Issue link: https://maltatoday.uberflip.com/i/1517916
20 Unity SUNDAY 24 MARCH 2024 Christian Vella M.Phil./Ph.D. Candidate Department of Gerontology and Dementia Studies WHEN picturing older individuals, the common imagery tends to adhere to a conventional storyline – visualising a cisgendered man and woman, perhaps as a couple or surrounded by grandchil- dren. However, this depiction oversim- plifies life's trajectory, overshadowing the rich tapestry of experiences among those who don't align with this narrow mold. In the context of long-term care, seniors frequently encounter desexu- alisation, where their sexuality takes a back seat to health and financial mat- ters. This perspective presents a unique hurdle for the Lesbian, Gay, Bisexual, Transgender, Intersex and Queer (LG- BTIQ) community, perpetuating the problematic concept of 'compulsory non-sexuality' for older persons and further marginalising those with di- verse sexual identities. The current generation of LGBTIQ individuals, who may eventually re- quire long-term care services, has lived through a history of active discrimi- nation and persecution due to their sexual and/or gender identity. Such negative experiences may have been encountered personally or witnessed among friends. Recent social and polit- ical shifts have begun to acknowledge and affirm their rights, prompting old- er LGBTIQ individuals to seek recog- nition, understanding, and integration in later life. The pressing question of 'who will care for us' becomes especial- ly significant as they age further, where many lack traditional support struc- tures and their own support system be- gins to diminish. A survey by the American Associa- tion of Retired Persons (2020) high- lighted significant concerns among LGBTIQ older persons regarding long- term care. A substantial percentage ex- pressed worry about the availability of family or social support, emphasising the absence of specific services tailored to their needs. In particular, transgen- der individuals faced heightened con- cerns about healthcare, sensitivity of providers, identity concealment, and housing discrimination. The fear of unfair treatment or inadequate care due to sexual orientation is prevalent among the LGBTIQ community, lead- ing some to conceal their identity in long-term care settings. Mistreatment in long-term care fa- cilities include refusal to assist with bathing, disclosing sexual orientation or gender identity without consent, separating same-sex couples, and ne- glecting medical care based on sexual orientation or gender identity. The lack of awareness and training among staff further compounds these challenges. Discrimination and microaggressions are perpetuated by a failure to inquire about gender identity and sexual orien- tation, creating an unwelcoming envi- ronment for LGBTIQ individuals. Anticipating potential discrimina- tion, some older LGBTIQ individuals may choose to conceal their identity, leading to a state of 're-closeting' or 'de-transitioning' after years of being 'out.' This denial can have consequenc- es on mental health and exacerbate feelings of invisibility. The inadequacy of staff training and communication tools further contributes to the chal- lenges faced by older LGBT individuals in long-term care. The AARP survey also reported on the European scenario and highlighted widespread concerns about neglect, abuse, limited access to services, and verbal or physical harass- ment among older LGBT individuals. Instances of abuse within care homes, as reported in the United Kingdom, un- derscore the urgent need for address- ing homophobia and providing proper protection for vulnerable individuals. The fear of losing control over identi- ty, especially among transgender indi- viduals facing dementia, adds another layer of complexity. Housing discrim- ination remains a pressing issue, par- ticularly for older Black and minority ethnic LGBT groups. Some advocate for specialised services tailored for LG- BT individuals, but the availability of such services is limited. The AARP survey suggested that LG- BTIQ seniors would find greater com- fort with healthcare professionals who undergo specialised training, visible ad- vertisements promoting LGBT-friend- ly services, awareness of the LGBTIQ identity among service providers or staff, and the presence of LGBTIQ-wel- coming signs or symbols in physical lo- cations and communication materials. This perspective has brought attention to exemplary practices observed in var- ious countries, including Europe, the United States of America, Australia, and Canada. These practices under- score the positive impact of continuous affirmative training and established frameworks. Additionally, the availa- bility of both LGBTIQ-affirmative care homes and exclusive care homes orre- tirement villages has been instrumen- tal in fostering safe living environments and providing peace of mind. Locally, the current state of long-term care predominantly adheres to het- eronormative practices and settings, lacking visibility for LGBTIQ individu- als. On a promising note, the National Strategic Policy for Active Ageing: Mal- ta 2023-2030 (Ministry for Active Age- ing, 2022) represents a significant step forward. For the first time, it includes a dedicated theme addressing the needs and concerns of LGBTIQ persons, marking a positive development in pro- moting inclusivity and recognition. Providing adequate care for older LGBTIQ individuals requires acknowl- edging their unique life experiences and addressing the challenges they face in long-term care settings. Sensitivity, training, and awareness are essential to create an inclusive and supportive environment for this population, en- suring their well-being and safeguard- ing against discrimination and abuse. Ignoring the history and future fears of older LGBTIQ individuals undermines the development of effective care plans, perpetuating their sense of marginali- sation and invisibility in society. References American Association of Retired Per- sons. (AARP) (2020). Maintaining dignity: Understanding and respond- ing to the challenges facing older LGBT Americans. https://www.aarp. o r g / c o n t e n t / d a m / a a r p / r e s e a r c h / surveys_statistics/life-leisure/2020/ maintaining-dignity-lgbt-reformatted. doi.10.26419-2Fres.00217.006.pdf Ministry for Active Ageing. (2022). National Strategic Policy for Active Ageing: Malta 2023-2030. https:// activeageing.gov.mt/wp-content/ u p l o a d s / 2 0 2 3 / 0 4 / N S P A c t i v e A g e - ing2023-30.pdf LGBTIQ older persons in long-term care Life care