Aged Care for Transgender People……. An Australian Perspective
No different to any other Western Country, Australia is entering into an era where the sheer number of people reaching into Retirement age is exploding. This is one of two reasons why “Aged Care” residential needs will see exponential growth. The other reason is that as our cultures have been made more culturally aware of Diversity on a Generational, Sexuality and Gender basis there has been an identified need to cater for these groups in a dignified and respectful way.
To this end I recently spoke with a Registered Nurse (RN) in Victoria, Australia, who has published a Paper on this very subject. She expressed a desire to withhold her name from Publication, although it was officially submitted under her real name.
Her view is that the sheer numbers of Gay, Transgender and other diverse groups that enter into Retirement in the coming years will force this situation on Society, and rather than just let it happen and risk further marginalisation and prejudicial treatment to occur it is better to plan for it. Specifically her Paper refers to Transgender People.
This is sound reasoning on both Humanistic and Economic grounds as well as being morally sound. For a significant number of Transgender folk they have endured hardship, homelessness, tortured mental health, dereliction of friends and family and serious loss of career and employment opportunity in much of their life. All in the name of living as their real Gender Identity. They will have sacrificed all to realise a life where they are free to express and live in their true identity. We, as a society, need to turn our attention to providing a dignified and accepting Aged Care facility within our Aged Care residences that provides them with Accommodation, Medical Care, Security and Companionship equal to that of any other resident.
In many other cultures there is not this Public and Private need to establish Care facilities as the Aging generations are accepted and Revered within their families and their Care needs are met within the family. A model I far prefer but have little to no hope of changing.
I would urge all of you to consider this critical and urgent need and where necessary lobby your government and local Representative members of Government and Opposition to prepare for and meet this need. Where necessary this process should be made a Key Element of your Trans* PRIDE Program. Every generation of Transgender/Transsexual life deserves Respect and Acceptance within our Caring community and in every aspect of Care.
Please read this Paper for a full submission on the Elements of Care needed….
LGBTIQ and AGED CARE
Written and © anonymised (name supplied)
Table of Contents
1. Brief History: ‘all cultures, all nations, all through history’ 3
2. So what is LGBTIQ exactly? 3
i. Sexual Orientation or Sexual Attraction: 3
L – Lesbian 3
G – Gay 3
B – Bisexual 3
ii. Gender Identity: 4
T – Transgender 4
Iii. Biological Sex: 4
I – Intersex 4
iv. Either 4
Q – Queer / Questioning 4
3. Myths, Stereotypes and Falsehoods. 5
LGBTIQ people are sexual perverts and sexually promiscuous. 5
Pathologisation – LGBTIQ people are mentally ill. 5
Paedophilia => gay men are child molesters. 5
Being LGBT means you have AIDS 6
Everyone is born male or female – the binary gender conspiracy 6
5. How to show respect to people who are transgender … 7
6. Implications for aged care 8
7. Personal Reflection Activity 10
8. Case Studies (real stories from LGBT in healthcare) 11
9. Links 12
10. Bibliography 12
1. Brief History: ‘all cultures, all nations, all through history’
Contrary to popular belief, LGBTIQ people are not a modern phenomenon. Same sex attraction, sexuality and transgender (or ‘third sex’) people have existed throughout human history in all cultures.
‘Among historical figures, some were recorded as having relations with others of their own sex — exclusively or together with opposite-sex relations — while others were recorded as only having relations with the opposite sex. However, there are instances of same-sex love and sexuality within almost all ancient civilizations. Additionally, Transgender and third sex peoples have been recorded in almost all cultures across human history.’ (http://en.wikipedia.org/wiki/LGBT_history)
FOCUS ON AUSTRALIA… DID YOU KNOW? – It wasn’t until 1994 that the Federal government passed legislation decriminalising gay male sexual activity. In 1996 the High Court of Australia overturned the law in Tasmania prohibiting gay male sexual conduct. Finally the Tasmanian Liberal Party passed a bill decriminalising Homosexuality in May 1997 making Tasmania the last state to decriminalise gay male sexual conduct. As of May 2013 neither of the major political parties support the notion of recognising Same Sex partnerships under Marriage law.
2. So what is LGBTIQ exactly?
LGBTIQ or GLBTIQ also known as LGBT or GLBT is an acronym that refers to the diversity of sexual orientation, biological sex, gender and gender identity amongst our human population. The group of acronyms is also sometimes referred to as the ‘Alphabet soup’ due to the number of letters. So what do the letters mean?
G Gay i. Sexual Orientation
T Transgender ii. Gender Identity
I Intersex iii. Biological Sex
Q Queer / Questioning iv. Either
i. Sexual Orientation or Sexual Attraction:
Parts of the LGBTIQ Alphabet soup that relate to sexual orientation or attraction:
L – Lesbian
Women who are sexually attracted to women
G – Gay
Males who are sexually attracted to men
B – Bisexual
A person who is sexually attracted to both sexes
ii. Gender Identity:
Part of the LGBTIQ Alphabet soup that relate to gender identity:
Gender Identity and Sexual orientation/ attraction are very different. A person may identify as male, female or anywhere in between and yet be attracted to same sex, opposite sex, bisexual or identify as a-sexual.
T – Transgender
A person whose gender identity is different to their gender assigned at birth.
This is an umbrella term that covers a number of non-binary gender identities including transsexual, transvestite, cross dresser, androgynous, eunuch etc. In a transsexual’s case the individual may have had some gender reassignment therapy or surgery resulting in secondary sexual characteristics that match the individuals gender identity.
They may or may not be visibly distinguishable from a genetic person of the same gender. Science is as yet unclear as to the cause of this condition (some recent studies suggest a variance in the BSTc section of the brain) but it has appeared through history in almost all cultures and is largely considered a biological condition.
Iii. Biological Sex:
Part of the LGBTIQ Alphabet soup that relates to biological sex:
I – Intersex
A person with both male and female attributes
This is yet another umbrella term that incorporates a multitude of non-binary biological sex conditions. Whilst our society generally thinks that sex/gender is binary (ie: male and female) the reality is that approx. 1.9% of all births are neither male nor female but instead what is termed intersex. Intersex is always congenital and can originate from genetic, chromosomal or hormonal variations. One example of an intersex condition is Klinefelters syndrome where a person is born neither XX nor XY.
Parts of the LGBTIQ Alphabet soup that relate to either sexual orientation or gender identity:
Q – Queer / Questioning
(the ‘Q’ can vary in meaning.. sometimes two Q’s are included as in LGBTIQQ)
Queer – A person who feels that their sexual orientation /gender identity falls outside heterosexual boundaries.
Questioning – a person who is still in the process of working out their sexuality or gender..
3. Myths, Stereotypes and Falsehoods.
LGBTIQ people are sexual perverts and sexually promiscuous.
– a LGBT person is no more or less likely to be sexually perverted or promiscuous than any other human being.
– A personal example… I am transgendered and have only had 1 sexual partner. I have been married for 21 years and have 4 children
Pathologisation – LGBTIQ people are mentally ill.
– Homosexuality was once considered a psychiatric disorder in the DSM (Diagnostic and Statistical Manual for Mental Disorders) but was removed in 1974.
– Other components such as transgender are still considered a psychiatric disorder in the DSM regardless of scientific evidence to the contrary.
– Many people in the LGBTIQ community object to being labelled as having a mental illness.
Paedophilia => gay men are child molesters.
– Modern history has often placed homosexuality and paedophilia together.. ie: the ‘Boys Beware’ public safety video from the 1950’s (http://www.youtube.com/watch?v=hzgKSGD6Hgo)
– The reality is that there is no correlation and in general a LGBTIQ person is less likely statistically to be a child abuser.
‘Are homosexual adults in general sexually attracted to children and are preadolescent children at greater risk of molestation from homosexual adults than from heterosexual adults? There is no reason to believe so.
The research to date all points to there being no significant relationship between a homosexual lifestyle and child molestation. There appears to be practically no reportage of sexual molestation of girls by lesbian adults, and the adult male who sexually molests young boys is not likely to be homosexual (Groth & Gary, 1982, p. 147).’
Being LGBT means you have AIDS
AIDS is an illness that affects human beings regardless of sexual orientation or gender. Below are the USA statistics of AIDS infection to 2010.
Transmission Category Number infected %
Male-to-male sexual contact 555,032 48.42
Injection drug use 277,738 24.23
Male-to-male and injection 80,902 7.06
Heterosexual contact 214,196 18.69
Other 18,402 1.61
Everyone is born male or female – the binary gender conspiracy
– Whilst our society generally thinks that sex and gender is binary (ie: male and female) the reality is that approx. 1.9% of all births are neither male nor female but instead what is termed intersex.
– In addition many people are born and assigned a male or female sex identity that differs from the gender to which they identify.
– there are also a variety of lived genders other than man or woman that people may choose to live as such as gender queer / androgynous.
5. How to show respect to people who are transgender …
6. Implications for aged care
The past 20-40 years have seen significant change in the acceptance of LGBTIQ people in the majority of Western Society. Whilst there is still a long way to go for true equality there is an increasing number of LGBTIQ people who are comfortable in being their true selves in society. eg: not ‘in the closet’.
The issue is considered so relevant that the Commonwealth Government initiated a study in 2012 to determine a strategy for the ongoing aged care of LGBTIQ people. (National Lesbian, Gay, Bisexual, Transgender and Intersex (LGBTI) Ageing and Aged Care Strategy, © Commonwealth of Australia 2012)
With the ageing population in Australia we will continue to see a greater number of LGBTIQ residents/clients in our aged care programs in the coming years. In addition people working in the industry will find many colleagues who identify as part of this community.
The following quotes and examples highlight a number of ways in which the growing LGBTIQ ‘out’ population is likely to impact Aged Care.
‘Such approaches have reinforced the invisibility of older LGBTI people and as a result have ignored a sizeable group of Australians of diverse sexual orientation, sex or gender identity, which is estimated to be up to 11% of the Australian population.’ (National Lesbian, Gay, Bisexual, Transgender and Intersex (LGBTI) Ageing and Aged Care Strategy, © Commonwealth of Australia 2012)
‘Dr Jo Harrison from the University of South Australia says there are instances where people have reported choosing to hide their sexuality or “return to the closet”.
Dr Harrison says the Government’s recognition that the elderly homosexuals are being discriminated against and have special need is a “historic turning point”.
“They announced an enormous swathe of aged care reforms and in amongst those reforms was that the Government is going to legislate and include lesbian, gay, bisexual, transgender and intersex older people in the Aged Care Act as a special needs group for the purposes of aged care,” she said.
“And that’s an incredibly significant turn around from like virtual invisibility at Federal Government level two years ago.
“Discrimination among aged care workers is partly due to the relatively high number of immigrants in the workforce. They are sometimes from countries where homosexuality is far less accepted.
Dr Jo Harrison says the Government is putting more money into training aged-care workers to be more tolerant.
“Some may have very strong religious views. They may have very strong traditional cultural views for whatever reason,” he said.
“But one of the issues with the education is to say you’re here to do a professional job, you’re here to treat people as human beings with dignity and rights and regardless of whatever your own personal view about this might be, you leave that outside.
“You come in here as a professional and you treat people in this fashion.”
DAVID URQUHART would rather ”swing from the ginkgo tree in the back yard” than go into a nursing home.
The scant acknowledgment of the need for gay-friendly aged-care services worries the 71-year-old photographer, who says he is scared about what the future holds for him.
Mr Urquhart lost touch with his family after he came out in 1968, and, without a partner, he wonders what will happen to him if he needs to be cared for or to give someone power of attorney.
Bernie Darling, a transgender woman from Brisbane who turns 60 next month, says she is worried about the attitudes she may be forced to confront in an aged care facility.
Ms Darling was born a male, but has slowly been transitioning into womanhood since her teenage years.
She now has breasts and no facial hair, but she has not yet taken the final step of being operated on.
“It is a scary notion – I’m hoping that I don’t have to go into an old persons home,” she said.
“It wouldn’t be nice to have to regress because whilst you still had your memory intact it would just make what you had left of your life miserable.
“Perhaps in my situation it would be harder than others because they would soon discover that I’ve transitioned in mind and body to a certain degree, but I haven’t had the final operation.
“So the first one to ever come and give me a sponge bath would get a hell of a shock.”
7. Personal Reflection Activity
i. How would you feel working alongside someone of the same gender who was homosexual or transgendered?
ii. What would your reaction be if you were caring for a woman who when showered you discovered she had a penis?
iii. What do you believe in relation to sexual orientation and gender identity? How is this likely to affect you in your work with LGBTIQ people?
iv. What things can you do to help you understand better people who identify as LGBTIQ?
8. Case Studies (real stories from LGBT in healthcare)
i. A PCA explains an ‘incident’ at her workplace.
‘I heard commotion & laughter coming from down the hallway. I didn’t know what the fuss was about until around 5 minutes later I walked down the hallway to find 2 RN’s, two nurses’ aides & the manager of the nursing home taunting an openly gay senior aged care worker. They were giving him such a difficult time that my heart sank when I realized how immature, cruel and heartless everyone was being.
The staff member in question was helping an aged & frail resident to go the toilet. Soon everyone was mocking the staff member saying things like “Oh did you enjoy that?”, “I bet you do that all the time”, “you like feeling old wrinkly balls?” etc. I was disgusted that they would stoop to such a level. The poor guy was getting agitated & flustered and the abuse never stopped there… it went on practically all day..’
ii. A transgender Div. 1 nurse shares her story.
‘I started my training as a General Nurse at Mildura Base Hospital in 1976. I was still Ian then. I have worked full time in Peri-Operative Nursing ever since. I LOVE it.
I moved to Sydney in May 2003 to live AND work as Robyn fulltime. Yes I am out at work. I am happy to talk about my situation and answer genuine enquiries about my life. The people I work with in Sydney have only known me as Robyn but are aware of my gender. Most are very good, some slip up occasionally with the odd male pronoun and only a few recidivists insist on calling me ‘he’.
I suppose you could call incorrect pronouns a form of harassment or discrimination but I let much of it slide as most make genuine efforts to be correct although there is one anaesthetist who has known me for 10 years and insists on calling me ‘he’.
I am pragmatic enough to realize that I will always be viewed as somewhere in the middle of the gender spectrum rather than further into the female side.
The people who seem to have the biggest difficulty are “Christian” people who think they know more about my relationship with God than I do. Fortunately these people are few and I do not have much to do with them.’
iii. A transgender woman of late middle age shares her fears.
Being in aged care is one of my secret fears Ellie … that one day I’ll find myself in an old folk’s home and dependent on others … I can imagine not being given my HRT dose, not shaved (if necessary), my wig discarded. It’s just a very scary image to me.