“Could We Hold Hands?” Older Lesbian and Gay Couples’ Perceptions of Long-Term Care Homes and Home Care

Abstract

This qualitative study describes expectations, concerns, and needs regarding long-term care (LTC) homes and home care services of 12 older lesbian and gay couples living in Canada. Our findings reflect four major themes: discrimination, identity, expenditure of energy, and nuanced care. Discrimination involved concerns about covert discrimination; loss of social buffers as one ages; and diminished ability to advocate for oneself and one's partner. Identity involved anticipated risk over disclosing one's sexual identity; the importance of being identified within a coupled relationship; and the importance of access to reference groups of other gay seniors. We conclude that partners were burdened by the emotional effort expended to hide parts of their identity, assess their environments for discrimination, and to placate others. Nuanced care involved a mutual level of comfort experienced by participants and their health care providers. These themes inform understandings of LTC homes and home care services for lesbian and gay older couples.

Sexual orientation disclosure in health care: a systematic review

“…27,30,31,45 Perceived outcome of disclosure. Fear of discrimination, including receiving poor or unequal care, 23,[26][27][28][29]32,40,43,45,47,48 having a negative impact on their career 25,43 or benefits, 25,28 as well as criminalisation, 43,49 were all cited as reasons not to disclose. In addition, many participants were hesitant to disclose for fear of a negative personal reaction from their healthcare professional, 23,24,29,30,[37][38][39][40][41]43,46,48,49 or feeling embarrassment or humiliation after disclosure.…”

“…In addition, many participants were hesitant to disclose for fear of a negative personal reaction from their healthcare professional, 23,24,29,30,[37][38][39][40][41]43,46,48,49 or feeling embarrassment or humiliation after disclosure. 31,33,37,39,46 Many participants cited concerns of breaches in patient-provider confidentiality 20,24,29,34,37,39,43,46,47,49 that would lead to non-clinical staff, 47 their family and friends, 34 or the wider community 43,49 discovering their SO as reasons not to disclose. Similarly, documentation of SO in medical records was seen as a barrier to disclosure.…”

“…The majority of patients were more likely to disclose to a healthcare professional with whom they had a long relationship. 23,39,47 Seven studies reported an increased likelihood of disclosure if the healthcare professional was themselves a member of the LGBT community. 20,25,32,38,41,46,48 Although having a heterosexual healthcare professional was not seen as a particular barrier to disclosure, a healthcare professional being perceived as accepting of the LGBT community, or of their patient being LGBT, was a significant facilitator.…”

Navigating Tensions About Resident Sexual Expression in Alberta’s Continuing Care Homes: a Qualitative Study of Leaders’ Experiences

“…For instance, the prevalence of ageist, eroto-phobic attitudes in continuing care, the restrictive physical design of the care home, and the predominant focus on medical tasks (Simpson, Brown Wilson, Brown, Dickinson, & Horne, 2017;Thys et al, 2019). The same applies for members of the LGBTQ2S+ community, who may experience discrimination in care homes (Furlotte et al, 2016;. As noted earlier, fluctuating and diminished capacity can further complicate these tensions.…”

“…Furthermore, when ageism, sexism, and ableism converge at the topic of sexual health, older persons experience disproportionate amounts of discrimination or stigma from care staff and family members (Doll, 2013;Frankowski & Clark, 2009). The marginalization is amplified for those who challenge sex and gender norms such as LGBTQ2S+ (lesbian, gay, bisexual, queer, transgender, two-spirited and other) persons (Furlotte, Gladstone, Cosby, & Fitzgerald, 2016;Lottmann & Kollak, 2017).…”