Long-Term Planning and Decision-Making Among Midlife and Older Gay Men and Lesbians

Abstract

This article examines the issues of long-term planning and decision-making among midlife and older gay men and lesbian caregivers. Using a qualitative methodology, in-depth interviews were conducted with 19 gay men and lesbians over 50. Participants reported on their long-term planning and decision-making processes. All but four persons reported that their partners had advance directives, but the majority of caregivers did not have advance directives for themselves. Concerns about informal family dynamics and interactions with formal systems were expressed, along with financial and ownership issues. It is important for social workers to intervene across individual, organizational, and community levels in advocacy for the needs of older gay men and lesbian clients.     

Who's afraid of growing old? Gay and lesbian perceptions of aging

This article is a study of how gay men and lesbian individuals perceive the aging process. The findings indicate that gay men have more negative views of how gay society views growing older and how they view their own growing older than do lesbian respondents. Gay men were also found to be more ageist, have a greater fear of negative evaluation by others, and give more importance to their own physical attractiveness. Implications for social work practice with elder homosexuals are addressed.     

A Pilot Study About the Needs of Older Gays and Lesbians

Abstract

In a pilot study, a population of gay and lesbian elders were surveyed to determine what types of long term plans they have made in preparation for their old age, what types of information they feel service providers need to know to better meet their long-term needs, and what is their perception of aging. The results of this pilot study demonstrated that almost three-fourths of the total sample have started to make plans for growing old. The respondents reported that social workers needed to be more knowledgeable about gay lifestyles and the importance of their partners. It was also found that the views of aging became more positive as the gay and lesbian individuals grow older.     

Developing Anti-Oppressive Empowering Social Work Practice with Older Lesbian Women and Gay Men

Summary Available studies suggest that around 10 per cent of the populationmight self-identify as a lesbian woman or gay man (Davies andNeal, 1996). It follows that social workers will engage witholder people who are homosexual. It does not follow that theywill know who they are, as this is a group often characterizedby its invisibility. This paper reports the results of a small-scale,exploratory study which examined how older lesbian women andgay men perceived their needs should they become ill or disabledas they age (Langley, 1997). Their concerns were viewed in thecontext of their past as well as present lives, and oppressionwas a unifying theme. Some of the findings are examined in orderto highlight key challenges for social work practice. Theseinclude: (i) working with invisibility and fear of oppression;(ii) developing awareness and recognition of lesbian and gayrelationships and supportive networks; (iii) the need for anti-oppressiveempowering services which match the needs and circumstancesof older lesbian women and gay men; (iv) importantly, the needfor greater awareness of the heterosexist assumptions whichinfluence institutional responses and individual practice.     

Advance directives among korean american older adults: knowledge, attitudes, and behavior

The study objective was to explore knowledge, attitudes, and behavior about advance directives and how cultural values influence these beliefs. Three focus groups with 23 Korean American older adults were conducted. Advance directives were seen as helpful for ensuring that preferences for unwanted end-of-life treatment are honored and for relieving the decision-making burden on family members. However, some viewed completing advance directives as contrary to focusing on living. Culturally competent education about advance directives for Korean American older adults is necessary to help them make informed decisions about end-of-life care and informing family and health care providers of these preferences.     

Advance Directives Among Korean American Older Adults: Knowledge,Attitudes, and Behavior

The study objective was to explore knowledge, attitudes, and behavior about advance directives and how cultural values influence these beliefs. Three focus groups with 23 Korean American older adults were conducted. Advance directives were seen as helpful for ensuring that preferences for unwanted end-of-life treatment are honored and for relieving the decision-making burden on family members. However, some viewed completing advance directives as contrary to focusing on living. Culturally competent education about advance directives for Korean American older adults is necessary to help them make informed decisions about end-of-life care and informing family and health care providers of these preferences.     

Older LGBT Adult Training Panels: An Opportunity to Educate About Issues Faced by the Older LGBT Community

Older lesbian, gay, bisexual, and transgender (LGBT) adults face unique issues that can impede their well-being. Although many advances have helped address these issues, there is a need for education efforts that raise awareness of service providers about these issues. This study explores evaluation data of training panels provided by older LGBT adults and the views of training participants on issues faced by the older LGBT community after attending the panels. Participants were 605 students and professionals from over 34 education and communication settings. Implications for trainings on participants and older LGBT trainers are discussed.     

Lesbian and Gay Elders and Long-Term Care: Identifying the Unique Psychosocial Perspectives and Challenges

This qualitative study of lesbian and gay elders seeks to identify the psychosocial challenges this community faces regarding long-term care. Two focus groups were conducted among 16 gay elders in community and long-term care settings. Participants reported fear of being rejected or neglected by healthcare providers, particularly personal care aides; fear of not being accepted and respected by other residents; fear of having to go back into the closet if placed in long-term care; and a preference for gay-friendly care. Participants suggested staff training to promote acceptance and respect for gay people, and favorably perceived gay-specific and gay-friendly living arrangements.     

Measuring Gay Populations and Antigay Hate Crime

Objectives . The study of crime directed at gay and lesbian targets is hampered by two measurement problems: Police agencies provide unreliable data on hate crime, and tract-level census data contain no direct information about gay or lesbian population density. This article attempts to gauge two quantities that cannot be measured directly or unambiguously: the size of the gay and lesbian populations and the number of hate crimes directed at gay and lesbian targets. Methods . Population data for New York City were gathered from market research lists and from a special tabulation of the 1990 Census. Hate crime data were obtained from the Anti-Violence Project and the New York Police Department. Confirmatory factor analysis was used to assess the reliability of each measure and the correlation between latent population density and hate crime. Results . Each of these measures offers a reliable means by which to assess cross-sectional differences in the population density and victimization of gay men. Census and police data prove to be inferior indicators of lesbian population density and antilesbian hate crime. For both men and women, population density is strongly correlated with the incidence of hate crime. Conclusions . Despite the fact that advocacy groups record many more antigay incidents than do the police, both sources of data are in agreement about where hate crimes occur. The strong correlation between population density and hate crime against gay men implies that Census data could be used to forecast the occurrence of hate crime in areas where no police records exist.     

Older bisexual people: Implications for social work from the ‘Looking Both Ways’ study

There is a growing social work literature about lesbian, gay, bisexual, and transgender (LGBT) older people. However, research and guidance are predominantly based on the experiences of older gay men and, to a lesser extent, older lesbians. There is little to help practitioners work with older bisexual people. The Looking Both Ways study aimed to contribute to this gap in knowledge. We undertook in-depth purposely sampled qualitative interviews with 12 people aged over 50, all of whom have bisexual relationship histories and half of whom also currently identify as bisexual. There were three main findings. First, biphobia (prejudice against bisexual people) impacts on older people with bisexual histories in ways that may affect their well-being in later life. Second, concerns around receiving care are similar in some ways and different in others from the concerns of lesbians and gay men. Third, people with bisexual relationship histories may have developed strong support networks and resilience, factors that may be very beneficial in later life. Three recommendations for social work professionals were identified: 1) understand biphobia, 2) recognize the legitimacy of concerns about receiving care, and 3) ask about support networks rather than assuming family support.     

The Influence of Sociodemographic and Psychosocial Factors on Advance Care Planning

This study investigated sociodemographic and psychosocial factors that enhance or impede the completion of advance care planning, analyzing data from the Health and Retirement Study. The analytic subsample included the panel participants who died between 2006 and 2010 and who had answered the psychosocial and lifestyle questionnaire when they were alive. Multinomial logistic regression was executed to answer the research question (N = 1,056). The study found that persons who were older, who were women, who identified themselves as White, and who had higher levels of income and education were more likely to be motivated to complete advance care planning. Having greater sense of control was found to weaken the adverse relationship between being African American and the completion of advance directives. Having cancer, suffering from the illnesses for longer periods of time, and having experience of nursing home institutionalization also predicted the completion of advance care planning. Implications include incorporating a culturally tailored approach for racial/ethnic minorities and using advance directives that are clear and easily understood. In addition, future research needs to include a larger minority population and examine the extent to which variations between racial/ethnic groups exist in relation to advance care planning.     

Families beyond boundaries: Conceptualising kinship in gay and lesbian adoption and fostering

This paper discusses some key findings taken from a qualitative study conducted with gay and lesbian adopters and foster carers in England and Wales. The study examined the experiences of 24 self‐identified lesbians and gay men, who had been involved in adoption or fostering processes since the introduction of the Adoption and Children Act, 2002. This article will explore why participants chose to adopt or foster and their approach to relationships generated through these routes. Findings indicate that gay and lesbian applicants troubled dominant conceptualisations of family and kinship and revealed both heteronormative and nuclear constructions of parenting within adoption and fostering social work. In contrast, participants often demonstrated a reflexive and creative approach to caring for looked after children. This paper will therefore consider how professionals can recognise nuanced or complex relationships, situated beyond traditional frameworks, through drawing upon wider concepts within sociological literature.     

Training,Geography, and Provision of Aging Services to Lesbian,Gay, Bisexual,and Transgender Older Adults

This research study surveyed leaders of Area Agencies on Aging (agencies) to understand their services, training, and beliefs about serving lesbian, gay, bisexual, and transgender (LGBT) older adults. Half of the existing agencies in the United States (320) participated. Few agencies provided LGBT services or outreach. One-third had trained staff around LGBT aging and four-fifths were willing to offer training; these numbers were significantly higher for urban-based agencies. Agencies that had provided staff training and urban-based agencies were more likely to provide LGBT outreach and services, to believe in addressing LGBT issues, and to receive LGBT assistance requests. Training, policy, organizing, and research implications are considered.     

Training, geography, and provision of aging services to lesbian, gay, bisexual, and transgender older adults

This research study surveyed leaders of Area Agencies on Aging (agencies) to understand their services, training, and beliefs about serving lesbian, gay, bisexual, and transgender (LGBT) older adults. Half of the existing agencies in the United States (320) participated. Few agencies provided LGBT services or outreach. One-third had trained staff around LGBT aging and four-fifths were willing to offer training; these numbers were significantly higher for urban-based agencies. Agencies that had provided staff training and urban-based agencies were more likely to provide LGBT outreach and services, to believe in addressing LGBT issues, and to receive LGBT assistance requests. Training, policy, organizing, and research implications are considered.     

Themes in Group Work with Lesbian and Gay Adolescents

ABSTRACT

Lesbian and gay youth often face severe isolation, growing up in an environment that is frequently ignorant of their unique needs and hostile toward them. Youth groups can serve a vital role in overcoming this isolation in addition to providing a safe space for working out the various problems surrounding the stigma of growing up gay. This article presents several themes in group work with lesbian and gay adolescents based on the author's experience as a group worker at a lesbian and gay youth project. Isolation, coming out, learning/re-learning, and initiation into a community are offered as four main themes which provide a foundation for understanding how to help lesbian and gay adolescents in groups.     

Comparing Supports for LGBT Aging in Rural Versus Urban Areas

Studies of rural populations typically underrepresent lesbian, gay, bisexual, and transgender (LGBT) older adults. This secondary analysis examined data from a nationwide sample of LGBT baby boomers (n?=?1201). Geographic differences with respect to self-reported outness, acceptance of sexual identity, social and familial support, and household income were assessed with one-way analyses of variance. Guardedness about one's sexual identity and household asset levels were assessed with chi-square analyses. Rural individuals reported lower levels of outness, guardedness with people including siblings and close friends, and lower levels of household income. Providers should consider strategies for connecting older rural LGBT adults for potential care and support.     

Working With LGBT Baby Boomers and Older Adults: Factors That Signal a Welcoming Service Environment

Many providers recognize the importance of creating culturally competent services for lesbian, gay, bisexual, and transgender (LGBT) older adults. Although multiple resources list steps to make professional practices more LGBT-welcoming, these resources provide no empirical data to support their recommendations. LGBT older adults (N = 327) were asked to describe what signals that a provider is LGBT-welcoming. Six of the top 10 signals related to provider behavior and suggest the importance of staff training; the balance included display of signage and rainbow flags, use of inclusive language on forms and the presence of LGBT-identified staff. Results provide evidence-based recommendations for working with LGBT older adults.     

Political Culture,Public Opinion,and Policy (Non)Diffusion: The Case of Gay‐ and Lesbian‐Related Issues in Arkansas*

Objectives. Just after three in four Arkansas voters endorsed a state constitutional amendment barring state recognition of same‐sex marriages, a comprehensive state‐level survey allowed a closer look into the attitudes of Arkansans on a variety of gay‐ and lesbian‐related issues. When placed in the context of Arkansas's political culture and ideological patters, this serves as a case study of the relationship between public opinion, specific policy issues, and the diffusion (or nondiffusion) of policies in an individual state. Methods. The 2005 Arkansas Poll included a battery of questions gauging citizens' attitudes on gay/lesbian individuals and the morality of same‐sex relations, same‐sex partner recognition, bans on gay adoption and foster parenting, bans on gays openly serving in the U.S. military, and expansion of civil rights laws to bar discrimination on the basis of sexual orientation, among other policies. This article reports those survey results and employs regression/logistic analysis in analyzing them. Results. The results reveal that while Arkansans are uncomfortable with homosexuality, they are surprisingly hesitant to prescribe state‐sanctioned discrimination. Conclusions. This tightrope between libertarianism and angst about homosexuality that resulted in policy nondiffusion until three years after the data reported here is reflective of the state's political culture, which combines traditionalistic and individualistic elements.     

Decision Making in Long-Term Care

Abstract

This article reports findings from a qualitative study of approaches to long-term care decision making used by older adults (N = 52) who continued to reside long-term in the community following nursing facility pre-admission screening. Older adults used different approaches to decision-making (autonomous, collaborative, and delegated) while seeking the most appropriate care setting. Factors such as mental capacity, the role of family caregivers, and self-advocacy skills influenced the choice of decision-making approach. Findings also illustrate how older adults moved through multiple pathways in order to reach their eventual long-term residence. These findings are discussed in terms of their implications for clinical practice and research.     

Challenges to Successful Community-based Integrated Approach to Dementia: A Qualitative Study

The aim of this study is to identify key challenges to successful community-based integrated team approach to the management of older adults with dementia. A nationwide community-based qualitative research strategy was applied. We purposively recruited 24 health-care providers and 13 family caregivers from selected 8 prefectures among 47 prefectures. Face to face interviews were conducted from May to September 2017. Qualitative content analysis was used to analyze the qualitative data. Ten themes regarding the challenges were emerged: Ignored wishes, Family caregivers’ full responsibilities, Encouragement, Practical and easy-to-understand information, Essential skills of dementia diagnosis and assessment, Gratitude by helping others, Difference between being kind and overly-kind, Legal barrier against information sharing, Coordination between volunteers and clients, and Conflict avoidance in multidisciplinary collaboration. The findings highlight the need to provide practical and easy-to-understand information for family caregivers, educate physicians in dementia diagnosis and assessment, share personal dementia care information among health-care providers, promote platforms which aim to match dementia care volunteers with older adults with dementia and their families in need of help, and raise awareness of advance care planning among both older individuals and health-care providers.