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.     

“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.     

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 Insurance and Older Adults in China: Effect of Education and Household Income on Coverage Following the 2009 Health Reform

Abstract

Education and income have been considered two primary determinants to affect individuals’ health outcomes. China initiated a comprehensive health reform in 2009, with the goals to provide equal access yet sufficient healthcare to all residents. However, social disparities continue to persist following this large reform. This research hypothesized that older adults’ years of education and income are determinants of participation in each social insurance scheme following the 2009 health reform. Multilevel logistic regression models were used with a nationally representative sample (n?=?5,274) to investigate the education and income disparities in each social insurance scheme for older adults, with random effects among provinces at the national level. The analyses show that years of education was not associated with enrollment in three social insurances, with the exception of the association between 11?years of formal education or above and the rural coverage. Participants with higher levels of household income had greater odds of having urban social insurances, but had lower odds of having the rural scheme. Further research should continue to investigate the disparities of enrollment of each social insurance. Chinese policy makers should consider these social factors carefully to reach a true universal coverage.     

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.     

The Forgotten: Dementia and the Aging LGBT Community

Although research documenting the experience of lesbian, gay, bisexual, transgendered (LGBT) aging in general is gaining traction, and literature on dementia continues to proliferate, few articles attend to how dementia affects members of the aging LGBT community. This article reviews the current state of knowledge on the experience of dementia for LGBT older adults, and suggests areas for further research. In addition, it aims to promote social work’s engagement with related disciplines and global dementia care. The article’s ultimate goal is to encourage development of care practices tailored to the experiences, expectations and needs of older LGBT individuals affected by dementia.     

Growing health disparities for persons who are aging with intellectual and developmental disabilities: the social work linchpin

Similar to the general population, adults with intellectual and developmental disabilities (IDD) are living into their 70s and beyond. Health care disparities have been well-documented for this vulnerable and underserved population. Social workers are often responsible for assessment, coordination of care, and negotiation of needed services for people with IDD. This article explores the challenges facing social workers in meeting the growing health and social needs of aging adults with IDD and their families. Trends in social work practice and gaps in education are discussed as they relate to addressing and reducing current health disparities.     

Reflections and Prospects of the Gerontological Social Work Training and Education: The AGESW Pre-Dissertation Fellows Program

ABSTRACT

The demand for professional training, mentorship, and research in the field of aging is expected to increase remarkably. Recent statistics indicate that less than 8% of social work students nationwide specialize in gerontology; however, a significant amount of social work graduates, regardless of their specialization at school, serve older adults in various health care settings. In addition, the aging populations that social work graduates serve are becoming more racially and ethnically diverse. In order to address this issue, it is critical to support students and emerging scholars to not only become more competent in gerontological social work, but also engage in culturally competent research and practices. In this commentary, I described my experiences as a former fellow of the AGESW (Association for Gerontology Education in Social Work) Pre-Dissertation Fellows Program that fosters doctoral students in the field of gerontological social work. The program helps its fellows comprehend basic principles of doctoral education, develop strong professional networks with other colleagues and mentors across the country, and respect diversity in the population we serve as well as those within our own fellow group.     

Evaluation of Smoking Cessation Classes for the Lesbian,Gay, Bisexual,and Transgender Community

ABSTRACT

This study evaluates the effectiveness of a smoking cessation course tailored to meet the needs of the lesbian, gay, bisexual, and transgender (LGBT) community. Of the 44 individuals who participated, 36 were in attendance in the final class, and 88.9% of those had successfully quit smoking. The study found an increase in importance to having cessation classes in gay-identified contexts, high ratings of the cultural appropriateness of the course content, and decreasing anxiety across the classes. Participants’ assessment of their health shifted differentially based on whether they were successful at quitting.     

An Exploratory Study of Substance Abuse Among Latino Older Adults

ABSTRACT

Substance abuse among older adults is on the rise. Of particular concern is the increase in alcohol and drug use predicted among Latino elders, expected to result from an upsurge in the Latino population and concurrent growth in the number of older adults. Providing effective treatment for this group will require age-specific, culturally competent interventions. However, few studies have focused on geriatric substance abuse among Latinos. This study aims to lay the groundwork for further research by examining perceptions of the problem among treatment providers and researchers in aging and substance abuse. Implications for social work research and practice are addressed.     

Grandmothering Across the Lifespan

Abstract

The aging population is becoming more ethnically diverse. This diversity will require more culturally competent social workers in the field of aging. To be successful in preparing the next generation of social workers, educators must consider introducing ethno-gerontology throughout the curriculum and not overly rely on a specialization or concentration in aging to close the gap. The article provides a history of ethnogerontology and presents its value in preparing culturally competent social workers. It also introduces theoretical frameworks within ethnogerontology. The author presents models to increase ethnogerontology content in the social work curriculum.     

Factors Affecting the LGBT Population When Choosing a Surrogate Decision Maker

ABSTRACT

For individuals in the marginalized population of lesbian, gay, bisexual, and trans- gender persons (LGBT), choosing a health care surrogate to make medical decisions is an emotionally challenging task. These decisions become more difficult when compounded by issues of discrimination, lack of legal and social support, varying levels of relationship commitment, and complications of disclosure to family and medical professionals. Limited research exists regarding the social, legal, medical, and familial environments that impact the choice of a surrogate decision maker for an LGBT individual. This systematic review examines 14 articles to identify factors influencing individual surrogate choice and existing gaps in the literature. To remedy current research limitations, future research recommendations address the areas of design, sampling, data collection, and data analysis within diverse subgroups of the LGBT population. This review further identifies related areas of service required by members of the LGBT population relative to diversity, demographics, and social, legal, medical, and familial environments influencing their choice of a surrogate decision maker.     

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.     

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.     

Rethinking Needs Assessment in Planning Services for Older Adults

ABSTRACT

Needs assessments are widely used in the field of aging, and are considered valuable tools for planning service responses to unmet and undermet needs of older adults. This article describes a comprehensive needs assessment of Bermuda's older population and presents some of its findings to illustrate concerns about needs assessments that emerged from this experience. We suggest that even when needs assessments are carefully planned and adhere to generally recognized best practice principles, they may not be able to fully provide desired information. A revision of key assumptions about needs assessment is offered for researchers, planners, and community workers.     

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.     

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.     

Interpersonal Perspectives on Black–White Health Disparities: Social Policy Implications

There are large and persistent disparities between the health status of Blacks and Whites in the United States. On average, the mental and physical health of Blacks is much poorer than Whites. In this article, we discuss several potential direct causes of Black–White disparities in health status, which include biological or genetic factors, prejudice and related processes, and socioeconomic factors. We also consider how the system-level, patient-level, and provider-level components of healthcare contribute to disparities in health status. We examine in detail the psychological processes associated with patient- and provider-level factors that may produce healthcare disparities. Of particular interest is the potential impact of racial attitudes and stereotypes on provider–patient interactions. Finally, we propose possible directions for future research on health disparities and discuss policy changes that might reduce disparities in health status and healthcare between social groups.