This paper will focus nursing home health care disparities among the LGBT elderly. Throughout the paper, there will be research to identify the problem and support the factors that contribute to the identified problem. This paper looks at the issue of nursing home disparities among the LGBT community at a micro, mezzo, and macro level by identifying how the problem is engulfed in all levels of practice and how the problem can be solved by addressing all levels of practice.
The solutions to the health care disparity will be supported by two different human behavior theories. The LGBT elderly population consist of individuals that come from different races and ethnicities, religions, and social classes. Research proposes that LGBT elderly face health care disparities that are linked to discrimination, societal stigma, and political discernment. The experiences of violence and victimization throughout the lifetime of LGBT elderly have had long-lasting effects on how they view themselves, their community, and the health care system.
Discrimination against the LGBT community, as a whole, has been associated with high rates of psychiatric disorders, substance abuse, and suicide (SAGEUSA, 2013). According to the Services and Advocacy for GLBT Elders by SAGEUSA, many LGBT elderly are impacted by poverty and have reduced economic security. Reportedly, it is caused by a lifetime of employment discrimination (SAGEUSA, 2013). In addition to the economic disparity, LGBT elderly deal with significant health disparities across areas related to physical and mental health (SAGEUSA, 2013).
Another factor with the LGBT elderly is feelings of social isolation, due to having to cope with stigma and discrimination in their daily lives and in our country’s aging system. SAGEUSA reports that the LGBT elderly are twice as ikely to live alone, twice as likely to be single, and 3-4 times less likely to have children (SAGEUSA, 2013). Many elderly within this community are estranged from their biological families (SAGEUSA, 2013).
Additional risk factors for social isolation include mobility or sensory impairments, socio-economic status, and psychological or cognitive vulnerabilities (SAGEUSA, 2013). For example, major life transitions such as the death of a loved one or location-related barriers, joined with stigma and discrimination, can make it difficult for LGBT elders to find the community supports they need to age successfully and avoid ocial isolation.
Having limed funds, minimal support, and facing discrimination can lead into the major health care disparity, the ability to obtain safe and stable healthcare services, such as nursing home care. Reviewing the theoretical and empirical research, there are several factors to consider in the etiology of the health care disparity within nursing home care. Our American history has created a sense of fear, hatred, or mistrust of gays and lesbians, which is seen as homophobia (Equal Rights Center 2014). Heterosexism works effectively to create obstacles in achieving full equality.
Heterosexism is identified as the privilege of heterosexuality over all other sexual orientation and identities (Equal Rights Center 2014). An example of heterosexism can be easily seen within the first three editions of the DSM, where homosexuality is seen as a mental illness. Focusing on nursing homes and assisted living facilities, one study found that LGBT elderly searching for retirement homes experienced unfavorable differential treatment compared to non-LGBT elderly (Equal Rights Center 2014).
The study was published by Equal Rights Center in 2014 after the nationwide matched-pair tudy was completed. The research compared LGBT identified senior and heterosexual identified senior in contacting the same senior housing community to determine availability. The results exposed that the LGBT identified senior experienced unfavorable differential treatment in terms of availability of housing, pricing, financial incentives, amenities, or application requirements (Equal Rights Center 2014).
Supplementary studies that utilized non-probability community samples, illustrate that LGBT elderly may feel distrust toward health and social service agencies, and avoid or delay health care for fear of iscrimination due to their sexual orientation (Croghan, Moone, & Olson, 2012). Incidents of overt homophobia from healthcare providers toward older sexual and gender minority adults are (Czaja et al. , 2015). One spondent within the study comm recalled how “when he got into the nursing home and they found out he was gay, they refunded him his money and threw him out” (Czaja et al. 2015, p. 6).
Almost 75% of respondents in a separate study, believed that residential care facilities did not include anti-discrimination policies and 34% believed they would need to conceal their sexual orientation to live in the facility Johnson et al, 2005). Attitudes toward treatment at end of life seemed more positive. Survey data results found that over 50% of the LGBT sample of elderly believed health professionals would treat them with respect at end of their life (Croghan, Moone, & Olson, 2012).
Many mainstream aging providers do not account for the unique realities and needs of LGBT elderly, leaving them at risk for isolation, neglect and discrimination. A national survey of LGBT elderly in long term care facilities found that only 22% of respondents felt they could be open about their LGBT identities ith facility staff, 89% predicted that staff would discriminate based on their sexual orientations and/or gender identities, and 43% reported instances of mistreatment (SAGEUSA, 2013). There was an article published in 1999 By Y.
Parsons entitled “Private Act, Public Places”, which reported on a story of two men living in a nursing home. An assistant enters the room without knocking and witnesses two men engaging in oral sex. The men are separated immediately and within a day one of the men is sent to a psychiatric ward. The community health board stated that the transfer was necessary due to deviant behavior. Living n a community that desexualizes elderly in general, the addition of homophobia can create a hostile environment. In a 1997 article by S.
Raphael within the Journal of Elder Abuse and Neglect, depicts staff that are intolerant and condemning of homosexuality among residents of nursing homes. Raphael tells a story of an aid refusing to bathe a resident because they did not want to touch “the lesbian” and of a homecare assistant threatening to “out” a gay client if they reported the neglectful care (Raphael, S. 1997). These stories alone show the reason that this issue is not just an issue on a micro level, but of how it ranscends to mezzo and macro levels.
In the United States there have been many polices that have reinforced the concepts of homophobia and heterosexism that have ultimately lead to the causation of health care disparities among the LGBT elderly population. Historically, there have been many legal setbacks to the LGBT community that criminalized gay and lesbian acts. In recent times, 2015, there has been the First Amendment Defense Act, which allows a person to deny services to a member of the LGBT community due to religious or moral beliefs. Until recently, same-sex ouples faced discrimination in accessing federal government benefits.
Prior to the strike down of DOMA (Defense of Marriage Act), same-sex couples were unable to access federal benefits programs built to provide financial assistance to older adults (Equal Rights Center in 2014). For example, same-sex couples were unable to access benefits from federal programs such as social security, Medicaid and long-term care, retirement plans, or retiree health insurance plans the same way adults in different-sex marriages could, even if their marriage was recognized the state-level (Burda, 2013).
