June is Pride month, and this time of celebration and affirmation in the LGBTQ+ community is a good time to explore how our needs are being met in society at large – including in the social care sector. 

I work at Opening Doors, which is the UK’s largest charity focused on supporting LGBTQ+ people over 50 – that bewildering acronym means that we are working for and with lesbians, gay men, bisexuals, trans people, queer people and others who have a ‘non-normative’ sexual or gender identity. 

An important aspect of this work involves supporting older LGBTQ+ people who are in the care system, as well as helping staff and organisations in the sector to work in an inclusive way.

Calling upon research

People sometimes ask us whether LGBTQ+ over-50s have different needs from the rest of the older population, and the team that I work with – which focuses on research and public policy – has an answer to that question. Research has consistently shown that older LGBTQ+ people are less likely to have familial support, more likely to live on their own and more likely to be socially isolated than their heterosexual and cisgender peers. 

In addition, what theorists have called ‘minority stress’ means they often have worse mental and physical health than their straight peers, while a significant number of gay men over 50 – and others – are dealing with a long-term HIV diagnosis.

Lack of confidence in care

However, although these factors mean that LGBTQ+ people are more likely to require statutory social services, other research has shown that as a group they feel less confidence in these services than their straight peers. A 2019 survey by the campaigning group Stonewall found that 61% of lesbian, gay and bisexual people were not confident that social care and support services would be able to meet their needs (compared to 51% for heterosexual people). 

In addition, many LGBTQ+ people have particular concerns about moving into a care home. In the same survey, 47% of LGB people said they would not be comfortable being open about their sexuality to care home staff, while 70% did not think they would be able to maintain a comfortable degree of privacy in this setting (compared to 61% for straight people).

A cautious approach

The lack of confidence that many LGBTQ+ people feel in the social care system is due, in part, to caution about being ‘out’ about one’s identity. Older LGBTQ+ people have lived through eras of greater social stigma – the 1980s and early 1990s, for instance, during the height of the AIDS crisis, was marked by rampant homophobia – and can be more cautious about being out. 

In addition, while the prejudice experienced by lesbians and gays may have reduced in recent years, other sections of the LGBTQ+ community – such as trans people – can still face profound ostracisation. The result is that many older LGBTQ+ people can be reluctant to disclose their identities to statutory services or may fear they will lose their support circle – or have to go ‘back in the closet’ – if they move into a care home.

Addressing gaps in research

To date there has been little research exploring how social care workers engage with and understand the needs of LGBTQ+ people needing care and support. However, Opening Doors is currently undertaking a study – in collaboration with the Universities of Birmingham, Manchester and Bristol – which is exploring how social care assessments are made and how LGBTQ+ people over 65 experience them. 

Multiple parties are involved in the research, including three local authorities, as well as people with lived experience of care services. Many things are being explored, such as the role of small ‘cues’ from staff and services: how these may help in generating trust and in reassuring service users that the practitioner – and the organisation – understands the significance of sexual and gender identity in their lives and will not discriminate against them.

Avoid assumptions

Another subject of the study is heteronormativity and cisnormativity – in other words, the privilege given to the straight perspective. This can lead to an assumption among practitioners that equality means ‘treating everyone the same’. Indeed, the same Stonewall survey revealed that six out of 10 care workers didn’t consider a person’s LGBTQ+ identity to be relevant when providing health or social care. 

This approach flattens the very real differences between LGBTQ+ people and others, ignoring the former’s life stories and experiences. An associated problem is lumping LGBTQ+ people into a single, homogenous group with assumed similar experiences, without considering the unique challenges or experiences of specific groups, such as trans people.

Ensuring appropriate training

A final startling statistic from the same survey is that three quarters of social care staff hadn’t received any information or training on the lives or needs of LGBTQ+ people, and this is a situation that Opening Doors has set out to rectify. Our ‘Pride in Care’ quality standard – which is recognised by Care England – is awarded to organisations that provide quality care and support to older LGBTQ+ people. 

The quality standard is attained through a process that includes policy reviews, staff surveys and site visits. We encourage staff to have the confidence to discuss issues of sexual and gender identity in a sensitive and affirming manner. In June, as many younger LGBTQ+ people take to the street in Pride marches, we must also think about how to make the world inclusive for their queer elders – notably those queer elders in the world of social care.