‘People of all sexualities have the right to equal respect, value and integrity’ (Davies, N. et al. 1996, 22).
Societal attitudes towards people who identify under the LGBTQ+ umbrella have undergone a significant change since the Equality Act (2010) affording greater protection from discrimination. However, although many LGBTQ+ people are able to live ‘openly’ there are significant numbers who continue to experience prejudice and rejection (from family, friends, work colleagues) and so may live in the ‘closet’ in selected areas of their life. Nevertheless whether or not ‘out’ research (including Marie Curie (2016) ‘Hiding who I am’: The reality of end of life’, Stonewall & YouGov (2015) ‘Unhealthy Attitudes: The treatment of LGBTQ+ people within health and social care services’) highlights discrimination concerns in accessing care and support services at a vulnerable time in their lives. Older generations in particular have trust issues having experienced state discrimination (sex between men for example was illegal until the 1967 part-decriminalisation act, and homosexuality remained classified as a mental illness until 1992) as well as peer prejudice for a significant part of their lives.
Experiencing poor and non-inclusive support systems such as having to challenge, or correct heteronormative assumptions undermines confidence in services. As a consequence, LGBTQ+ people often do not access health and wellbeing services until crisis point. This has implications in support provision such that developing networks for LGBTQ+ people are difficult. LGBTQ+ needs and experiences of care are under-researched (notably in relation to bisexual and gender-identity people) particularly in terms of psychological and sociological outcomes outside the context of HIV/AIDS.
Availability of support provision is patchy across the UK including London. Nevertheless, there are a growing number of LGBTQ+ support services including the first UK LGBTQ+ home care agency, Alternative Care Services (London), National LGB&T Partnership, Opening Doors, London (for 50+), Rainbow Lives Project (supporting LGBTQ+ people in social housing and care), as well as through umbrella organisations such as Age UK, Stonewall and Terence Higgins Trust. There are also a number of innovative projects exploring access to, and experience of, health and health-related issues. However, access is not always clearly defined in exclusive LGBTQ+ terms. Carers Wales led the way in 2017 producing a separate guidance and support leaflet ‘LGBTQ & Caring’ for end of life care.
Workshop programmes, especially when delivered by LGBTQ+ people are helping to allay health professionals’ concerns of uncertainty in understanding LGBTQ+ needs in providing clear guidelines for them to adopt and ensure confidence when working with LGBTQ+ people; Pride in Practice, for example provides a support service for clinicians, health practice managers and staff that works in partnership to improve LGBTQ+ peoples’ experiences of support as well as ensuring compliance with the General Medical Council Good Practice Guidelines and the Equality Act 2010. Age UK has also produced a resource pack for professionals ‘Safe to be me’ to help meeting the needs of the LGBTQ+ people using health and social care services.
As LGBTQ+ people are less likely to engage with health interventions, screening programmes and generic support networks with particular difficulties for transgender and gender fluid/neutral individuals, it is vital that support services including care homes embrace greater inclusivity within their local communities by acknowledging the needs of LGBTQ+ people as well as implementing and developing welcoming and supportive environments.
Authored by Dr Jonathan Tobbutt with grateful thanks from OPAAL.
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