How Inclusivity Training Leads to Safer Care

Compassionate care is the hallmark of home health. But for some seniors, health care in general—including care at home—has been fraught with obstacles and discrimination. This is especially true for members of the LGBT community as they age.

Empath Health, a Florida-based nonprofit integrated network of care that includes home health and hospice, set out to change that experience for seniors. The company pursued the platinum credential from SAGE, an advocacy group dedicated to improving the lives of LGBT elders.

Empath President and CEO Rafael J. Sciullo said that the company cares for 4,000 people a day across its service area, including members of the LGBT community. The company created Empath Partners in Care (EPIC) following a merger with the AIDS Service of Pinellas and Francis House; it focuses on the testing and management of HIV and also serves aging members of the LGBT community.

“We needed to understand their needs based on their identities and the challenges they are experiencing in health and be sensitive to some of the experiences they have had based on the intolerance of others,” he said. “It was important to be as educated as possible.”

Training for Inclusion

For a health care provider to pursue any credential beyond what federal and state governments require is a move towards quality, value-based care. Committing to serving a particular segment of society takes that commitment a step further. SAGE created the credential to recognize and encourage providers willing to take steps toward cultural competency and increased care for the target population.

“We recognized that providers who are committing the time and energy to complete staff training want and deserve a public symbol that communicates their commitment to staff training and creating more LGBT-inclusive services,” said Tim R. Johnston, senior director of national projects for SAGE. “The credential is a way for providers to send a positive message to potential clients. It is a tool that LGBT older adults and caregivers can use to assess which providers will be open and excited about working with LGBT communities.”

SAGECare, the credentialing arm of the organization, exists to create inclusive LGBTQ health care. The program has now trained more than 87,000 industry workers in 48 states, offering four levels of certification: bronze, silver, gold and platinum. To achieve the platinum credential, at least 80% of a company’s senior leadership must participate in a half-day training session, and at least 80% of other staff must complete an hour of LGBT aging cultural competency training. Johnston noted that some providers work their way up through the levels of training in order to refine their best practices.

Empath did not take that path, choosing to shoot straight for the top.

“We made a decision when we went through this to go for the highest level,” said Stacy Orloff, vice president of innovation and community health for Empath Health. “That meant having most of our employees and leadership team go through the training. That was our commitment early on—if we were going to do this, we would be all in.”

SAGECare provides a marketing toolkit for agencies wishing to share the credential with the world.

“We can work with each organization to determine its outreach goals and help achieve them,” Johnston said. “Word of mouth is still one of the most potent ways to reach LGBT people, so public commitments to inclusion are crucial to establishing your organization’s reputation as a welcoming space.”

All Are Welcome

For Empath, inclusivity goes beyond the patients the company cares for. The company ensures that employees feel safe, as well. Individuals can select their preferred pronouns on their business cards, and employees in the process of transitioning gender are provided with health insurance coverage to do so.

Empath also implemented signage at their locations that reflects the idea that all are welcome. In the EPIC offices, the company carries LGBT periodicals and educational materials. The agency, an integrated network of post-acute care that includes a PACE program, home health and palliative care, began as Suncoast Hospice 43 years ago and now serves clients in three Central Florida counties.

In June of 2020, with the COVID-19 pandemic cancelling Pride celebrations and parades, the company opted to join the city of Clearwater in lighting up its campus in the rainbow colors of the pride flag.

“Our language reflects inclusivity, our pictures reflect inclusivity” said Orloff. “I think we all gained more knowledge of the power of words and the impact generationally. A word that may have been offensive for the LGBT community in the ’60s or ’70s is now a very popular word with the younger members. We are constantly open to how we best communicate and reflect our deeply held values [to the community].”

Combating Bias

While many baby boomers and older seniors are open to and accepting of members of marginalized communities, others are less so. Working with any person that is sick and in need of care can come with its dangers. Home health workers, who are often female and members of minority communities, often face harassment on the job in the form of racist or sexual comments. Patients may face bias from caregivers or other patients for many different reasons, including sexual orientation.

For Empath, working against bias is important to the mission of inclusivity. When team members encounter discrimination from anyone, they work to bring the person back to the organization’s mission.

“Our way of approaching that is to always go back to our values,” said Sciullo. “One of our values is inclusion. That’s who we are and who we want to be. So reminding anyone that if we hear something like that, observe something like that, we call them back to our values. We remind them of that and remind them that there is no place for intolerance or demeaning statements.”

Johnston added that it’s important to keep an open mind and focus on inclusivity.

“You may put all of our recommendations into place and find that nobody comes out of the closet, and that is OK! You need to trust that even if people do not feel comfortable disclosing their identity, they notice these changes and probably feel more comfortable because they see your organization’s commitment to working with LGBT people,” he said.

Care Across the Ages

Empath serves patients of all ages, including pediatric hospice and palliative care patients. The EPIC program has launched a program called EPIC Generations focusing on LGBT seniors. EPIC Generations has launched something it’s calling the “Friendly Caller Program,” which matches community members with trained volunteers to provide social connection and outreach.

“With everything going on, it’s a way to connect people together and decrease social isolation. It will allow us to increase opportunities to provide care and services to people who may not know where to go for care,” said Orloff.

A planned outgrowth of the Friendly Caller Program will connect LGBT youth with community members for mentorship opportunities. Orloff said the goal is to connect with teens who may be struggling to find acceptance from their families and others.

“We know the rates of suicide and other destructive behaviors in that age group. we want to show them that it will get better, [for an adult to say] ‘It’s OK, I made it, I can help you.’” Orloff said. She noted that the program may look different than originally intended due to the pandemic and stay-at-home orders, but Empath plans to roll out the new initiative when the Friendly Caller Program is up and running.

What Next?

Credentialing and training are fundamental to an agency’s health and service to the community. Opportunities for additional training can help with caregiver retention, since a caregiver will benefit from increased knowledge about the population they serve. The SAGECare credential has an annual renewal period, according to its website. Home health and hospice providers seeking the training can sign up online; in-person training is also available through a network of SAGECare certified trainers.