Recently there have been some significant events affecting the LGBTI (lesbian, gay, bisexual, trans and intersex) community that hopefully mark the beginning of ensuring they also have an equal right to participate in all community practices of society, not least including safe access to healthcare.
Many people may think that they already hold an accepting and open view of diversity, and that they treat everyone as an equal. Often, high-level conversations within healthcare organisations are prefaced with statements such as: “As far as I am concerned, people can do and live how they want”, and; “I don’t have a problem with people from the LGBTI community.”
Although these sentiments are encouraging, this is not enough to ensure that our work is truly inclusive. To have a further understanding of the unique issues that people from the LGBTI community may have had to – and in many cases, still need to – overcome, training and open communication is needed for our healthcare workers.
Australia’s History of LGBTI Issues
Presently in Australia, homosexuality has been decriminalised across all states and territories, with Queensland in 1990 and Tasmania as late as 1997.
Because of this lateness, the current generation of older LGBTI community members were still navigating their adulthood years when their sex, sexual orientation or gender identity had terrible consequences.
The freedom that many teenagers and young adults experience today was not necessarily afforded to those who identified as LGBTI before them. For some Australians, the impact of past criminal convictions still remains with them today.
As many LGBTI seniors have and may continue to experience discrimination, it is important that we understand that this can have an effect on their health in many different ways. It is therefore important that as care providers, we ensure we have a basic understanding of these issues.
Simple Steps That You Can Take
Providing a Safe and Inclusive Environment
Providing a safe and inclusive environment should be the priority of all healthcare organisations and their workers, no matter the patient.
Do not automatically assume that everyone is heterosexual. Giving people the option to disclose their identification is important, however, it may take some time to build trust between you as a healthcare worker and your client. If a client does disclose their gender identity or orientation to you, make sure that you ask them specifically who the information is for. Some people may be ‘out’ to you and their close friends, but not to other family members or acquaintances.
It is important to establish with whom this information may be shared with.
Definition of Family
A person’s definition of family may be different to your traditional understanding. Some people may have lost contact or have been rejected by their family members because of their disclosure. As a healthcare worker, it is important to accept and take into consideration the acknowledgement of long-term partners or other members of your clients’ close group when discussing health options and care treatments.
Listening to and acknowledging partnerships will help you to provide a safe and respectful environment to enable your client to discuss healthcare issues.
Not all Health Issues are the Same
As with all people, health issues are unique to the individual. Providing true patient-centred care will enable you to work with the individual and their specific needs.
In the transgender community, for example, some clients will undergo gender reassignment surgery, while others may undergo transitioning without surgical intervention. Listening attentively to your client that is going through this transition will clarify how your client would like to be addressed, possibly reduce embarrassment with personal care needs (especially if there has not been surgery involved) and give support and understanding to people who are essentially a minority within a minority group.
LGBTI clients may be more vulnerable to mental health issues. People may have had to endure a lifetime of bullying, harassment and rejection from others whom they have been close to. Living a life of constant stress of not being able to be themselves, being on constant guard for fear of being exposed, and a fear of losing a health service if their sexual orientation, gender identity or intersex status becomes known, can be very detrimental to a person’s mental health.
Sometimes older people may also return to hiding their true identity even after having lived for many years as an open member of the LGBTI community, for fear of discrimination in nursing care homes or with care workers who are providing services for personal and other care needs.
Again, ensuring that your work practices communicate a sense of security and inclusiveness will help to ensure that your client can access proper healthcare.
Checking Your Organisation
All members of society have the right to access equal and individual healthcare. Speaking with your supervisors regarding extra training for yourself or your colleagues will help with ensuring that your practices are diverse and inclusive for everyone. There should be a process for assessing the professional development needs of all staff and volunteers in regards to LGBTI-inclusive practice and the cultural needs of staff members.
There are many ways that you can help to work with your organisation to ensure that it adopts a culture of inclusive practice. Some initiatives are circulating information about LGBTI cultural safety, consumer consultation, appropriate disclosure and documentation as well as safe intake processes.
Often, cultural change starts with one person. Ensuring that your own practice and provision of service is diverse and inclusive, I think, for healthcare workers, should be the goal.
- Department of Health 2017, Review of the Implementation of the National Lesbian, Gay, Bisexual, Transgender and Intersex Ageing and Aged Care Strategy, Australian Government, Canberra, ACT, viewed 11 December 2017, https://agedcare.health.gov.au/sites/g/files/net1426/f/documents/11_2017/lgbti_ageing_and_aged_care_strategy.pdf
- GLHV n.d., LGBTI Inclusive Practice, Melbourne, VIC, viewed 11 December 2017, http://www.glhv.org.au/lgbti-inclusive-practice
- Lee, R 2000, ‘Health care problems of lesbian, gay, bisexual, and transgender patients’, Western Journal of Medicine, vol. 172, no. 6, pp. 403-8, viewed 11 December 2017, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1070935/