1. Running Head: Health Care Inequalities Surrounding LGBT Elder Care 1
Health Care Inequalities Surrounding LBGT Elder Care
Shelley Ware
Springfield College School of Social Work
2. LGBT Elder Care 2
Abstract
As the world watched on June 26th, 2015, the U.S. Supreme Court ruled that states can no
longer ban gay marriage. This was a historical moment for LGBT individuals in gaining
equality. However, there is still a crisis with our aging LGBT population, many of whom are
going back into the closet as they become dependent on others for care. There are minimal
programs for aging LGBT individuals. This study sought to explore the gaps in medical care
that is resulting in LGBT persons feeling as if they have to hide their orientation or choose not to
seek medical care at all, resulting in health disparities. The author explored this issue through
literature review and face to face interviews. Findings showed that there is a need for policy
changes in elder care agencies in order to improve education and cultural competence as well as
to minimize health disparities of LGBT individuals and provide an increased quality of care.
Introduction
Dr. Nancy Orel (2013) published an article in the Journal of Homosexuality examining
the needs and concerns of LGBT older adults. Dr. Orel pointed out that, since January 1, 2011,
approximately ten thousand “Baby Boomers” (those born between 1946 and 1964) have been
turning 65 every single day (pp 54). Between 2000 and 2010, the population of Americans 65
years and over increased by 15.1%; a faster rate than that of the total U.S population at 9.7%
(Werner, 2011). Recent population-based surveys also indicate that approximately 3.5% of
adults in the U.S. identify as lesbian, gay or bisexual and 0.3% of adults identify as transgender.
This equates to nearly 9 million people (Ard & Makadon, 2012) and at least 1.5 million of them
are over the age of 65 (Sage general facts & discrimination, 2012-2015).
3. LGBT Elder Care 3
The purpose of this study was to explore the social crisis that surrounds our lesbian, gay,
bisexual and transgender (LGBT) older adults. Studies are showing that these elders are fearful
for their safety as they age and require more care. LGBT Baby Boomers, also referred to as
“Stonewall Seniors,” who fought for gay rights and equality in the 1960s, are being considered
the first “out” generation in LGBT history (Fitzgerald, 2013). Stonewall Seniors are now
retiring, becoming frailer and starting to think about their aging needs, including the possibility
of having to depend on others for care. However, many of them are not seeking that care out of
fear that direct care workers who come into their homes for the purpose of providing personal
hands-on care might discriminate against them. Other fears include possible abuse or the force
of religious prayer with the purpose of asking forgiveness for the choice of engaging in
homosexuality.
There is also a disturbing trend of LGBT elders avoiding their doctor’s office altogether
because the staff may not have had the sensitivity training necessary to manage the diverse needs
of this culture (Fitzgerald, 2013). As a result, these individuals are either feeling the need to hide
their sexual identity and appear “straight” or they are altogether avoiding seeking critical medical
care (Maddux, 2010). If needing care in a nursing home (NH), there is the added fear of having
to leave a loved one under the care of the NH staff, not knowing if that staff may be
discriminatory or abusive.
LGBT individuals are more likely to age alone as opposed to heterosexual elders
(Thurston, 2009)(Brennan-Ing, Karpiak, & Seidel, 2011). They often have a minimal support
network and may have lost many family members and friends after choosing to reveal their
sexual orientation or gender identity. These frail elders are often dying younger due to lack of
support and proper medical care. What is even more troubling is that one study in England
4. LGBT Elder Care 4
revealed that some transgender individuals are planning to commit suicide before getting to the
point of requiring care from medical professionals who do not understand their needs or are
uncomfortable due to lack of diversity training (Ward, Rivers, & Sutherland, 2012).
Advancement is critical in ensuring that all agencies serving the elder population are
LGBT friendly. It begins with raising awareness on this issue with elder care agencies.
Trainings also need to be provided to all medical and direct care staff in order to develop cultural
competence and sensitivity when dealing with the unique needs of the LGBT elder population.
These steps are crucial so that Stonewall Seniors can stop being afraid and can confidently seek
medical and in-home, hands-on care as they age. No elder should be alone and without the
compassion and quality care that is needed in the later years of life. In an attempt to resolve this
social crisis, this research paper will explore the following question: What are the primary
concerns of LGBT individuals related to perceived gaps in the healthcare system surrounding the
needs of aging members of their community?
Review ofLiterature
The purpose of this study was to identify gaps in care, where medical care and education
are lacking and what needs to be done within the healthcare system to better support the under-
served Lesbian, Gay, Bisexual and Transgender (LGBT) elder population. It is important to
point out that, although LGBT is inclusive of all individuals who identify as other than
heterosexual, the needs of each group are very unique to each other. Transgender people do not
identify with the gender assigned to them at birth; they feel they were born in the wrong body.
This has been known to cause feelings of contention among transgender people, who have
pointed out that gays and lesbians cannot possibly identify with the inner turmoil of being
5. LGBT Elder Care 5
transgender (Brydum, 2015). For the purpose of this study, however, we will examine LGBT
needs globally.
Several studies and articles were reviewed that examined elder care services surrounding
LGBT societies. All of the research reviewed had an alarming trend; indicating that all
disciplines within the medical field do not receive sufficient training in the unique care needs of
LGBT elders. This lack of education creates an unfortunate domino effect. Insufficient training
of medical workers results in inadequate services and staff that lack empathy and knowledge of
LGBT issues. Subsequently, this leaves LGBT individuals with limited clinics to go to for
informed, quality care. The deficiency of care, in turn, leads to healthcare avoidance behaviors
which eventually results in health complications, comorbidities and in many cases, premature
death.
Fredriksen-Goldsen, et al.(2014) studied the health disparities of LGBT elders. They
identified LGBT individuals as a marginalized population and identified that there are associated
risk factors for poor health, disability and untimely death. In 2012, LGBT individuals were
identified as an at-risk population with regards to not having access to quality healthcare.
Dr. Nancy Orel (2013) examined the needs and concerns of LGBT older adults through
the use of qualitative and quantitative methodology. She put together focus group discussions
with 26 LGB individuals (she was unable to employ any trans people to participate, despite her
efforts at recruitment and inclusion). Dr. Orel’s interviews identified seven areas of importance
to LGB individuals. The seven identified concerns included medical/health care, legal,
institutional/housing, spiritual, family, mental health and social (Orel, 2013).
Dr. Orel’s interview data was consistent with past studies showing that there are many
health disparities in the LGBT culture. These disparities typically result from discrimination,
6. LGBT Elder Care 6
which increases stress, resulting in a higher probability of poor health and limited access to care
(Orel, 2013). There is also a disproportionately higher risk for violent hate crimes, sexually
transmitted diseases and mental health issues (Orel, 2013)(2015 National LGBTQ Task Force,
2015).
Rogers, Rebbe, Gardella, Worlein, & Chamberlin (2013) completed a study “exploring
the impact that training panels given by older LGBT adults had on training participants, many of
whom were future service providers” (pp 584). Their trainings were offered through the Gay and
Gray Program (GGP) out of Portland Oregon. The GGP is an agency that provides LGBT elders
with services including advocacy, social and legal support, meals, companions, health and
wellness education and case management (Rogers, Rebbe, Gardella, Worlein, & Chamberlin,
2013).
Rogers et al explains that, as a result of past discrimination and insensitivity from service
agencies, LGBT elders are reluctant to disclose their sexual orientation/gender identity or access
services altogether from non-LGBT agencies. The panel trainings focus their education on a
variety of issues that LGBT senior citizens are faced with; the goal being “to help the
participants reflect on their biases and attitudes toward older LGBT adults” (pp 585). The
trainings are given by a group of LGBT volunteers. The study concluded that the panel
discussions were successful in raising awareness, putting a face on LGBT issues, facilitating
self-reflection, promoting deeper understanding and acceptance and garnering empathy (Rogers,
Rebbe, Gardella, Worlein, & Chamberlin, 2013).
Another study by Lim and Bernstein (2012) examined the need to promote awareness of
LGBT issues in aging in a baccalaureate nursing program. Not only did this study reiterate the
critical need for more training of medical professionals, but it also sought to answer the question
7. LGBT Elder Care 7
of how we gain back the trust of LGBT Baby Boomers. These ‘boomers’ came out of the closet
and fought for gay equality during a time of intolerance; a time when people were deemed
mentally ill because of their sexual orientation (Lim & Bernstein, 2012). Even today, Gender
Dysphoria, the inability to identify with the gender assigned at birth, continues to be a diagnosis
in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM 5).
Lim and Bernstein’s research revealed that, out of the 150 medical schools examined in
their study, the average number of hours dedicated to LGBT related topics in the medical
curricula was only five (Lim & Bernstein, 2012). In the height of the aging boom, there will be a
projected 88.5 million people over the age of 65. Five hours of medical training seems
inordinately disproportionate for a population that, in the year 2050, is estimated to comprise one
out of every 13 elders (Lim & Bernstein, 2012).
Wood and Conley (2014) reviewed the impact that being lesbian, gay, bisexual or
transgender has on one’s religious and spiritual (R/S) identity. This is an important factor to
consider because of the negativism that religion associates with being LGBT. The loss of one’s
religious identity can result in feelings of depression and anxiety and can have a negative impact
on one’s overall health and well-being (Wood & Conley, 2014).
Wood and Conley broke down the various types of R/S abuses that can occur by
members of the congregation, whether in a leadership role or as peers. The abuses identified
include Leadership Representing God, Spiritual Bullying, Acceptance via Performance, Spiritual
Neglect, Expanding External/Internal Tension, Manifestation of Internal States and Sexual
Microaggressions (Wood & Conley, 2014). All of these, in some way, cause the individual to
feel like they are going against God’s will because of their LGBT identity. As a result of the
8. LGBT Elder Care 8
R/S abuse, the LGBT individual may experience feelings of self-doubt, depression, anxiety and
suicidal ideation.
Hughes, Harold and Boyer (2014) conducted an exploratory study on the level of
awareness of LGBT aging issues among aging service providers. They developed a
questionnaire that they handed out at the 2010 AAA conference in Michigan; an annual
conference for providers employed by local aging services agencies. The 87 surveys that were
completed were done so primarily by Caucasian, heterosexual women with a mean age of 46.
Sixty-eight percent rated themselves as ‘very comfortable’ providing assistance to older
LGBT adults and 31 percent rated themselves as ‘very knowledgable’ on LGBT
Medicare/Medicaid issues. The majority (35% - 48%), however, rated themselves as only
‘somewhat knowledgable’ on LGBT issues, such as legal and financial issues,barriers to service
and medical issues (Hughes, Harold, & Boyer, 2011). When asked if they wanted further
training on LGBT issues, 50 agencies reported wanting additional training while 29 did not
(Hughes, Harold, & Boyer, 2011).
Porter and Krinsky (2013) examined whether LGBT trainings actually result in positive
change within elder service agencies. Their data, collected through pretests prior to a LGBT
training and posttests following it, showed an increase of knowledge surrounding public policies
and LGBT resources. The training also increased participants’ beliefs that intake paperwork
should include sexual orientation and gender identity as it can lessen the perception by LGBT
individuals that medical providers are not sensitive to their needs (Porter & Krinsky, 2013).
The training postively improved the participants’ comfort level if one of their patients
were to come out to them. The only decrease in comfort level from pretest to posttest was in
providing care to a transgender person. Porter and Krinsky surmised that the decrease might be a
9. LGBT Elder Care 9
result of a reduction in the confidence of the provider’s ability to meet transgender needs as they
learned more about what those needs consist of (Porter & Krinsky, 2013).
Lastly, Brennan-Ing, Karpiak and Seidel put together a comprehensive report through the
AIDS Community Research Initiative of America (ACRIA) in 2011. Their sample included just
over 200 individuals with a mean age of 60. Of the 200 participants, 71% were men, 24% were
women and 5% identified as transgender or intersex (Brennan-Ing, Karpiak, & Seidel, 2011).
The purpose of their study was not only to identify health and psychosocial needs of LGBT
elders, but also to pinpoint similarities and differences between LGBT persons with and without
the HIV virus (pp 12).
Some of the more noteworthy findings surrounded mental health, substance abuse and
sexual activity. Their statistics showed that the rate of severe depression more than doubled for
HIV positive individuals (29%) as compared to those who are HIV negative (14%). In
measuring the rate of current use (within the last 3 months) of substances, rates were
significantly higher for those who are HIV+ than those HIV- with regards to the use of cigarettes
(49% vs. 13%), crystal meth (4% vs 0%), cocaine (13% vs 1%), crack (10% vs 1.5%), heroin
(3% vs. 0%), marijuana (31% vs. 10%) and poppers (20% vs. 7%).
Alcohol use was higher among HIV- (66% vs. 57%) and use of pain killers was almost
equal (29% HIV+ and 25% HIV-). Those with HIV were more likely to report sex as being very
important to them and to having unprotected sex than their HIV- counterparts (Brennan-Ing,
Karpiak, & Seidel, 2011). Given the pattern of data from the aforementioned studies, this study
will seek to answer the following questions: Are there perceived gaps in medical care for LGBT
persons? What is causing the avoidance behavior of LGBT individals regarding medical care?
What needs to be done to educate medical professionals on the needs of aging LGBT persons?
10. LGBT Elder Care 10
Methodology
Using a qualitative design, the researcher’s objective was to answer the question “What
are the primary concerns of LGBT individuals related to perceived gaps in the healthcare system
surrounding the needs of aging members of their community?” The qualitative approach taken
to explore this overarching question was Phenomenological Analysis. The researcher was
planning on purposive sampling, which is the deliberate process of selecting respondents based
on their ability to provide the needed information (Padgett, 2008).
Attempts were made at recruiting participants for this study by sending correspondence to
several agencies that service the LGBT elder population. These agencies included the Worcester
LGBT Elder Network (WLEN) at the Worcester Senior Center, Fenway Health in Boston and
The History Project in Boston. These agencies were each informed about the research study and
its purpose. In the interest of privacy laws, these agencies were not asked to refer people to the
researcher, but to provide the researcher’s contact information to anyone they felt would be
willing to participate.
Fenway Health and The History Project returned correspondence to the researcher
indicating that they could not assist in the study. They each referred the researcher to the
agencies that had already been contacted. WLEN did respond and invited the research to attend
their monthly LGBT luncheon that is hosted there. Although unable to make the luncheon, the
researcher made a flyer that was passed out at the LGBT luncheon by one of the volunteers there.
The WLEN volunteer reported to the researcher that several of the attendees at the
monthly luncheon took the flyer, however the researcher received no responses to this attempt at
recruitment. Convenience sampling then became necessary after attempts at recruiting LGBT
11. LGBT Elder Care 11
elders did not yield any voluntary participants. Snowball sampling was also utilized as
participants in the study were asked to refer people in their network for ensuing interviews.
The four participants in this study were all chosen because of their sexual orientation.
Two of the interviewees were a Caucasian male couple, ages 36 and 55, who are currently living
in Central Worcester County. They were married earlier this year. Although younger than the
original age-range being considered for this study, the researcher felt it important to seek the
experiences and opinions of this couple as they have a 19 year age difference and have had
discussions regarding future planning. They were recruited through text message. They are
friends of the researcher and were asked to refer the researcher to anyone else they know who
might want to participate in this study.
The other two participants were women who both identify as lesbians. One is 58 years of
age and has been in a relationship with her wife for over 25 years and they have been married for
approximately eight of those years. The other is 78 years of age and lost her wife earlier this
year after 30 years together. Both women also reside in Worcester County. The participation of
these women was valuable because, not only did they give a different perspective than the male
participants, but also, according to research, older lesbians are more likely to hide their
orientation (Fitzgerald, 2013). As one of the women was also the caregiver for her wife and took
care of her with the assistance of hospice and care providers in the home, she was able to give a
unique perspective to that experience. The participants will be referred to as P1, P2, P3 and P4.
Data collection for qualitative research typically consists of three modalities:
observation, interviews, and review of documents (Padgett, 2008). Each participant was offered
their choice of locale for the interview; being either their home, the researcher’s home or a public
venue. All of the interviewees chose to come to the researcher’s home. Each interview occurred
12. LGBT Elder Care 12
at the dining room table in the late afternoon. There was one meeting per interview and the
interviews were recorded, each lasting between 30 to 60 minutes.
To ensure protection of the rights and dignity of each participant, they signed an ethics
consent form outlining the purpose of the study and providing them contact information for the
researcher, the professor and a LGBT hotline (see appendix 1). Each participant was assured
that they did not have to answer any question that they were uncomfortable with and each was
offered a copy of the final research project. Each participant was also compensated for their
time.
Careful preparation was taken to allow for the interviewee to assist the researcher in entering
their world. The researcher asked the same-sex male couple to watch the documentary, Gen
Silent, by director, Stu Maddox (2010), to bring awareness on this social crisis. The researcher
also gave each interviewee some background on why this project has taken shape and why it is
critical to promote awareness to both elderly and younger LGBT persons.
The beginning of the interview focused on the participants’ sexual orientation and then each
was asked to describe when they came out to friends and family. These questions were designed
not only as a benevolent introduction to how they each identify, but also to better understand
whether their experience of coming out was a positive or negative one. Research has shown that
people that do not have a good support network are more inclined to experience health disparities
(Ard & Makadon, 2012)(Fitzgerald, 2013).
Subsequent interview questions explored whether the participants have any concerns or
discomfort when seeking medical care and whether they feel their doctor’s office is LGBT-
friendly. These questions were intended to illustrate any perceived gaps in the healthcare system
related to cultural competence and whether steps are taken at clinics to demonstrate inclusion.
13. LGBT Elder Care 13
Studies reviewed indicate that there is limited awareness of LGBT issues within the health care
system (Hughes, Harold, & Boyer, 2011), that clinics do not always promote inclusion
(Worcester LGBT Elder Network (WLEN) sponsored by ESWA; Brightstar Care, 2015) and that
there is very limited LGBT education provided in medical schools to prepare future care
providers for management of these issues(Lim & Bernstein, 2012).
Further questions moved on to the participants’ feelings related to nursing home placement
and whether direct care workers are equipped to deal with LGBT aging issues. As Stu Maddox
(2010) demonstrated in his documentary, Gen Silent, which focuses on aging issues related to
LGBT elder care, if a person’s perception is a lack of understanding or the potential for
discrimination, then they are less likely to seek medical care at all until a crisis occurs.
Concurrent studies have corroborated this and have also shown that LGBT persons are less
likely to be medically insured (Gates, 2015) and that these individuals are not receiving equitable
healthcare (Fredriksen-Goldsen, et al., 2014). Data analysis involved analyzing the recorded
interviews in order to gather themes and patterns. Other analysis included observation of the
body language of each participant during the interviews as well as review of peer-reviewed
scholarly articles and other studies conducted on this topic.
Findings
Several core themes emerged from the data analysis of the four interviews. The first
theme identified was emotional/coping. Within this theme, several issues were discussed
including addiction, depression, fear, courage and denial. The emotional distresses all
surrounded the realization of being gay and the eventual acceptance of it. Two of the
participants struggled with addiction while another dealt with their spouse’s addiction. The
14. LGBT Elder Care 14
fourth did not mention addiction. All four indicated that they had emotional difficulty after the
initial realization that they might be gay. Each participant also displayed remarkable courage
when making the decision to come out to family and friends, knowing that it may have resulted
in the loss of some of their closest relationships.
Another theme that emerged was the social impact surrounding the sexual orientation of
each study participant. This theme emcompassed religion, support network, romantic
relationships and/or marriage, family, friends, neighbors and career. Religion was not initially
part of the interview questions, but was subsequently incorporated after the first two interviewees
raised this as a significant area of focus (see appendix #2).
P1 struggled severely on a religious level, feeling that he was an “abomination” and
feared that God would hate him for being gay. He sought to be “cured” by attending church. He
hit a turning point in his journey, however, after experiencing what he described as the hand of
God resting on his shoulder and he heard God tell him “It is okay. You are my son and I love
you just the way you are”. He finally felt a sense of peace and no longer believed that God hated
him.
P2 stated his belief that “God makes people who they are supposed to be. I don’t think I
ever struggled religiously with being gay”. P3 and P4 both stopped going to church; P3 because
the Catholic church has historically been against homosexuality and P4 became “turned off”
after she approached a Catholic priest, who appeared to have no interest in offering her support
or comfort and “did not seem to want to be bothered”. All four participants still have
faith/spirituality and P3 is considering committing to the Unitarian church, as they are accepting
of and welcoming to LGBT individuals.
15. LGBT Elder Care 15
Another theme identified was LGBT considerations, which was comprised of what age
the participants were when they realized they were gay, coming out, sexuality, LGBT in sports,
transgender, cross-dressers and Provincetown. One interesting finding within this theme
surrounded the age of coming out to family and friends. Though both males realized that they
were gay before the age of ten, neither came out until they were almost 30 and both came out to
the women in their family first. Both of the female participants realized they were lesbian during
teenage years; one came out around age 16 and the other around age 21.
Subsequent themes included Negativism, Advocacy/Resources, Future Planning and
Lifestyle. The theme, future planning, reflected on medical care, nursing home placement
(NHP), caregiving, long term care insurance and accepting help. An interesting and unexpected
finding was that none of the interviewees reported having concerns about going to their doctor’s
office. It was noted, though, that none of the medical offices are outwardly LGBT-friendly,
meaning literature, marketing materials, posters and other supplies that target the LGBT
population with the goal being inclusion and a welcoming atmosphere.
Additionally, the participants were evenly divided when asked whether they have
concerns related to NHP. P1 and P3 did express concerns related to having to live or put their
spouse in a nursing home, while P2 and P4 did not. Those that expressed concerns stated they
were troubled by the lack of education and sensitivity training for medical staff and direct-care
workers regarding LGBT issues. Those that did not express concern about NHP stated they have
“no qualms about it” and P4 stated “I try to joke with people…If they come aboard on my side,
then great, but if not, I would know my place, but would not let them walk over me.”
Finally, the theme of advocacy revealed issues such as death with dignity, housing for
LGBT, policy change, resources, and what is important for non-LGBT medical professionals to
16. LGBT Elder Care 16
know. An important finding here relates to three of the four interviewees acknowledging that
they would prefer to live in LGBT housing. The fourth was ambivalent about housing. The key
reasons for preferring LGBT housing were not just for inclusion and comfort, though that was
primary. Other reasons that surfaced had to do with activities of interest as well as providing a
“safe haven” for people from other cultures or countries which may imprison or execute a person
for being homosexual.
When asked if housing for LGBT would be isolating, one participant challenged the
researcher, asking “If a facility is not LGBT friendly, [that person] is already isolated. If I had to
go back into the closet, how much more isolated can you be? If the staff is either gay or
empathetic to the struggles these people have been through, then they will be in a place of love
and support and that will keep you free of isolation.” Two of the interviewees also made the
suggestion that this type of housing would not need to be exclusively for LGBT individuals and
that they would welcome integration of non-LGBT, but with the understanding that it would be
an open facility.
Some words of wisdom that the participants felt that non-LGBT medical staff should be
aware of included the following statements: “Being gay is not a disease that you catch; it’s
something that you’re born with.” “Just be aware and open and not so close-minded. Don’t
assume; it’s basic social work. We meet the clients where they’re at.” “We’re like everybody
else. Be sensitive to differences, whether they’re gay or a minority of some other type.” “Just be
yourself and let us be ourselves.”
Implications and conclusion
The findings of this study were consistent with other studies conducted over the past five
years. There are several changes that need to take place to improve care to the LGBT elder
17. LGBT Elder Care 17
population, which continues to be underserved (Lim & Bernstein, 2012). The first step to
minimizing discomfort among medical professionals is education. Policy changes are needed to
ensure that LGBT training is mandatory and recurrent (at least annually) for healthcare workers.
Education promotes awareness which, in turn, creates empathy and understanding (Rogers,
Rebbe, Gardella, Worlein, & Chamberlin, 2013).
Despite the finding that none of the study participants expressed discomfort when going
to see their medical doctor, what did emerge is that they all believe there is still a long way to go
regarding clinics adapting their outward appearance in order to create a more LGBT-friendly
atmosphere. Nancy Orel (2013) also concluded in her study that “one of the greatest obstacles
[continues to be] the level of homophobia and heterosexism within the culture” (pp. 70).
Additional consideration should be taken by clinicians about the impact that the loss of
religious and spritiual identity has on LGBT individuals. Religious impact was brought up by
each of the participants in this study and it clearly played a role in the ability for some of them to
cope with and come to an acceptance of their homosexuality. The loss of R/S identity can not
only negatively impact emotional and mental well-being, but LGBT individuals are at a higher
risk of experiencing R/S abuse (Wood & Conley, 2014).
Some limitations to the study was the small sample size of only four participants. Only
one interviewee was over the age of 65, which could account for why only half the sample
expressed concerns related to medical care. Younger LGBT individuals appear more open and
less concerned about conventionalism. The researcher was also only able to recruit individuals
who identify as gay and lesbian, and was not able to recruit a transgender individual. Due to
participants for this study being collected through convenience and snowball sampling, it is also
likely that they overrepresented people who are more open to talking about their experiences.
18. LGBT Elder Care 18
Further research should be done with health care agencies to explore why trainings on
LGBT issues are not regularly provided to staff. Studies on this topic have only spanned the last
five to ten years. Further studies of a longitudinal nature may be necessary to ascertain if
systematic LGBT trainings do effectuate positive change in the long term attitudes and empathy
of healthcare workers. Porter & Krinsky (2013) agree that supplemental trainings would be
necessary and should not be just a singular curriculum. It is again important to note that,
although the LGBT acronym globally considers all individuals that identify as queer, each
subcategory of the acronym carries its own unique needs and cannot be mistaken for a ‘one size
fits all’ philosophy. Their needs are shaped by many factors including race, ethnicity, age and
socioeconomic status (Lim & Bernstein, 2012).
Today’s youth appears to be playing a significant role in the shift in attitudes and biases
towards LGBT individuals. This shift has taken place over the last 12 years, since Massachusetts
became the first state to legalize gay marriage (Jones, Cox, & Navarro-Rivera, 2014). The
Millenial generation seems to be less accepting of the heteronormative codes of the late twentieth
century mainstream culture and more people now approve of gay marriage than ever before
(Jones, Cox, & Navarro-Rivera, 2014).
This shift, however, is still in its infancy. Until today’s youth begins taking care of our
seniors in the next 20-30 years, it is more important than ever to heed the words so eloquently
spoken by an interviewee from this study. When asked what is important for non-LGBT persons
to know, he responded “Do you really want to cause these people more pain than they have
already experienced? More understanding leads to more empathy, compassion and patience.
Understand my struggle and walk in my shoes before passing judgment on me.”
20. LGBT Elder Care 20
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