Awareness of LGBT Aging Issues Among Aging Services Network Providers

Very little research exists examining the interactions between community-based aging service providers and lesbian, gay, bisexual, and transgender (LGBT) older adults. It is unclear whether mainstream aging services acknowledge the needs of this community. We asked direct care providers and administrators in the Michigan aging services network to describe their work with LGBT older adults. We found there are very few services specific to the needs of older LGBT adults and very little outreach to this community. At the agency level, resistance to providing services was found.     

Awareness of LGBT aging issues among aging services network providers

Very little research exists examining the interactions between community-based aging service providers and lesbian, gay, bisexual, and transgender (LGBT) older adults. It is unclear whether mainstream aging services acknowledge the needs of this community. We asked direct care providers and administrators in the Michigan aging services network to describe their work with LGBT older adults. We found there are very few services specific to the needs of older LGBT adults and very little outreach to this community. At the agency level, resistance to providing services was found.     

Social Work Practice With LGBT Seniors

The Los Angeles Gay & Lesbian Center began providing services to LGBT seniors in 2008. Since then, the Center’s seniors program has grown to over 3,300 clients. It provides a variety of enrichment and support services with the overarching goal of empowering seniors to successfully age in place. This article outlines the service delivery program of the Center’s Seniors Services Department and describes its successes and challenges in meeting the needs of diverse LGBT seniors. It offers future directions for social work practice, policy, and research with LGBT older adults.     

End-of-Life Preparations among Lesbian,Gay, Bisexual,and Transgender People: Integrative Review of Prevalent Behaviors

Proactively making end-of-life (EOL) preparations is important to ensure high quality EOL care. Critical to preparation is the discussion of preferences with one’s primary health care providers. Lesbian, gay, bisexual, and transgender (LGBT) people often experience discrimination from health care providers that will detrimentally affect their ability to communicate their care preferences. Structural barriers, such as those based on sexual orientation and gender identity, may impede timely and quality care when one is most in need. The aim of this study was to examine the prevalence of EOL preparatory behaviors among LGBT people, with particular focus on transgender individuals. Eight survey instruments with 30 prevalence estimates found in the literature were analyzed. EOL discussions between LGBT people and their primary health care providers were rare (10%). Transgender people were found to be even less prepared for EOL; they were 50–70% less likely than their LGB counterparts to have a will, a living will or to have appointed a healthcare proxy. A need exists for future mixed-methods research focused on LGBT populations accompanied by the cultural sensitivity needed to ensure their wishes are honored at the EOL.     

“Fear Runs Deep:” The Anticipated Needs of LGBT Older Adults in Long-Term Care

Objectives: Older lesbian, gay, bisexual, and transgender (LGBT) adults are a vulnerable yet resilient population who face unique stressors as they foresee health decline. This paper presents the results of a study about community-dwelling LGBT older adults’ anticipated needs and fears related to nursing homes and assisted living. Methods: This qualitative study collected data through seven focus groups. The sample (N = 50) consisted of LGBT-identified adults age 55 and over. We used an inductive, thematic analysis approach to data analysis. Results: Participants seek an inclusive environment where they will be safe and feel connected to a community. They fear dependence on healthcare providers, dementia, mistreatment, and isolation. Importantly, these fears can lead to identity concealment and psychological distress, including suicide ideation. Discussion: This study adds to the existing literature about the worries of older LGBT adults as they anticipate long-term care. The results suggest that older LGBT adults seek LGBT-inclusive residential care settings that encompass two distinct yet related aspects of LGBT-affirmative care: the procedural (e.g. culturally competent skills and knowledge of practitioners) and the implicit (e.g. the values and mission of the organization). This paper identifies implications for practice, policy, and training.     

Creating Supportive Environments for LGBT Older Adults: An Efficacy Evaluation of Staff Training in a Senior Living Facility

ABSTRACT

Supportive housing later in life tends to be a key concern for lesbian, gay, bisexual, and transgender (LGBT) elders. Most senior care providers are un(der)prepared to meet the needs of older LGBT adults. This study evaluated the efficacy of a 4 hours, face-to-face, research-based, LGBT-diversity training designed to improve senior housing facility staff’s cultural competency regarding the needs of LGBT elders. Findings from this study found a significant increase in LGBT content knowledge between pre- and post-intervention assessments and a significant decrease in perceived preparedness when working with LGBT elders. These effects remained significant after controlling for staff designation, religion, educational attainment, and training session. Findings suggest that staff’s cultural competence affected their perceived readiness to address LGBT elders’ needs. Implications are related to the concept of cultural humility or the lifelong process of understanding others’ experiences based on the recognition of lack of un(der)preparedness to create a culturally supportive residential environment.     

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.     

Advance care planning throughout the end-of-life: focusing the lens for social work practice

Advance care planning throughout the end-of-life is an increasingly important aspect of professional practice with older adults and their families. As the nation's population continues to live longer, more and more people will experience years of functional and cognitive decline prior to death. This article discusses the growing importance of advance care planning using a long-range, holistic perspective of examining care needs throughout the end of life. End-of-life care is conceptualized by three trajectories of decline leading to death, with about two-thirds of all older adults succumbing to four key conditions: congestive heart failure, emphysema, frailty, and dementia. Research regarding the advance care planning needs of older adults with the key conditions is presented. Further research is needed to enhance social work practice in this area.     

Being with a Person in Our Care: Person-Centered Social Work Practice that is Authentically Person-Centered

ABSTRACT

Person-centered care (PCC) has emerged over the last several decades as the benchmark for providing quality care for diverse populations, including older adults with multiple chronic conditions that affect daily life. This article critiques current conceptualizations of PCC, including the social work competencies recently developed by the Council on Social Work Education, finding that they do not fully incorporate certain key elements that would make them authentically person-centered. In addition to integrating traditional social work values and practice, social work’s PCC should be grounded in the principles of classical Rogerian person-centered counseling and an expanded conceptualization of personhood that incorporates Kitwood’s concepts for working with persons with dementia. Critically important in such a model of care is the relationship between the caring professional and the care recipient. This article recommends new social work competencies that incorporate both the relationship-building attitudes and skills needed to provide PCC that is authentically person-centered.     

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.     

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.     

Health Self-management Among Older Prisoners: Current Understandings and Directions for Policy,Practice, and Research

The population of aging prisoners has increased significantly over the past several decades, resulting in concerns about the criminal justice system’s ability to address the needs of prisoners and parolees with chronic health conditions. This is troubling, given the health disparities among incarcerated populations. Health self-management has become a strategy within the community-based health care industry to improve health services and outcomes while reducing health care costs for nonincarcerated individuals with chronic conditions. However, to date little research has focused on the practice or promotion of health self-management among current and former incarcerated populations. This article highlights current understandings about chronic health self-management among older prisoners and parolees, with an emphasis on the potential benefits and current challenges in promoting their health self-management practices. Finally, specific recommendations are made for promoting health self-management for these populations through social work practice, policy advocacy, and research to achieve goals in improving health outcomes and reducing healthcare costs.     

Live Discharge from Hospice and the Grief Experience of Dementia Caregivers

When an individual has dementia, family members are involved in many care transitions in their roles as caregivers. One such transition is the ‘live’ discharge from hospice services. This occurs when an individual no longer meets eligibility criteria. This can be difficult for caregivers who have been anticipating an end to understand in the context of their grief process. This qualitative study (N = 24) explored the experience of caregivers of adults with dementia, including Alzheimer’s disease, who experienced a ‘live’ discharge from hospice. Specifically, the experience of grief is examined. Results from this study highlight the complexity of caring for someone with a terminal disease and the grief experience in end-of-life care as caregivers struggle to understand the individual’s terminal prognosis as temporary. This is further complicated for caregivers who must resume caregiving responsibilities or assume a new caregiving role after experiencing a loss of hospice services. Finally, hospice social workers are well positioned to offer emotional and other concrete support to caregivers who experience a ‘live’ discharge.     

New Directions for the Study of Incarcerated Older Adults: Using Social Capital Theory

As the population of older adults continues to rise, so, too, does the population of older adults in prison. The body of literature on older adults in corrections is scant, particularly with regard to health and social functioning. Past studies of aging inmates primarily focus on health care and related costs. The purpose of this article is twofold: (a) outline and synthesize the research on older adults living in prison; and (b) propose a framework for future research and intervention development based on social capital theory. Recommendations for social work practice, programs, and research are discussed.     

Preparing Social Work Students to Work with Grandparents in Kinship Care

Summary

Grandparents in kinship care represent an expanding population of older adults assuming primary parenting responsibilities for their grandchildren at a time when many grandparents may also be experiencing developmental changes accompanying their own aging process. Research documents a lack of social workers prepared to respond to the needs of an aging population in general, and grandparents in kinship care in particular, as curricular content on this population has been limited in undergraduate and graduate social work programs. This article describes an infusion model proposed for an undergraduate social work program's GeroRich Project designed to introduce content on an aging population in four foundation courses to expand students' knowledge of older adults and grandparents as kinship care providers.     

Social work and aging in the emerging health care world

Social work practice with older adults and their families is increasingly recognized by the profession as a major field of practice in a wide range of health care and community-based settings. This article reviews emerging trends and issues in the fields of aging and health care, drawing on gerontological health care research which bridges these areas. Given the growing number and diversity of older adults in our society, and dramatic changes in the organization and delivery of health care, the authors suggest skills and competencies essential to enhancing the well-being of older adults and their families in the 21st Century.     

Use of Space and Human Rights: Planning Dementia Friendly Settings

Environmental psychology has been a topic of great interest for many researchers in the field of aging and dementia. Thus, several orientations can be identified in the contemporary scientific literature concerning environmental design for people with dementia. In this article, we discuss recent research on environmental design models for people with dementia and propose an approach referring to the concept of use of space and human rights.We use a methodology based on observation of special care units to determine an environmental design framework that should be taken into account when designing residential facilities for people with dementia. Content analysis identified 6 primary dimensions and 13 secondary dimensions relevant to the rights of people with dementia. We then discuss the results according to the related literature in environmental psychology and gerontology in terms of well-being and quality of life.     

Providing Care for Persons with Dementia in Rural Communities: Informal Caregivers’ Perceptions of Supports and Services

Dementia is one of the costliest and most time-consuming diseases among older persons. Although informal caregivers provide the majority of care for persons with dementia, little is known about the self-perceived need for social services of caregivers of persons with dementia within rural areas. This pilot study examined the knowledge, access and intent of the practice-oriented service model of caregivers of persons with dementia in rural communities in the Midwest U.S. After a systematic training, researchers interviewed 11 rural caregivers of persons with dementia (n = 11). Data were analyzed using thematic analysis. Although similarities with other caregivers of persons with dementia were found, important differences suggesting unique issues among these rural caregivers of persons with dementia. Many participants found strength in their community, which often served as a safety net of support. Consistent with existing literature, participants expressed financial concerns, geographic barriers and lack of dementia-specific services when using formal services. The need for more specialized formal services in rural areas to supplement existing informal care networks is discussed. Policies and services based on rural caregivers’ unique concerns and challenges and that build upon their existing care networks are recommended.     

Exploring the Health Needs of Aging LGBT Adults in the Cape Fear Region of North Carolina

ABSTRACT

This study explored issues of culturally sensitive healthcare practice and needs among lesbian, gay, bisexual and transgender aging adults in coastal North Carolina. Survey data results indicated the largest problem was a history of verbally harassment and need for culturally sensitive healthcare. In conclusion, culturally sensitive interventions are needed to address the health disparities and unique needs of LGBT aging adults. Cultural sensitivity training for service providers is suggested as a vital step in addressing health disparities of aging LGBT adults. Implications for research include further exploration of health related needs of these often hidden and underserved population groups.