Exploring Staff Clinical Knowledge and Practice with LGBT Residents in Long-Term Care: A Grounded Theory of Cultural Competency and Training Needs

Abstract

Providing culturally competent care to LGBT residents is an important area of concern in the current practice of long-term care (LTC) staff and providers. Existing literature shows thatLGBT residents are likely to face discrimination and suboptimal care in LTC facilities due to homophobia, transphobia, and heteronormative/cisnormative policies. This grounded theory study assessed the LGBT cultural competency that exists among staff working in LTC facilities, and provides a framework for understanding how their knowledge, skills, and attitudes with respect to LGBT residents are connected to their ability to care for those populations. The core category identified in this study was "staff sensitivity to minority sexual orientation and gender identity (SOGI) of residents." Main categories reflected the ways that competency, awareness, knowledge, experience with LGBT people, attitudes toward LGBT people, and current training needs reflect staff sensitivity to resident SOGI. Recommendations are made for training LTC staff to be sensitive to the particular needs of sexual and gender minorities in their facilities.

Providing inclusive, person‐centred care for LGBT+ older adults: A discussion on health and social care design and delivery

“…In Ireland, only one third of LGBT+ older adults believed that health care professionals had sufficient knowledge about LGBT issues, and less than half felt respected as an LGBT+ person by health care providers (Higgins et al, 2011). Internationally, staff may wish to provide affirming, high‐quality care to LGBT+ older adults, but have little knowledge of LGBT‐specific health concerns, or to signpost to agencies which provide LGBT+ specific services (Donaldson et al 2016). In the management of complex needs, such as frailty, older adults become users of many different kinds of services within the health system (Roe et al., 2017).…”

“…Knowing this information could influence care plans and prompt staff to involve ‘chosen family’; use preferred pronouns; include same‐sex partners; assist appropriate room placement in nursing home care; and ensure LGBT+ older adults are cared for in a way they would have chosen at the end of life (Cartwright et al., 2012; Daley et al., 2016; de Vries et al., 2020; Donaldson & Vacha‐Haase, 2016; Fredriksen Goldsen et al., 2019; MacDonnell & Daley, 2015; Roe et al., 2020). This information would also help staff clinically, for example managing age regression delusions in dementia, or ensuring transgender women are given proper screening for prostate cancer (Donaldson et al 2016). The inclusion of details on gender identity and sexual orientation in assessment forms would make older LGBT+ people who are not connected to traditional heteronormative systems of support ‘visible’ to care providers (De Vries et al., 2020).…”

“…There is evidence to show the support and health needs of LGBT+ older adults are not always adequately addressed within health systems (Donaldson & Vacha‐Haase, 2016; Fredriksen Goldsen et al., 2019; Roe et al., 2020). Without training in cultural competency, care providers can be unprepared when working with LGBT+ older people (Holman et al., 2020).…”

Idosos LGBT que Vivem em Instituições de Cuidados: Desafios e Barreiras para a Manutenção dos Direitos Sexuais

“…Debido a esto, su implicación nos parece esencial para que la diversidad sexual dentro de las residencias sea contemplada y se respeten los derechos de los residentes LGBT, eliminado cualquier vestigio de actitudes prejuiciosas o práctica discriminaría tanto en los profesionales como en entre los residentes (Hillman, 2017). Así, son ellos los primeros responsables de asegurar unos cuidados de alta calidad y respetuosos con los derechos de los residentes (Donaldson & Vacha-Haase, 2016;Porter & Krinsky, 2014).…”

Their Time Has Come: Providing Culturally Competent Care to LGBT Older Adults

“…Similarly, I am so pleased that Weston Donaldson chose Clinical Gerontologist to publish his important dissertation work on staff knowledge and practice with LGBT residents in long term care (Donaldson & Vacha-Haase, 2016). They report on indepth interviews with 22 LTC staff to move us from the "should" of cultural competency to "how best can we" provide affirmative care.…”