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Dr Paul Willis, Lecturer in Social Work & Michele Raithby, Lecturer in Social Work

IFSW Conference Stockholm July 9-12 2012.

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Dr Paul Willis, Lecturer in Social Work & Michele Raithby, Lecturer in Social Work

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  1. IFSW Conference Stockholm July 9-12 2012 Meeting the Needs of Older LGB Citizens in Care Environments in WalesMeeting the care needs of older LGB citizens: Provision of anti-discriminatory services to older lesbian, gay, bisexual-identifying (LGB) people in residential environments in Wales Dr Paul Willis, Lecturer in Social Work • & Michele Raithby, Lecturer in Social Work P.B.Willis@swansea.ac.uk M.J.Raithby@swansea.ac.uk

  2. Themes • Rationale & policy • Research question: How are the sexual identities and relationships of older LGB residents perceived and supported in residential care environments in Wales? • Approach to the research • Interim findings – Funded two years to March 2013

  3. Policy Background • Estimated 175,000 LGB people living in Wales: 65 000 aged 50+ (Davies et al 2009) • Older LGB people identified as minority communities in Wales(WAG 2008) • Welsh Government Single Equality Scheme (2009:17): Ensure “(…) equality, considerations of fairness, respect, equality and dignity are at the heart of decision taking, policy making, and service delivery.” • Equality Act 2010 compels public services and services contracted by public bodies to assess how they are providing anti-discriminatory services

  4. What we Already Know (and Don’t Know) • Sexuality of older people in long-term care environments is ‘last taboo’ (ILC-UK 2011, Doll 2012) • Heteronormative assumptions and discrimination persist in LGB older people’s health & social care (Heaphy et al 2004; Knocker 2003; Addis et al 2009) • Situation of older LGB residents in long-term care environments in Wales not known • Lack of training materials for care home staff

  5. Advisory Group • Include: • Age Cymru • Older LGBT Network • My Home Life Cymru • All Wales Transgender Support Group • LGBT Excellence Centre Wales • Community members • Service providers

  6. Project Methods Questionnaire Survey: • Staff members’ attitudes to/perceptions of older people’s sexuality & relationships and older LGB people/residents • Sample size: 150 providers randomly selected from list of care providers • Questionnaire Measures- composite: • LGB KASH (Heterosexual Attitudes to LGBT) • ASKAS (Ageing Sexuality Knowledge & Attitudes)

  7. Survey Coverage Urban & rural Wales North & South Wales Geographic and linguistic diversity

  8. Inclusive Practice and LGB Expectations • 8 Stakeholder focus groups: • Health and social care staff & managers in care environments • Older people’s health and social policy makers in Wales • Stakeholder advocacy groups • Semi-structured interviews: • 30 older LGB people (aged 50+) currently residing in Wales - potential service user group expectations of care environments • Desktop review of Inspectorate Reports

  9. Phase 1 findings: Inspectorate reports • Content analysis of Inspectorate Reports – examining for content relating to sexual identity, sexual health, sexual relationships, sexual activity, LGB residents, etc. • Sample: 2009-10 Inspectorate reports online – 40% random sample selected (n=98 reports) • Care environments including nursing facilities and ‘elderly and mentally infirm’ (EMI)

  10. Phase 1 findings: Inspectorate reports • Notable absence – no discussion of sexuality, sexual relations, intimacy, romance, LGB identities…… • Reducing risk – discussions about single and double room occupancy centred on minimizing risk e.g. infection control • ‘Nebulous’ concepts through an asexual lens – broad references to privacy, independence and dignity • Bonds between residents - no information about interpersonal or intimate relationships between residents

  11. Phase 2 findings: Interviews with older LGB community members • Sample so far ….. 7 men, 15women (n=22) • Between 50-80 years of age • Theme list includes: future hopes and expectations for residential care or domiciliary care, sources of informal care, contact with other LGB-identifying people • How would you expect to be treated by care and nursing staff? • What would help you to feel included by others in the home? • What kind of training do you think care and nursing staff should receive?

  12. Phase 2 findings: Interviews with older LGB community members • Seeking staff ‘awareness’ and ‘respect’ – awareness of what? • High levels of self-sufficiency amongst older lesbian networks • Difficult to imagine living in a heterosexual/ mixed-gender world • ‘Activist’ generation – NOT going back into the closet! • Anxiety about separation from partner – especially where age gap is present

  13. Where to from here…? Future directions • Interviews and focus groups – exploring how concepts such as ‘awareness and ‘respect’ translate into practice • What kind of care environments? Mixed, single-gender, LGBT-specific facilities … • Capacity of extra-care/ supported living facilities to meet the needs of older LGB residents • Putting sex & older LGB issues on the radar – Inspectorate monitoring, staff development & training • How prepared are care and nursing facilities for future generations?

  14. Tack. Diolchynfawr. Thank You Co-investigators Swansea University: Dr Tracey Maegusuku-Hewett Dr Paul Nash Dr Christine Baker Dr Sherrill Snelgrove Researcher: Dr Penny Miles P.B.Willis@swansea.ac.uk M.J.Raithby@swansea.ac.uk

  15. References Addis, S., Davies, M., Greene, G., S MacBride-Stewart, S. & Shepherd, M. (2009) The health, social care and housing needs of lesbian, gay, bisexual and transgender older people: A review of the literature. Health and Social Care in the Community 17(6) 647–658 Bauer, M., Nay, R., & McAuliffe, L. (2009) Catering to Love, Sex and Intimacy in Residential Aged Care: What Information is provided to consumers? Sexuality and Disability, 27(1), 3-9. Clarke, V., Ellis, S.J., Peel, E. & Riggs, D. (2010) Lesbian, gay, bisexual, trans and queer psychology: an introduction. Cambridge: Cambridge University Press Doll, G. (2012) Sexuality and Long-Term Care: Understanding and Supporting the Needs of Older Adults. Baltimore: Health Professions Press Heaphy, B., Yip, A. & Thompson, D. (2004) Ageing in a non-heterosexual context. Ageing and Society24 (6) 881- 902

  16. References (continued) International Longevity Centre UK (ILC-UK) (2011) The Last Taboo: A guide to dementia, sexuality, intimacy and sexual behaviour in care homes. London: ILC-UK Knocker, S. (2003) The Whole of Me: Meeting the needs of older lesbians, gay men, and bisexuals living in care homes and extra care housing. London: Age Concern Welsh Assembly Government (2008) Strategy for Older People in Wales. Cardiff: WAG White, C. (1981) A Scale for the Assessment of Attitudes and Knowledge Regarding Sexuality in the Aged. Paper presented at the 89th Annual Convention of the American Psychological Association, Los Angeles, CA, August 24–26 Windle, G. & Burholt, V. (2006) The Sexual Health of Older People. Cardiff: WAG Worthington, R., Dillon, F. & Becker-Schutte, A. (2005) Development, Reliability, and Validity of the Lesbian, Gay, and Bisexual Knowledge and Attitudes Scale for Heterosexuals (LGB-KASH) Journal of Counseling Psychology52(1) 104-118

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