Older lesbians' experiences with home care: Varying levels of disclosure and discrimination

ABSTRACT

There is considerable evidence that lesbian, gay, bisexual and transgender (LGBT) older adults have experienced barriers to health care access and have profound fears about how they will be treated in the long-term care system, but the specific experiences of older lesbians have received less attention. Most older adults needing long-term services and supports (LTSS) prefer to remain at home, and this is true for lesbians as well. This article reports on a national, qualitative study of the experiences of 20 older lesbians (age 65 and older) with home care workers. The experiences of six informal partner caregivers with home care services are also included. Emergent themes regarding level of disclosure, experiences with homophobia, evaluation of care received, and thoughts about ideal LTSS are described. Most study participants did not disclose their sexual orientation to their home care workers. A significant minority experienced homophobia, but nearly all ultimately found workers who provided good care with which they were comfortable. Their visions of ideal LTSS included greater affordability and particular qualities that were important for home care workers to possess, such as competence, caring and acceptance. Practice and policy implications are outlined including careful recruitment, training and supervision of home care workers to foster lesbian-sensitive care, but also improved wages and work conditions in order to maintain a quality home care workforce.     

Lessons on social and health disparities from older lesbians with alcoholism and the role of interventions to promote culturally competent services

ABSTRACT

Older adults who are lesbian, gay, bisexual, or transgender (LGBT) face greater health risks and possibly more costly care because of their reluctance to seek out health and long-term care services because of limited cultural sensitivity of service providers. This is particularly evident in older lesbians who face substantial risk of health problems associated with alcoholism and are less likely to be open with health care providers because of stigma combined with feelings of alienation, stress, and depression. An estimated 4.4 million older adults are predicted to have problems with alcohol by 2020, and the rates of alcohol-related hospitalizations are similar to those for heart attacks, creating exorbitant medical costs. More culturally competent health and long-term care may reduce health care costs by effectively addressing the dynamics of alcoholism, aging, and lesbian culture. Training initiatives such as those developed by the National Resource Center on LGBT Aging have begun to address the need of a more culturally competent aging services network. This article provides exemplars from empirical data on older lesbians with alcoholism to highlight some of the health, economic, and social disparities experienced in the aging LGBT community. Current interventions in the form of cultural competence training for service providers are presented as a potential step toward addressing health disparities among LGBT older adults.     

Rural Lesbian Mothers and Their Families

Abstract

Lesbian mothers face unique challenges to parenting based on their status as lesbians. They face not only the challenges of discrimination based on sexism and homophobia, but the challenges of parenting. This article explores these challenges and offers practice recommendations to be supportive of good parenting and resources for parenting enrichment.

Lesbians who are parenting either alone or as part of a couple face numerous barriers. And women living in rural communities present unique issues to mental health practitioners. Mental health practitioners working with rural lesbian mothers and their families need an awareness of those issues which are unique to this population as well as those issues which are exacerbated by the combination of minority statuses and social and geographic isolation.

Lesbian mothers in any geographic location find themselves belonging to several populations: lesbians, women, and mothers, to name a few (Friedman, 1990). Each of these populations has its accompanying pressures which, when combined, exacerbate some of the sub-group issues. Rural social service practitioners will encounter lesbian mothers and their families. A clear understanding of their issues will enhance the therapeutic process. The issues and themes of each of the sub-groups will be explored and then examined in the context of rural life.     

Older Gays and Lesbians

Summary

This article discusses the impact that coming of age in the Pre-Stonewall era has had on older gays and lesbians. Anti-gay hate and violence, within a historical context of homophobia and heterosex-ism, are examined. Risk factors, as well as coping capacities, for older lesbians and gays are explored. Research on the psychological adjustment and well-being of older gays and lesbians is reviewed, and suggestions for intervention with this population are proposed.     

Older Lesbians and Work in the Australian Health and Aged Care Sector

While research has identified challenges lesbians face in the workplace, there is limited understanding of the particular experiences of older lesbians, especially those working in the health and aged care sector. This article draws on the stories of four women who participated in a narrative research project on lesbian and gay people's experiences of health and aged care. It highlights the need for future research to examine the complexity of identity expression and community affiliation, how people negotiate “coming out” in the workplace, the impact of discrimination, and the resources (such as friends) available to lesbians in the workplace.     

Rural HIV/AIDS Social Services for Gays and Lesbians

Abstract

The HIV pandemic persists into its second decade, with an untoward toll on rural gays which continues to generate suffering and loss. Rural HIV infections are increasing, and the unique problems of health and social services represent new challenges. Professional social services that would overcome barriers to care for rural gays and lesbians have been historically inadequate or non-existent. The HIV pandemic shows that services for HIV diseases must become part of efforts to strengthen the care delivery services for all in rural America, especially by fostering the power and resiliency of gays and lesbians. The empowerment of rural gays, bisexuals, lesbians and transgendered persons assumes that basic differences occur between those in rural and urban areas, and health and social services must build upon the unique strengths of these diverse groups.     

The Physical Self-Perceptions of Rural Lesbians and Heterosexual Women

Lesbians are underrepresented in women's health research. Research exploring lesbians in rural environments is virtually nonexistent. The current study adds to the knowledge base of lesbian health and explores the perceptions of body image, fitness, and health for both lesbians and heterosexual women in rural communities. Findings from exploratory analyses indicated that both groups of women are significantly overweight. However, lesbians exercised more times per week than heterosexual women. Results demonstrated that lesbians with college educations had more positive body image and fitness self-perceptions, whereas heterosexual women with college educations had less positive body image and fitness self-perceptions. Findings have implications for direct practice with lesbians in physical and mental health service settings.     

Identity Management Strategies Among Lesbians of African Ancestry

ABSTRACT

The authors present the results from a study investigating identity management strategies among African-ancestral lesbians within their families of origin. The researchers collected qualitative data from 16 African-ancestral lesbians, which were analyzed using the CQR method. From these responses we examined themes relating to the coming-out experiences, familial support patterns, and the integration and management of lesbian identities within African-ancestral families. We found that participants typically reported positive feelings and attitudes about themselves and their lesbian identities. Although levels of distress experienced during the coming-out process were mixed, our participants consistently endorsed the importance of relationships with family members as a means of more effectively managing their lesbian identities.     

“We Have to Create Family”: Aging Support Issues and Needs Among Older Lesbians

Gay and lesbian seniors are more likely to be single, live alone, and be childless. The current evidence base suggests that limited social supports are associated with a variety of health disparities among all older adults. Research regarding the aging issues of lesbian seniors is scarce. This instrumental collective case study of 4 older lesbians (ages 59 and older) illustrates unique aging support concerns, issues, and needs. The purpose of the case study is to increase provider sensitivity and provide supportive evidence of the need for more research. Findings suggest that limited biological family support, childlessness, and “families of choice” may be important factors in support service and health care decisions for older lesbians. Implications for care providers in working with the older lesbian population include exploring existing supports and assisting with the formation of culturally acceptable support systems and services. Given the current evidence base regarding the impact of social support on elder health, it is critical for providers to have a better understanding of elder lesbians’ unique concerns and needs relating to support and health care services in order to prevent health disparities among this vulnerable population.     

From Fragmentation to Integration

Abstract

Within the mental health field, there is an increased attention to issues of diversity. However, this awareness has not yet been applied to racially and culturally diverse gays and lesbians who are chronically mentally ill. Some of the reasons for this include the long history of homogeneity of American institutions; the underutilization of mental health services by minority groups; the stigmatization of the mentally ill; and homophobia, within both the psychiatric community and society at large. As a result, there is a need for mental health professionals to acknowledge minority gays and lesbians with chronic mental illness, and begin to provide programs that affirm their sexual orientation, race, and cultural identities.     

African American Gay Men and Lesbians: Examining the Complexity of Gay Identity Development

Abstract

This article addresses the concept of gay and lesbian identity development with respect to African American gay men and lesbians. The authors suggest that the integration of one's gay identity and the coming out process are uniquely constructed for African American gay men and lesbians, who may be multiply challenged by racial prejudice, limited acceptance by the African American community, and a lack of integration into the larger, White gay community. Race, African American culture, a continuum of gay cultures, gender, and individual characteristics are suggested as salient variables that distinguish the gay identity experience of African American gays from that proposed by most gay identity models.     

Older Lesbians and Gays Accessing Health and Aged-Care Services

Abstract

The present paper examines older lesbian and gay people's experiences of and expectations for the delivery of health and aged-care services. In-depth narrative interviews were conducted with older gays and lesbians in the Blue Mountains, west of Sydney (NSW, Australia). Data were analysed by identifying evaluative statements within specific narratives and grouping these statements into themes. Participants reflected on the meaning of their sexual identity and how they would like it to be acknowledged when in contact with health and aged-care service providers. In addition to direct discrimination, participants reported a more indirect form of discrimination in providers’ assumption of heterosexuality among clients and their failure to provide lesbian- or gay friendly services. The findings highlight the need for health and aged-care services to better understand and acknowledge older gay and lesbian people's sexual identities to enable improved access to services in the future.     

Thinking through Domestic Pluralities

Abstract

This article reflects on the meanings of home and domestic space among a group of women, who over the past five decades or so have sought to create alternative public and intimate living spaces. The protagonists who enact the ethnographic narrative are a small group of older lesbians, mainly feminist activists, residing in the metropolis of London. In this article, their life experiences are recounted through memories of domestic space, mainly that of the kitchen. I explore the way the domestic kitchen is experienced, spoken about, and imagined by this specific group of women. In this ethnography, the kitchen emerges as a contested, transformative, and political domestic space. Throughout, I illustrate how this seemingly private space is in fact entangled with larger notions of culture, society, kinship, and politics; and, like the everyday, is fraught with norms, codes and pluralities, and also with emotions, deviations, contestation, and transgression.     

Introduction: Leading Lesbians Fight Disease and Disability

This thematic issue of the Journal of Lesbian Studies focuses on the ways in which lesbian leaders have dealt with disease and disability. In the articles that follow, eight prominent lesbians describe what it means to cope with serious illness and medical treatment in the context of lesbian identity and community. This introduction provides an overview of some of the themes that arose in the various articles, focusing on lesbian support systems as well as best medical practices.     

Building Strength Through Challenging Homophobia: Liberation Workshops with Younger and Midlife Irish Lesbians

Drawing on the theoretical framework of liberation psychology, this article details workshops on liberation psychology conducted in Ireland with lesbian and transgendered persons aged from early 20's to late 50's. Both younger and older lesbians in the workshops benefited from the opportunity to focus on oppression and to explore options for transformation. The workshops illustrated many of the strengths and vulnerabilities associated with living with homophobia and demonstrated the value of action and engagement. Midlife lesbians were more aware of the systemic nature of homophobia and of the negative emotions related to that. They saw many of these as understandable and even necessary reactions to oppression rather than as negative patterns. These older lesbians tended to be more accepting of the course their lives had taken and of the ways in which choices had been influenced by homophobia and heterosexism. They tended to be more relativistic in their views on coming out, viewing coming out as a decision for each context rather than an overall principle. They valued the importance of community and of activism, and though they were aware of some of the challenges, they also had more positive experiences in this area. These strengths can facilitate managing both homophobia and aging more effectively.     

Older and Isolated Women and Domestic Violence Project

ABSTRACT

An innovative national research project was undertaken in Australia to identify and explore the needs of older and isolated women who live with domestic violence. Face to face interviews, focus groups, and a national phone-in were conducted, and a wealth of rich information was provided by many women from metropolitan, rural and isolated areas. Older women from indigenous, non-indigenous, and diverse language and cultural communities spoke of their experiences as well as women with varying abilities and those with mental health problems. This paper will identify the significant themes that emerged from the phone-in and will highlight the major issues identified by older women needing attention by government authorities, health professionals, and service providers. Recommendations will be made for policy development, improved service provision, and prevention strategies.     

Future Planning and Financial Education Needs for Asset Building Among Persons with Multiple Sclerosis in Rural Areas

Abstract

This paper presents findings from a study of individuals with multiple sclerosis examining their planning and preparation activities for their future independent living and long-term care needs. Data collected from a representative sample of National Multiple Sclerosis Society members in the greater metropolitan St. Louis and eastern Illinois area indicate significant differences in income, assets, education, health and functional limitation status between individuals living in rural versus urban areas. Additionally, findings show respondents with greater levels of education and assets, and those living in urban areas, are more likely to have saved for retirement, made legal preparations, or engaged in planning activities for future needs. Recommendations for asset building programs include incorporating education and training on planning for independent living and long-term care into financial planning curriculum, particularly for people with multiple sclerosis living in rural areas.     

It Takes a Community: Older Lesbians Meeting Social and Care Needs

Although specialized formal services are becoming more prevalent in addressing the needs of the older LGBT community, little is known about informal groups that have organized to meet the needs of this population. This article presents two case examples that depict the efforts of older lesbians to meet the social and care needs of members of their communities. The concept of psychological contracting is used to analyze these experiences, and combined with a review of the literature, practice implications for care and support for this special population are discussed.     

Lift Every Voice: Voices of African-American Lesbian Elders

Old lesbians of African descent have experienced racism, heterosexism, homophobia, and ageism. This article explores the topics of aging, ageism, heterosexism, and minority stress among older African-American lesbians. The narratives and subsequent analysis offer significant contributions to the dialogue regarding Black aging lesbians in the aging and lesbian, gay, bisexual, and transgender (LGBT) communities generally and in the African-American and African-American lesbian communities specifically.     

Integrating Services for Older People in Aging Communities in The Netherlands: A Comparison of Urban and Rural Approaches

ABSTRACT

The aim of this article is to discuss approaches to services integration for older people in urban and rural aging environments in The Netherlands, and the preliminary effects of these approaches on local aging conditions. In urban areas, services integration revolves around the creation of functional spatial hierarchy. In rural areas, the emphasis is on forging links between service providers. Outcomes for health and use of professional care services are similar. Out-comes for housing, informal care, and accessibility of services differ between urban and rural areas in ways that can be traced back to local aging conditions and elements of the specific approach to services integration used. In both urban and rural areas, much more could be done to connect formal programs to the lifeworlds of older dwellers.