rainbow swoops
More than empty promises
by Vince Sanchez, Aimee Delaney, Adam Guetzow & David Alfini

One of the most exciting aspects of being part of the homecare industry is that it is in constant motion. Changes in society, health care and technology are providing daily opportunities and challenges.

The emergence of the openly LGBTQ senior as a consumer of homecare services is one such development that presents new and unique opportunities and challenges for homecare, home health and hospice providers.

To best maximize these opportunities, it is important to understand this population, what makes them different from other older adults and how their needs can best be met by your organization.

Know the Reality

In 2017, the National Center for Biotechnology Information cited studies estimating that there were 2.7 million adults aged 50 years or older who identify as LGBTQ; the percentage of this population is higher in larger metropolitan areas. It is predicted that this number was expected to double by 2060.

Studies have further shown that the LGBTQ population is increasingly interested in aging in place. One of the primary factors motivating this desire is the LGBTQ senior’s concern that they are likely to face discrimination in senior living facilities. One study revealed that as many as 73% of the LGBTQ survey participants believed that discrimination existed and would come from both staff and residents. Another 34% of participants reported that they would hide their sexual orientation if they had to move to a senior living facility.

One other important characteristic of the LGBTQ senior population is that they are more likely to live alone. Additionally, the LGBTQ senior is less likely to have children. This increases the possibility that they will have less immediate family available to provide support and care during the aging process—and that is one of the starkest contrasts to the non-LGBTQ population. In general, upwards of 80% of the long-term care in the United States is provided by family members.

A Shared History & A Shared Clinical Status

A shared history of marginalization has had a documented impact on the mental and physical health of the LGBTQ senior. Because the LGBTQ senior is more likely to live alone, they are more likely to face social isolation and the accompanying mental health challenges presented by it. Additionally, a shared history of harassment and discrimination has led to higher rates of anxiety, depression and substance use disorders in this population.

LGBTQ seniors are also likely to have faced barriers to access to health care services, potentially leaving them with a more challenging health care history than their counterparts. This includes chronic illnesses such as diabetes and hypertension.  Additionally, the gay male community was disproportionately impacted by the HIV/AIDS epidemic. There are LGBTQ seniors who have lived with HIV for decades due to anti-viral medication. While these medications have evolved over time, many of the early regimens caused long-term side effects. Additionally, the use of hormones by members of the transgender community has lingering health side effects that are still being discovered.

Serving the LGBTQ Client

The question then becomes how you can best serve the LGBTQ client. The industry as a whole will be better served if this preparation starts before the first LGBTQ ever client comes to your organization. Here are some areas to explore:

1. Marketing & Outreach

As detailed above, the LGBTQ senior may have spent a good part of their lifetime feeling they were discriminated against. They can be understandably hesitant with respect to service providers who will be coming into their home.

The homecare provider can address these fears at the outset by making it clear that their organization is welcoming to LGBTQ clients. Several providers have updated their websites and printed materials to expressly state that they do not discriminate against any clients on the basis of any protected category, including sexual orientation and gender identity.

Other homecare providers have gone further, including information that is specifically tailored to the LGBTQ senior community, such as testimonials from LGBTQ seniors. The marketing and outreach materials also frequently include descriptions of employee training that includes the issues experienced byLGBTQ seniors.

2. Employee Training

Employee training is another important element of serving the LGBTQ client. Homecare, home health and hospice employees come from all backgrounds and not all have an understanding of even the basic terminology. This lack of understanding can lead to misunderstandings that can ultimately prevent the client from receiving optimal service.

Many homecare providers have added LGBTQ competency training to their employee training programs. In the best circumstances, the training is targeted at all levels of employees. The fact that the organization has decided to invest the time in this training sends a strong message to the employee about the importance of this topic.

The training itself takes many forms. That being said, it does need to be made clear that the company has a nondiscrimination policy that includes sexual orientation and gender identity. Any written nondiscrimination policy should be included in the presentation. It also needs to be made clear that any bias or prejudice that any individual may have against a certain group will not be tolerated in the workplace.

The training can also include discussions of the terminology used and the shared history of the LGBTQ senior. Additionally, it should assist the employee to understand some of the behaviors and clinical presentation of the client.

Homecare agencies have reported that this type of training is especially important for caregivers. From the conversations that arise during the training, it becomes evident that these are topics that the caregiver may not have encountered in the past. Interestingly, this is also true of clinical staff in the home health and hospice setting. The training is an opportunity to begin conversations that are sometimes new and challenging for certain individuals.

3. Case Management

Because of their history, the LGBTQ senior is less likely to have a strong understanding of how to manage their health care. Additionally, they are less likely to have the support system to help manage that care, which gives the case management process heightened importance. Homecare services are provided with the primary goal of preventing institutional care, and LGBTQ-sensitive case management can set agencies distinctly apart.

As is the case for many homecare clients, it’s not just about clinical care for LGBTQ seniors—it’s about maintaining their lives. And there are many opportunities to meet their needs outside of the clinical setting between patient care visits. In fact, case managers are the first to communicate with homecare clients. But to effectively break through complex barriers, a case manager must leverage their interpersonal acumen in a professional and sensitive yet honest manner, all while fostering confidence and hope. The LGBTQ client is looking for understanding and acceptance, and they have done their research. An astute awareness of their historical disparities is manifested daily in the provision of compassionate, optimal and ethical patient care. Listening to their stories, understanding that they have led a hidden and marginalized life, showing concern and providing counseling are essential in successful case management.

There is no question that the LGBTQ senior population presents many opportunities for growth for your client base. With these considerations in mind, your organization can be proactive in its approach to this emerging client population and set itself apart in the market.

Vince Sanchez is the co-owner and administrator of Angel’s Care Home Health Services, Inc., a boutique agency serving five counties in the Chicago area.

Aimee Delaney, Adam Guetzow and David Alfini are partners at the law firm of Hinshaw & Culbertson LLP and are the leaders of the firm’s aging services practice area. Their practice focuses on labor and employment issues as well as client-facing risk management issues.