Providing LGBTQ+ inclusive dementia care: What it takes and why it’s important

Did you know that LGBTQ+ inclusive care isn’t just a nice-to-have, but a vital part of effective dementia services? Providing care that is affirming and respectful of sexuality, gender identity and gender expression, and understand and meets the needs of each person, improves comfort, trust, emotional wellbeing, and care outcomes for people living with dementia and their families.

In this episode Pauline Crameri, coordinator of Val’s LGBTI Ageing & Aged Care, and Yashi explore what inclusive LGBTQ+ dementia care might look like. They discuss a range of aspects that may be experienced by LGBTQ+ people living with dementia and why understanding identity, history, lived experiences, and cultural safety makes a difference and how care providers can best support LGBTQ+ Australians living with dementia.

Tune in to learn about:

·         The key components of LGBTQ+ inclusive dementia care

·         Why identity, respect, and psychological safety matter in aged care settings

·         Common challenges LGBTQ+ older people face when accessing care

·         Strategies to build trust and create safe, welcoming environments

·         Practical tips for support workers and care teams

·         How inclusive care benefits individuals, families, and the broader community

If you work in aged care or support an LGBTQ+ older person, this episode is a must-listen. 

Suggested reading: Protecting the dignity of older LGBTQ+ Australians, Australian Ageing Agenda. We Are Still Gay: An evidence-based resource exploring the experiences and needs of lesbian, gay, bisexual and trans Australians living with dementia (also available in the DREAM Resource Library) 

Transcript

SPEAKER_01 0:00

Did you know that LGBTQ plus inclusive care isn't just a nice to have but a vital part of effective dementia services, providing care that acknowledges and respects gender identity, sexuality, pronouns, and life experiences improves trust, safety and outcomes for people living with dementia and of course their families. Hello and welcome to Voices in Dream. This podcast is by the Dream Team, a collaboration between the Wiking Dementia Research and Education Center and the Dementia Support Australia. Whether you're a support worker, a nurse, a volunteer, or someone who cares, then you are in the right place. Voices in Dream connects you to a community of HK workers to support you to support people living with dementia. I'm your host, Yashi, and each episode we share real stories, practical insights, and support for anyone involved in dementia care, especially those in respite settings. So let's learn together one shift at a time. Today I'm joined by Pauline, coordinator of Valve's LG, PTI, AISING, and HK to explore some specific challenges, practical strategies, and meaningful actions support workers and care teams can take to create safe, inclusive, and affirming environments for older people from LGBTQI plus background while accessing dementia care. Welcome and thank you for being here today, Pauline. Thank you for inviting me to speak to you. It's really great to have you here. Can we just start off by understanding what you do and who you are?

SPEAKER_00 1:38

Sure. So I coordinate um quite a small program. There's really just two of us, um, called VELS LGBTI Aging and Ag Care. And we are the aging program of Rainbow Health Australia, and we sit at the Australian Research Centre in Sex Health and Society at La Trobe University. So what do you do as part of the program? Our aim has always been to improve the health, well-being, and visibility of older lesbian, gay, bisexual, trans, gender diverse, and intersex people and people of diverse sexualities, gender identities, and bodies in their access to care and ensure that service providers have not only an awareness, but hopefully embark on some clear actions towards inclusion. And also to ensure that older LGBTI plus people have the information that they need as they age and to empower them with that information so that they can access services.

SPEAKER_01 2:44

This area is not very much talked about, and I think there's a fundamental lack of knowledge in terms of how we can provide care that's safe and respectful to people from LGBTQ community. For those who may not be familiar, what does LGBTQ plus inclusive dementia care look like in practice and why is it so important?

SPEAKER_00 3:07

We could talk about that for certainly a long time, but in a nutshell, I think inclusive practice really begins with awareness and an understanding that we're talking about a group of people or identities who have quite different needs and experiences. And I guess the needs really stem from experiences. We know that many older LGBTI plus, or regardless of what acronym you use, they have experienced many older LGBTI plus people have experienced profound social stigma and discrimination throughout their lives, particularly in their younger years. And that has also informed their aging experiences as well. Often we think about history being in the past and that you know things have changed now, we most definitely for better, but there is still a long way to go. So if we think that that things are better now, but there is still a long way to go. Think about if you've got, you know, a 60, 70, or 80-year-old client or resident, they grew up in a period of profound social stigma and discrimination. We're talking about criminalization, pathologization, um conversion practices, um, really negative responses and outright discrimination from all sectors of society, but including service providers, families and communities. So for them in their aging experiences, or for those people who are living with dementia, those expert earlier experiences most definitely will inform their access, their knowledge of um services, but also that their confidence in accessing them. I think for service providers, the starting point is education.

SPEAKER_01 5:11

Yeah, I was going to get into that challenges, um, you know, not just the person that is um receiving the care that might face challenges, be the support workers or those who are providing services, they might they might also face challenges, you know, trying to understand how to provide safe and respectful care. What are the common challenges that you've um you've noticed yourself from people that you've talked with or from your understanding? What are the common challenges people from both parties um encounter in day-to-day life?

SPEAKER_00 5:39

I think if we're talking about um support and care workers, most definitely what comes across, and particularly those that that come to our training or contact us, they really communicate to us that they're scared of getting it wrong or scared of offending people. But that's through lack of knowledge, lack of understanding potentially, or um maybe lack of exposure. Maybe if if they've got an LGBTI plus client or resident, they um they may not have any um past experience or and particularly with older people, in a nutshell they're really scared of getting it wrong. So what often happens is they don't say or do anything, and sometimes that that might appear um as them being hostile or um um not wanting to care. Yeah, exactly, exactly. So that's how I will feel. So I think again, going back to education and and accessing either training or resources or videos or whatever there is out there to assist um um care workers um and support workers because it's really important that they're resourced. Um but I think for all for many older people and for for people living with dementia, for people accessing services, their concerns are often that um they're going to experience discrimination. That's number one, usually. That um from their past experiences, perhaps when they're younger.

SPEAKER_01 7:24

That would definitely be related to how they were dealt with when they were younger, all that discrimination, that fear of not being able to talk about their feelings. That's right. I I think that plays a big role, doesn't it?

SPEAKER_00 7:36

Yeah, and and in fact, for many people, services could outrightly discriminate, say, well, you know, we don't want your type here, or we don't provide services to people like you. We're also talking about a large proportion of people that lived through the HIV and AIDS epidemics in in Australia, but also internationally, and that all has also had an impact. So for many um LGBTI plus people who did live through that um that intense period in the 80s and 90s, they were discriminated against by service providers. So again, that has really informed um their experiences. And while they may not have personally, we're talking about a community that experienced widespread um discrimination. So again, accessing support and care services with um as they're either aging or in particular um with um living with dementia, there is that um number one thing that everyone says that they're fearful of ongoing or a return to discrimination.

SPEAKER_01 8:52

Yeah, I'm learning all of these as we're doing this podcast from what you've just said. It all comes down to them not being able to ask for help because of that fear of rejection and fear of chizometics. Absolutely.

SPEAKER_00 9:05

Um it that is fundamental and one of the key um aspects with regard to accessing services or help. The other aspect that impacts is that for many older LGBTI plus people, we know um from some research that they're more likely to be single, more likely to live alone, and less likely to have children. We also know from um, you know, the history of social stigma and discrimination that they may not have contact with biological family. So if you put that all together, who helps them access services? We know how challenging and complex it can be if you have, you know, maybe um adult children to help you navigate aged care services or other family members or a partner, but what happens if you don't have that?

SPEAKER_01 10:04

Yeah, exactly. So a bit there to think about for everyone, I guess. I've never thought of it this way, but yeah, that's such an eye-opening statement that you've just made. So, what can I do? What can I do as somebody who is providing care? Um how can I build that conversation or how can I build that relationship? How can I be helpful?

SPEAKER_00 10:27

I guess there's lots of ways. Um, as an individual worker, as I said, accessing education. So there's a range of education around our program, Valves, um, provides um some um monthly sessions which are held online, but there's also a range of other um education around understanding the needs and experiences of older LGBTI plus people, um, such as education provided through Silver Rainbow, contacting your local pride group in different states and territories. There's lots of organizations now that will be able to help. There's lots of things that you can read. But I also think from the wider service sector, thinking about um strategies and ways that you can demonstrate your welcome and inclusion for older LGBTI plus people and LGBTI plus people living with dementia. You know, have a look at your website. How do you communicate to people that you might um that you might provide um services to the diverse community that we all live in? Um if you're you regardless of of your um cultural background um or your diversity, if you think about and have a look on your website, how would other people perceive that? But I think that also has to be backed up with um real actions. So as I said, education's a great starting point, but there are other things that you can do. Um if if if you're a residential age care provider, looking at your perhaps your activity program, how does that cater for a range of diversity and including LGBTI plus people? How does um thinking about um the way that you talk to and onboard new clients and residents, how would they know that you were a safe, welcoming, and inclusive provider? So there's a lot of things, um, you know, small things that you can do, but I I guess the big picture aspects of inclusion can often take take longer. There's also specialization verification framework, which is um one of the key aged care reforms that service providers can achieve, and LGBTI is one of those. And we can certainly assist service providers with some key actions that can really demonstrate that you and communicate to LGBTI people that you're a welcoming service. So, you know, there's some of the ways, but there's there's many more, I guess.

SPEAKER_01 13:26

Yep, so you just need to learn about it, try and get education as much as possible, reach out to the community that provides those sort of education, and even in the organization level, if you really want to um, you know, educate your staff, then there are services that are available for you to incorporate in your training and in your in your organizational website, and that's the way to go forward with um providing the safe and respectful care to people from this community.

SPEAKER_00 13:53

Most definitely. That's a great starting point. Um, also recognize that you potentially have a workforce or people within your workforce who are part of the LGBTI community as well. And while we don't want to put the responsibility on them to be the sole providers of inclusive care, often they have a lot of knowledge and skills around ways that this could be embedded within um within organizations and within um work teams. So that's also another way as well.

SPEAKER_01 14:28

Yeah, yeah. Do you have any final takeaway messages for our uh edge care workers?

SPEAKER_00 14:35

Um most importantly, I think education, understanding history is really fundamental to understanding where older people and where the community is as a whole, because history has really impacted um people's lives, but also the way that community still thinks. Don't make assumptions, um, be curious and look for ways to communicate um welcome and inclusion.

SPEAKER_01 15:06

Yeah.

SPEAKER_00 15:06

And also make sure that you can back that up with um real actions. So we certainly don't want people to put a rainbow flag on the door but have no substance behind that rainbow flag or no actions, because that makes it quite culturally unsafe for people. If they think a service is safe, welcoming, and inclusive, and then they don't experience that, that um has a real impact as well.

SPEAKER_01 15:34

Thank you so much, Pauline, for sharing your insight today. We really appreciate you, and I've learned so much from you, and I'm sure other people will learn from this as well. And thanks for pointing out those um resources that I available. I will be putting down some links um in our platform for people to access it if they're interested after listening to this podcast. So thank you. Thanks for being here today. Thanks, Yashi. And before we wrap up, here is something for you to reflect on. What is one action that you can take today to make your dementia care service more inclusive, safe, and welcoming for people from LGBTQ community to let us know. Thanks for listening to Voices Syndrome today, connecting you to the community of aged care workers to support you to support people living with dementia. If you found this episode helpful, share it with the co-worker or even mention during your handover. Let's keep building a strong connected care team. Follow the Wiking Center on Facebook and LinkedIn for more episodes and free resources. And also to keep learning and growing, check out our free courses like Dream Program, Equipped Learning, and Understanding and Preventing Dementia. Take care of yourself and those you support. And see you next week on Voices in Dream. Bye.