Dr. Regina Koepp  0:00  
Laurie cook Daniels has been working on both LGBT and aging issues since 1974, and the 90s, she was a primary staff person for the National Center on Elder abuse. She founded the transgender Aging Network in 1998. And in 2000, became the policy and program director for forge a 26 year old national transgender and Safa that stands for significant others friends, family and allies, organization that specializes in transgender aging and victims of violence. Laurie is a pioneer in transgender aging, and has recently or was recently invited to do a White House listening session on senior supports and elder care for transgender individuals in September 2021. And today, Laurie is on the podcast talking with us about how to be an ally to transgender older adults. So Laurie, thank you so much for joining us.

Loree Cook-Daniels  0:57  
Thank you for inviting me.

Dr. Regina Koepp  0:59  
When you share a little bit about your background, outside of your bio, your background in transgender aging, and why this topic is so important to you.

Loree Cook-Daniels  1:11  
Yes, I, it's been personal. My work with LGBT issues has been personal from the beginning. I came out as a lesbian, back in 1974. And in the early 80s, I partnered with a person who fairly quickly told me that they felt they were male, even though I perceived them as female. And I was, I was a lesbian activist. So I actually blocked him from transitioning for nine years, because it would change my identity, and I wasn't willing to go there. And when I finally saw the light, part of our negotiation during his transition was that I would continue to be an activist. So that moved me into the trans community instead of the lesbian community where I found lots to work on. But since I had been doing LGBT aging issues for a long time, people started asking me about trans aging. And so at that point, I founded the transgender Aging Network, which was simply to try and gather together and create a communications channel between anyone I could find that was interested in trans aging. Because there's, you know, they're still even 20 some odd years later, there's still no really organized place for discussions about trans aging to take place.

Dr. Regina Koepp  2:55  
Yeah. And how often are those conversations taking place? Now with the transgender Aging Network?

Loree Cook-Daniels  3:00  
Well, um, the transgender Aging Network has had almost no funding for its history. So it's been pro bono whenever I could make something happen. So what has been really active is we have a peer support listserv that's been going for 24 years now. And that, that at times, there are times when we have dozens of posts a day. And then there are times when nobody has anything to say, but that has regularly had about 100 and some odd people on it. The other thing that we have is a listserv for the transgender Aging Network, which is for anyone. Elder tg is just for trans elders, and their close partners. And so that listserv, that listserv is slow. It's a couple of a couple of posts a month. And we opened a Facebook page as well as people started shifting their how they were communicating. I'm looking for funding now to try and ramp up the trans Aging Network, because I am getting, I'm getting more and more requests. People are interested.

Dr. Regina Koepp  4:20  
Wonderful. What do you suppose is inspiring the interest now?

Loree Cook-Daniels  4:26  
What we're all aging. And I think you and I before you, before we started this tape, we're talking about cultural competency, and how people are getting that they need to be culturally competent. And I think that's happened that's also happening in the trans field as people are realizing, oh, there are these people out out here, and we probably ought to know something. So there's more interest right now.

Dr. Regina Koepp  4:56  
Yeah. Part of what I've been noticing I do A lot of multicultural education and multicultural humility education in senior care communities as well and senior community recreational centers with their staff and mental health clinics. One of the areas of the most educational need is in transgender health and mental health and wellness and inclusion and equity, in resources and in treatment and, you know, just the basic humanity in terms of inclusion, and so those transgender health and mental health and gender nonconforming and gender non binary health and mental health often stand out as an area that needs to be bolstered when we're doing multicultural work. Yeah, yeah. Say a little bit. I'm so curious to learn about this White House listening session on senior supports and elder care for transgender individuals. What was that?

Loree Cook-Daniels  5:56  
Well, you know, I'm not entirely certain. I know the framework of it. I got an email asking me to participate in this trans elder roundtable, but it didn't tell me the context in which it was being done. I suspect it may have been an outgrowth of President Biden's gender work. I'm not entirely sure. But what they did was, there were between 20 and 30 of us on on a zoom call. And we each had three minutes to talk about what we felt the key trans elder issues were. And then we were asked to do recommendations on what the federal government could do. So it was interesting, it was a really varied, they were really varied responses. There were those of us that are used to doing organizing and kind of talked in terms of the trans elder community. And then there were people that wanted to talk about their particular story. So it was it there were it was an interesting mix of what was talked about, they did have a lot of personnel from various agencies. And that was kind of exciting. Because it wasn't, it wasn't all. You wasn't the usual suspects. It wasn't just the people that the advocates have talked to before. And it was kind of interesting to see it to or to imagine it getting kind of seated in various agencies. So I have not yet seen anything coming out of it. But I'm I'm hopeful.

Dr. Regina Koepp  8:10  
Are you able to talk about your three issues and recommendations?

Loree Cook-Daniels  8:16  
No, because I have COVID brain and I talk.

Dr. Regina Koepp  8:20  
And I'm just like, throwing you a curveball.

Loree Cook-Daniels  8:24  
I couldn't look it up in writing, because Because COVID brain is really not helping.

Dr. Regina Koepp  8:31  
Well, and speaking of writing, you do you have done and continue to do a lot of writing. So you have written book chapters on transgender aging, you've written fact sheets and guides for senior care communities or even health aides working with transgender older adults, how to provide affirming assistance in terms of health aid assistance to older adults, or transgender older adults. And then most recently, you authored a guide on how to be an ally to transgender older adults. And that's that's sort of the purpose of our our meeting today. So I'm, I'm, this is an issue. And I don't want to actually say issue. So I'm trying to get a move away from the term issue. This is a topic that I think is incredibly important for so many of us who strive to be allies, with multiple groups of people with histories of marginalization and harm and trauma, and who have been left out systemically of you know, mental health care, health care, education, sports, and so on life, right, just living spaces. And so we're all I know so many, like myself are yearning for more education about how to be I think even more than an ally a co conspirator. But for this purpose, we'll talk about ally ship, which is how to be an effective ally in a way that's affirming and not a I'm pejorative or reinforcing any, any of the, the experiences that transgender people have had. And so, I know so many people will be eager to learn about how to be an effective ally and a helpful ally. So thank you for being here. So what does it mean to be an ally? Well,

Loree Cook-Daniels  10:24  
it's I want to start with saying that actually forged the transgender agency I work for, we tend to not use the word ally, because we want people to own the kind of world we all want to live in. And that's not an hour, that's a person help, you know, helping the collective. You know, I tend to think like with with the police shootings, it's like, I don't want the police to stop shooting black men, I want them to stop shooting people. Yes, they're mainly killing black men. But, but that's not the world I want is where people get shot by police. So we actually don't use ELA very often. However, we haven't experienced a few years ago, where we were doing a series of trainings with a group that a government based group that offered substance use, housing, mental health care, a lot of lot of those sorts of things. And we were we were doing a six, six part training and doing focus groups. And particularly in the focus group, some people were talking about helping their clients with transition issues, transition, meaning moving from one gender to another. And I was really confused, because they were substance use agencies, they were, they were mental health aides, they were not. They that wasn't their job. And I realized in talking to them and working with them, that they knew it wasn't their job. But they really wanted to be helpful. It was important to them as service providers, as well as what may be called an ally, to be helpful to these people. And I also realized that trans people in general, have had such bad experiences with service providers that we have a lot of reluctance to, to go to another service provider, because what if they're, they're discriminatory? Or what if they're disrespectful. And so I realized that these, the clients, these people were working with, had established trust in them. And therefore they were turning to them for a range of things, because here was one of the few trusted service providers they knew. So when Cheryl Whelan, who is part of sage, came to me and said, I want I want a guide for allies, because people are asking me, How do I help? That was the framework I had of someone that is probably providing professional services of some sort, but not necessarily credit, transgender related, and want it to be helpful. So that's kind of the ally that that I have in mind. And I think an ally, I would contrast an ally with two other concepts. One is is a friend, a friend is a relationship of reciprocity. You're helping each other You're it's it signee quality relationship. And then there's a service provider that usually providing particular services. It's not a two way relationship for the most part. And the service providers supposed to do something generally provide some kind of service. That's why they're called service providers. An ally is kind of a hybrid. The main goal of the Li is to support to help the other person navigate life and emotions. We all need that. They don't tell a person what to do, but the person may ask them to do things like running errands or Something like that, but they're not there to be advisors. The Allies goal is to make the person's life easier and more pleasurable. And they may become friends. I, it was important for me to put that in early on, because

Loree Cook-Daniels  15:21  
I don't, I didn't want to promote the idea that there can be sense with an ally, there's that one is up and one is down. And that doesn't necessarily that is not necessarily the case. There's room to develop honest relationships, honest friendships.

Dr. Regina Koepp  15:42  
I'm curious for for therapists or people who are in this role where there are inequities in the relationship based on the roles a client with the therapist, how do you how would you encourage us to look at ally ship or coconspirator ship or that equitable relationship in the context of a relationship that is inherently at the beginning and throughout? has a power differential client and psychologist client and therapist? Right?

Loree Cook-Daniels  16:19  
I I think I wouldn't go that far. I think I wouldn't call them an ally, I think I would keep them in their role in their defined role in the in the role that they have negotiated with their client, more so than as an ally. I'm amazed, I think I'm mainly talking about people that don't have a formal role with their client. But now that is, that is looking at ally as as primarily ally to an individual. If we talk about ally to a community, that's really different. And in that case, we're talking about how do I change the world in in a way that makes it easier. And that may be the way that you're primarily thinking about Li is looking looking at that world peace. And mine, mine ally here was looking at individual support? Or?

Dr. Regina Koepp  17:34  
Yeah, and I'm thinking about ways for professionals in this space. You know, are your systems affirming? And I know that is it sage and the National LGTB aging Resource Center has a great guide for creating affirming communities. Yes. So like for hospital systems and long term care communities, creating affirming spaces? And so would that be one way for professionals to be an ally to the transgender community by incorporating some of those guidelines from those resources into their systems?

Loree Cook-Daniels  18:09  
Absolutely, absolutely. You can be an advocate within your own system. And in fact, I would argue, if you're not advocating within your own system, and your system is not behaving well, don't call yourself an ally. Because your system is doing Are you really do need to work on your own system. But some of the other other suggestions we had for, for working out in the world on trans issues is bring up trans people and topics. I mean, it's really simple. It's, it's what anybody can do. And it just helps break the decades long silence we've had and it helps norm trans people and just just putting up the subject can be really helpful. We have watch for and use opportunities to advocate so that's when someone is saying something that is incorrect or offensive and just trying to correct those those things when you when you can we have helped service providers learn more, because the service providers need a lot more training. And we're, you know, we we think well, that's somebody's role is to get that training. Well, yes. And people on the outcome side, just talking to a service provider can go you know, you really ought to have some training on this. So there's there's simple, simple things we can do. And then the last one was advocate for public policy changes. I mean, as I said, Like even something that seems so narrow and will actually actually truly affect, like a handful of schoolchildren nationwide, we just don't have a tons of trans kids trying to get on teams. And yet, as I said that, that creates an environment that affects all trans people, and in fact, affects. It affects parents and community members. I mean, I, I worry about what's going to happen if the child of some of these people ends up coming out? Or will the child not say to their parent, that they're identifying as trans or non binary, because mom has already said she doesn't like us? Or doesn't think I should be on the team. You know, I think that people forget sometimes that what they say, gets heard by other people, and may have an impact they had no idea about, or,

Dr. Regina Koepp  21:23  
and I think the impact is severe in those cases. I think also the impact on people and children who are cisgender is harmful. If we see people in our communities being alienated and traumatized, and rejected on a systemic and public level. That gets internalized in cisgender people too, and it and it's like a

Loree Cook-Daniels  21:58  
rot.

Dr. Regina Koepp  21:59  
I just think it's like mold inside of us that we have to then spend a lifetime cleaning up, I think, and it's just perpetuates harm in societies. And it, it's so I think it's harmful. Across the globe. It's particularly harmful to LGBTQ folks and trans identified folks. It's also harmful to cisgender people.

Loree Cook-Daniels  22:23  
Yeah. And if I, if I'm in a situation where I'm seeing somebody being bullied, what does that do to me, is it tells me, keep yourself in line, you know, do whatever you have to do to not be bullied, it frightens all of us, it makes us conform, whether conformity is good for us or not. It makes us walk around in fear. You know, I've done some trainings and publications for support groups. And I keep emphasizing, if you don't confront it, not necessarily confront. But if you don't respond to a bias statement. It's not just affecting the target that we call a target. It's affecting everybody in that room that's thinking, I wonder what I might say that might get attacked. It's really squelching. It's very squelching.

Dr. Regina Koepp  23:37  
Can you share a bit about the terms? So what the difference is between transgender gender non conforming non binary, there was a lot of curiosity about what are the terms actually mean? And when can I use them? What can I say?

Loree Cook-Daniels  23:53  
We should have just titled this complicating everything. Because my answer to that is gonna be a little different than you expect, okay? There was a time many, many years ago, were forged did a training for sexual assault professionals. And we did the definitions. And then the training broke up and we were we were watching. We were just hanging out, you know, the way you do. And we watched one of the service providers go over to a trans person and say, you know, that term you use for yourself, it's not right.

Loree Cook-Daniels  24:43  
As a trainer, you just want to melt through the floor. It's like, Oh, that is so not right. So now we teach about the terms paradox, which is it's really important to know What term your client uses, because that's their identity. And when you reflect that word, you say, I see you, and I respect you, and you have a right to be who you are. It's very important, particularly for mental health professionals. And at the same time, that term is going to tell you squat, because the terms change rapidly. The terms are different based on generation. And they're just they're just evolving, we actually have. Forge has publications that are still on the website that use transgendered. That was, that was perfectly acceptable language 20 years ago, 15 years ago, it's not anymore. And we have to figure out, okay, are we going to go back and edit all those documents or not. But there are still people out there that call themselves transgendered. Or not another area that we've where we've got a very strong divide is that younger trans people view tend to view the word transsexual as offensive. Well, I work with trans older adults, and that and transsexual was the word that they found for themselves 40 years ago? And what does it say to them? When you say that words offensive? Are you calling them offensive? Are you disrespecting them? Are you saying all that all the people that came before me are irrelevant, because they didn't have the right language? I mean, you know, there's, there's all of these things there. So I mean, we can, we can just, we can describe what transgender means. Generally, it's, it's an umbrella term, that means someone was assigned at birth as either male or female, and now have a gender identity different from what they were assigned. So it might have been going from one gender to another, it might have been going to non binary, which is not fitting into male or female, it might be going to there are dozens of words people have made up for how, how to describe themselves. And interestingly, I read a psychiatry, psychology paper that said that that making up of terms was actually mentally very helpful. That that the process of self defining even if it goes to making up a name that has not existed before, was good for the mental health.

Dr. Regina Koepp  28:12  
I can see that there's a claiming of your identity, like I'm, I am worth who I am I am, I'm worthy.

Loree Cook-Daniels  28:20  
Yeah, it's, it makes it hard for the rest of us. But you know, we already know life is not easy.

Dr. Regina Koepp  28:28  
And back to the nuances...

Loree Cook-Daniels  28:30  
Really the terms paradox is, I think is really helpful. You need to know the person's term. But don't pretend to tells you anything. Transsexual for awhile meant you went through surgery, or that you wanted surgery, it doesn't mean that anymore. You know, so if you think well, that means they've had surgery you would possibly be wrong. So just try not to go there.

Dr. Regina Koepp  28:58  
And speaking of terms, outside of the terms paradox, there are terms that are more or less affirming when we talk about hormone affirming treatments, or what terms are the most affirming terms to use when we talk in medicine, or in medical care?

Loree Cook-Daniels  29:17  
Right now, it is gender affirming. I can tell you don't use sex change. But what gender affirming suggests I mean, with words, we're talking nuances. What gender affirming suggests is that your gender was always what it is. And by affirming it, we're just adjusting society around it. And so that's why it's an affirming term.

Dr. Regina Koepp  29:47  
Okay, so it's gender affirming treatments.

Loree Cook-Daniels  29:53  
And that'll be different next week. I want I'm only I'm only half joking. We try very hard to keep up with the language changes, because, you know, we work this is 24/7. And it is still, you know, we nobody sends out the memo that says this is now you know, x is now why we just all of a sudden you realize, oh, people are using why.

Dr. Regina Koepp  30:27  
And so what would you say then to people who don't live this 24/7? Well,

Loree Cook-Daniels  30:33  
let me let me divide that into two. If you're working with an individual. The only thing that really matters is what the individual uses. I mean, you could say, what, what are you calling the surgery you just scheduled? Yeah, you know, it's so what one on one, you can ask? I mean, the truth is that people are using both terms. We know some terms we've definitely outgrown. But there are other terms that, like, well, I've actually heard a person call themselves that, you know, I mean, we need to have some humility. The society is changing around us. And yeah, if you were trying to figure out what language you wanted to use, I would, I would probably go to some of the trans websites and see what what's getting used currently. And, and just know that just be prepared to possibly be challenged. And say, I didn't know that had changed. You know, don't try not to think you can be perfect on this because it is so this is this is an ocean and the waves keep coming. This is one of the major reasons there is bias against transgender people, is because we mess up the name the terms people have, and the way that they think about it. And we just we are so challenging to boxes, including words. So this is an inherent characteristic of this population is we mess with the boxes. Yeah.

Dr. Regina Koepp  32:43  
In your guide, the how to be an ally to transgender older adults. You talked about some of the common issues that transgender older adults might be experiencing, like medical, mental health discrimination and violence, long term care dementia. Can we talk about some of those common issues for transgender older adults? And what people working with old transgender older adults might need to be thoughtful of or keep in mind? What are some of the medical issues that transgender older adults face?

Loree Cook-Daniels  33:14  
Okay, I'm going to back us up on this. Okay. Because when we're when we're talking about when we're talking about the whole ball of wax, some of the issues are the same thing that all of us are dealing with increasing health issues in life questions, finding and funding, long term care, dementia, etc. These are all things that trans elders might be dealing with. Another set of issues are more transpacific. So that would be the anti trans discrimination, including refusal to admit a trans elder to a nursing home, we have a case of that recently, anti trans violence healthcare related to body parts that are considered incongruent. So a trans woman with a prostate gland that needs checking, even though there are boxes that on the forms, having to come out to help and long term care providers minority stress, so those things that are fairly transpacific, so those are two. And then the third, are issues related to transition, moving from one gender to another. And this is what people tend to think of when they think of transgender people, is they think of that time when you're making the change. Well, in reality, trans elders could have made this transition back when they were in their teams. They could have made it midlife, in which case, you know, they've got, they've lived in it in probably two genders or they could be transitioning in later life. So the so the guide is divided up a little bit to separate out the transition issues, because so many trans people are like Been there done that I've got, you know, why don't need to talk about, and to talk about some of the other issues that are more specific to being trans.

Dr. Regina Koepp  35:29  
So the first was just general issues related to aging that are common among all older adults, like vulnerability to illness and of life concerns. Then there, the second is the history of violence and discrimination toward transgender elders and older adults, transgender people in general, across the lifespan experience, we're seeing this with children being alienated from sports, and then, and then issues related to the transition itself. And for some older adults, this may no longer be a topic that they need to work through or on or that's relevant. And for others, it may be. If we were to talk about the history of violence and discrimination, specific to transgender older adults, what are some important themes that service providers or mental health providers need to be mindful of?

Loree Cook-Daniels  36:33  
There's a couple of things that are really critical. One is poly victimization. When we look at trans adults, let alone trans older adults, what we are typically looking at is people who have had multiple experiences of violence of different types. And we've have even been known to say to people, you, you won't get a trans person that hasn't experienced violence. That's not really true. But, but we typically have a high rates of, of trauma, and in fact, set we have some research that shows it starts in childhood, even before the kid comes out as trans. We don't quite know how that's, you know, the mechanisms there. So we're talking a lot, we're talking a lot of history, some of that violence, or at least major discriminate discrimination experiences, have come from health care providers, and mental health providers. So you not only have a general non trusting because you know, darn well, the world is not pro trans. But you have you may have I get I have a panic attack when I walk into a doctor's office. So that you know that that history of victimization can be a real problem. What is interesting, this makes me think of a study that we did over a decade ago, we were trying to ask people about elder abuse experiences. And we gave them the definition of the various types of elder abuse. But that they did not use those definitions. They used like abandonment was losing their family. Abuse was being kept out of a public restroom. So I think we're also looking at, we need to be open to what the elder is seeing as their experiences and not get stuck in. Well, that's not elder abuse. It's another one of the terms things.

Dr. Regina Koepp  39:05  
Yes. So yes, but I can see that abandonment and being excluded from public restroom is emotional abuse, as neglect in those are doesn't it doesn't take long to search for where to identify where the abuse is in that.

Loree Cook-Daniels  39:27  
Right. And it was interesting because we did SELF SELF SELF neglect and nearly everybody that we talked it was a small study but nearly everyone said that they had self neglect it well that's that has a particular definition in elder abuse, but it did. So it did make me think what what if we talked to people of various ages about self neglect? What what would come up? What would we be what What do we learn from that?

Dr. Regina Koepp  40:02  
We'll say more about that. What are give me an example?

Loree Cook-Daniels  40:06  
I think it's Pete, I think it was probably people who, who just got so depressed or had so many issues that they couldn't keep their own self together. And they were calling that self neglect.

Dr. Regina Koepp  40:23  
When it was rooted in

Loree Cook-Daniels  40:26  
I don't know what we call it. What is the term we would use for it when it's an elder who's not taking care of herself? Not feeding ourselves, not bathing yourself, whatever. We call it self neglect. What do we call it when it's a four year old? Yeah,

Dr. Regina Koepp  40:47  
I don't know. It might be self neglect, as a result of depression, or trauma, or rejection or alienation is

Loree Cook-Daniels  40:59  
just an area, it was just an area that was really interesting, because everybody was saying, oh, yeah, I've had that.

Dr. Regina Koepp  41:07  
Well, and that is one of the symptoms, right of a depressive disorder. Yes, you know, withdrawal from others. And then also, when we do our, for clinicians who are listening our mental status exam, you look at grooming, is the person taking care of themselves and have a lot of the older adults who I'm worried about who worried for self neglect, I'll ask them what they're eating and how often they're bathing. And, you know, and I think that could be related to all sorts of conditions. Right.

Loree Cook-Daniels  41:40  
And that actually brings up a topic that I have been concerned about for some time, because I did it I did do elder abuse work for quite a while. One of the things we see with self new collectors is a lot of times is I'm independent, and I'm not going to become dependent. Well, I think that's probably even stronger among trans elders. And I know, I have heard trans elders say, I would rather die than go into a nursing home. So that issue of Do we have more trans elders self neglecting? Then, you know, population would say, I think the answer is probably

Dr. Regina Koepp  42:26  
yes. Your experience your anecdotal experience? Yeah. Yeah.

Loree Cook-Daniels  42:30  
Because people do not want to do nursing homes. And they do not want to chance service provider

Dr. Regina Koepp  42:40  
interactions. And I think the risk for that is higher, given statistics on family supports for caregiving, who's there to check in and make sure that the trans elder is doing okay, their community supports,

Loree Cook-Daniels  42:56  
right. And that that does that does. This one's this one to one of my soap boxes, it's like pulling out the soapbox. Part of the reason that we have so much isolation among trans elders is no one is supporting their spouses and adult children. There is no one saying to those 35 year wives, actually, there are women who stay. Let me tell you how they're doing it. There's no one for the adults to go to the adult children. For us to say, actually, your four year old is not going to be confused. Your four year old is just gonna go. Grandma used to be grandpa. Okay. And then they're gonna run off. You know, there's, there's no, there's no support for these family members. And so I feel like society has created some of the isolation that we're now dealing with. Yeah, it's our fault. Yeah.

Dr. Regina Koepp  44:05  
And that's why we're talking today, because we need to change that. Yeah. 100% Now, now, we talked about poly victimization, and that the risk for that is, is high in transgender elders. And across the lifespan, you're saying that that might even show up early in childhood, before the person has come out? Or revealed their identity. Can I say it like that, Laurie? Yeah. And and in terms of issues related to the transition, then well, let me back up. Because then you mentioned I'd rather die than move into a nursing home and Long Term Care is a huge we've mentioned it a couple of times is a huge issue for transgender older adults. Can you talk a little bit about the issues in long term care for transgender older adults?

Loree Cook-Daniels  44:58  
Yes. Yeah, we are still as a community fighting for health insurance coverage of our surgeries. Which means that people who are elders now are highly unlikely to have had gender affirming surgeries, which bluntly means when they're unclothed, they have body parts that people don't expect. So what that means, in the case of nursing homes, and some home health care, is that the trans person has no opportunity to be closeted, they have to be out as trans, whether they say it, or their body says it. So the level of vulnerability that a trans elder has going into long term care is much higher, even then a lesbian or gay or bi. Resident because of the LGBs, you might be able to, you know, manage to go through without anybody really challenging you. But trans, it's out there. So that's that really, I think, is the crux of the the fear of nursing homes and home care is, what if I need something like help with toileting for bathing?

Dr. Regina Koepp  46:38  
And then the loss of personal space and integrity?

Loree Cook-Daniels  46:44  
Well, I think I mean, one of the things that I tried to do is, is keep remembering what is transpacific and what is generic, and nobody likes going into a nursing home, no one likes losing their independence, no one likes the regimentation. I mean, you know, there are, yeah, it's all of that plus,

Dr. Regina Koepp  47:09  
plus the, the fear of non consent, but there's this, like, I don't even know how to describe it. It's, it's not necessarily lack of consent, because the hopefully the person is opting in to that community. But there's feels like there's a violation.

Loree Cook-Daniels  47:28  
There does, it does feel like a violation, and you got to remember the turnover is high on these in the in these facilities, so it's like, having to be outed to someone a couple of times a week. I mean, that is really stressful.

Dr. Regina Koepp  47:46  
This begs the question, how can we preserve the integrity and dignity of the person? Like what can we as a system or a long term care communities do to to ease that violation or, you know, improve this for transgender older adults?

Loree Cook-Daniels  48:08  
Well, what, what Forge is done with some of our audiences, because one, for instance, we work with sexual assault nurse examiners, and we've had some sexual assault nurse examiners say, the trans person needs to come out before I before I have had them naked. And we're like, no, they don't. You know, they may they have other worries, they've just been sexually assaulted, they have other worries, a person in the nursing home has other worries than whether she's come out to you. So what we've done with the sexual assault nurse examiners is when we train them, we ask them what they have seen on bodies that they weren't expecting to see. To remind them, that this is part of their job. And just because there's a body part they weren't expecting, they don't have to melt down. And I we could do the same thing with nurse's aid. I mean, it could be that simple. Yeah. But, you know, socially, we're taught that that's just, I mean, we've we've, we've built whole films, discovering that somebody has a buddy or you weren't expecting. No, we gotta norm it. You know, when people get naked? It turns out there are things to close covered that you didn't see before, or you didn't know about.

Dr. Regina Koepp  49:46  
Yeah, so to normalize for the staff, that and then so that when they're providing care like toileting or bathing, that it's part of a human body, and we accept it as part of the human body. that were caring for. And then what about for the just the emotional experience of the, of the transgender older adult? I mean, because they're experiencing, who will find out and, you know, one part of it is that the staff has to respond to the person as a person, and not as a unusual same person, you know, and not objectify them and respond is that they're odd or different or melt down like you described it. But how can we, hello, is there anything else? Well into that,

Loree Cook-Daniels  50:40  
if you were, if you were allying to a trance, older adult that was entering a nursing home, I would try to be there as much in the first few days as possible, just to reassure the elder that you would help advocate and support if anything did happen. Obviously telling the telling the staff ahead of time, you know, working with the staff ahead of time on trans issues would help. If there's anybody out there that has a bunch of money sitting around, I want to do a trans nursing home guide.

Dr. Regina Koepp  51:28  
You want to create a trans nursing home guide. Oh, that would be so good.

Loree Cook-Daniels  51:32  
Based on what I've done in the past is ask people why they what they worried about, like we're having men in the support group. And then I've gone to the people that have been in the support group or have had trans people in nursing homes and say, What was your experience? And then I put the two together. And that's what I want. So that people so that people who are afraid of what's going to happen, find out that other people have and can deal with issues, prevent and deal. So that was my that was my plug.

Dr. Regina Koepp  52:12  
Yeah, that's a good plug. Also, because the agencies you work with are nonprofit, right? You look for grant funding to support the education that you provide. Well, earlier, you talked about the third point, which was issues related to transition that some transgender Older adults may have transitioned earlier in their life, and it may no longer be relevant clinical or service related conversation, though some are maybe newer to the transition process or are embarking on it. And so what are some of the topics and sort of features to be considered remindful of?

Loree Cook-Daniels  52:52  
Well, one that might be the first is figuring out their identity, are they really, you know, what is their identity? One thing that I find really interesting is that some of our early 70s transitioners, no longer call themselves, male or female, that call themselves on something under the non binary. And it makes me think that they they made their transition decisions back when there were only two boxes. So if you weren't comfortable in one, you must belong to the other one. Then they got in the other one, and decided that was too suffocating. So now they've gotten out of both boxes. So I think one of the things that I have a tendency to do is just a little bit of seeding of Have you considered non binary. Because that might be that might fit some people better, and it's just particularly with our older transitioners. They never thought of anything outside male and female. So the next stage is if you can, if you're going to if you've choose chosen something other than what you've been living, then one of the major issues is Do you do anything medically about that? Do you do hormones? Do you do surgeries? Then you may have to obtain therapy, and that could be because you want therapy. Or it could be because we still have physicians and surgeons that won't prescribe or do surgery on trans people. Unless a therapist has testified to their sanity, which is a problem we could talk about for a long time. You've got changing their identification, navigating job issues if they're still employed, and then the big one of trying to keep their families To interact if if they've got a family. So those are all things that an ally might be helping with. And what I would say for allies in those cases is the most important thing is to listen, cheerlead and empower you do not want to do things for the trans elder. This is their process, and they need to they need to feel powerful enough to to make it happen. You can, you can get resources you can hold hands, you can accompany, but it should not be yours to do if you're the ally. 

Dr. Regina Koepp  55:44  
One of the things that came up to me as we were talking about long term care communities in nursing homes was training for ombudsman. Do you all do any training for on but ombudsman who serve as patient advocates or resident advocates?

Loree Cook-Daniels  55:57  
I have not have been an ombudsman. What I do say about ombudsman is ombudsman and sexual assault nurse examiners are the two professions that I'm willing to say to a trans person prime, because they're both trained to do the right stuff. The Ombudsman is trained to follow what the resident wants. Now, they might be they might not do that they might have they might. There's some stuff that's that, you know, there are risk there. And the sexual assault nurse is also really well trained for doing trauma, informed care and Person Centered Care, the kinds of values that we want, for people that work with trans people are in those two professions. So I would I would, you know, even an untrained ombudsman, I would recommend trying, but yeah, I'd love to do training, give them more training. 

Dr. Regina Koepp  57:07  
I wholeheartedly agree. You know, as you were saying that, my firt before I became a psychologist, I volunteered in my 20s with San Francisco Women Against Rape, and was a trained sexual assault volunteer, I would meet people in the ER who had been sexually assaulted and were receiving their rape kit. Like a such an exam following Yeah, sexual assault. And yes, the training for that was extensive. And even this was probably I'm 45. So this was more than 20 years ago. And they had extensive training on anti oppression and transgender identity and trans transgender health and sexual health, it after assault. And for every identity, it was one of the best trainings, anti oppression trainings I've had. Yeah, so hopefully, an ombudsman might hear this and then reach out to you for training because it would be an essential training, I think, for ombudsman, well, Laurie, you have gifted us with wisdom, nuance, talent, or a reminder that people do not fit in boxes, and we shouldn't try to make them fit. And, and that there are not simple answers to these really complex lived experiences and societally sort of oppressive experiences. And, you know, it's just, I found myself really wanting something simple. And though, in the midst of our conversation, realizing this, this cannot be simple. And just that you hold space for the just to acknowledge who people are, and that we're not simple. And we can't be labeled. And it can't, we won't have a label that will match everybody perfectly and follow the lead. And so thank you, there was an important experiential moment for me.

Loree Cook-Daniels  59:19  
Oh, good, I challenged you.

Dr. Regina Koepp  59:21  
So let's talk a little bit about where people can learn more about your work. And about this guide. How to be an ally to transgender older adults.

Loree Cook-Daniels  59:30  
Okay, so Forge is our main website is forge hyphen, forward.org. And it's set up primarily for sexual assault and domestic violence service professionals. So you probably ought to search for aging to pull up our stuff, and that would include how to be an ally to trans older adults.

Dr. Regina Koepp  59:57  
I'll link to that in your bio.

Loree Cook-Daniels  59:59  
The One, the one piece that you and I had discussed before we started, whether I thought particular pieces were going to be ground, world shaking. The piece that I thought was going to be world shaking is I have a new trans client. Now what? That one is specifically written thinking about certified nurse aides in mind, it's a little more simple, it's very practical of asking the questions that they might like to ask, but what would be inappropriate? Like, you know, what will I see when I when the clients and clothes were naked? So that one, I definitely recommend that people take a look at and use whenever possible?

Dr. Regina Koepp  1:00:55  
That's great. Yeah. And I think that goes back to the point about to normalize. You're working with bodies, period. Right? bodies come in all shapes and sizes. Right.

Loree Cook-Daniels  1:01:09  
Yeah. And also, it also talks about mutual respect. And I mean, it's some of the values that that are in that piece. Because the, the way that our world treats difference is often I want to I wanted the nurse aides to, to hear me say, you deserve respect, and so does your client.

Dr. Regina Koepp  1:01:41  
Great, so we'll link to I have a new trans client now what? And the will link to forge dash ford.org and into the elements on the website that are related to aging and then how to be an ally to transgender older adults. Well, thank you so much. I look forward to more and more trainings with you for our listeners. All right. Thank you both.

Unknown Speaker  1:02:06  
Thanks. Bye.