitudes. The Roman Catholic Church is something else again. If you listen to its authorities, it sounds as though there is no room to move. People like us are an abomination. However, running underneath the church authorities, in my experience, there are many, many agencies and staff who give the best and most respectful care of all. My partner spent the last 6 weeks of her life in the St Vincent’s Sacred Heart Hospice. We chose that because I had done a lot of palliative care work there, especially in the years when many gay guys were dying of HIV/AIDS and I believed it was the best hospice in Sydney. The care was impeccable, so respectful and inclusive. Ali’s friends were amazed by all that was done for us both. So, when we are looking at aged-care facilities, I certainly wouldn’t rule out those belonging to the Catholic Church. There would, of course, be places belonging to other religions. I have not explored them, but I suspect people would need to go with caution. Even the popular Dalai Lama doesn’t approve of us. I suspect that all religions have varieties of opinion within them and radical and conservative branches. Of course, in saying all of this, I am suggesting that we who are LGBTI need to look carefully and ask questions of managerial staff before we settle on a particular agedcare facility for us. or those we love. Having said that, I want to raise a real issue. All care facilities, and private schools for that matter, are heavily subsidized by public money via government grants. For example, the care facilities of the Uniting Church are subsidized for around 70% of their costs by government grants. It is my view that it is high time that we ask what that means in terms of care policies within these organizations. Why should the money which is owned by the community at large be used to support agencies which do not serve the whole community equally?
  6. 6. Of course, it would be very hard to police what goes on within each agency, even if we demanded that they be inclusive. However, we could at least formally require them to be that if they are to receive funding, and then encourage the people who they have in their care, and the families who relate to them, to report any violation of this rule. In saying this, I am not suggesting any winding down of religious freedom within the religion concerned, but that those agencies using significant amounts of public funding be required to justly and inclusively serve the whole community. Overall, I believe that we are gradually making progress. Because I am old, I can look back and see how things have changed over the many decades of my life. People like some of us, who are safe in their work positions, or retirement, having outed ourselves some time ago, will need to be the voices for justice and compassion, alongside straight people who care about that too. In doing this, we are part of a movement for creating a safer and more compassionate world for all people – a true community. The context for this is not very encouraging at the moment in a political scene where politicians and much of the media are focused on spin and tweaking our meanness. That is the challenge, but, again having lived a long time, I know that change is possible and we can be part of it. Let us hold onto each other as we go and believe that we can lead the way towards a new world. Dorothy McRae-McMahon

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