Silver Rainbows: Advances in Australian ageing and aged care

Abstract

The ageing of the ‘baby boomer’ generation and the resultant expectation of dramatically increased service demand have inspired greater focus by the Commonwealth Government on healthy ageing and the Australian ageing and aged care sector 1. In previous decades, there has been minimal coverage of the diverse gender, body, sexuality and relationship experiences of older people in Australia. Thus, the increasing number of lesbian, gay, bisexual, trans and intersex (LGBTI) people accessing aged care services presents an emerging potential challenge for aged care service providers who may have limited familiarity with the needs of these populations. LGBTI populations make up a substantive proportion of the Australian population. Nationally representative Australian research found that 9% of men and 19% of women report same-gender attraction and/or experience 2. In New Zealand findings, 1.2% reported being transgender and 2.5% reported being unsure of their gender 3. Approximately 2% of people may be born with one or more of various intersex characteristics 4. These figures probably underestimate these populations due to barriers to accurate data collection and reporting, including widespread use of identity categories rather than descriptions of people's genders, bodies, sexualities, relationships, and preferred terminology across cultures and generations. Many Australians support marriage equality bills, but fewer recognise LGBTI elders' need for inclusive residential and home-based aged care. Youth-focused work is often more glamorous and accessible to people working within LGBTI organisations and in broader Australian contexts than the needs of older people. Many LGBTI elders have faced lifelong discrimination, often in overt and shocking ways. Consequently, many elders fear mistreatment in later life and may find reliance on services simultaneously necessary and unsettling. Elders born with intersex characteristics continue to navigate a medical system that pathologises and imposes unwanted ‘normalising’ interventions on them. People of trans experience are still classified as disordered in psychiatric manuals, and often report denial or delayed access when seeking gender-affirming identity documents and/or medical interventions. Lesbian, gay and bisexual elders have lived through times in which their sexualities and relationships were stigmatised, illegal and categorised as mental illness. Many elders still face institutionally sanctioned bullying and intimidation. The time of life during which people begin to rely on healthy ageing services and aged care can be a time of great vulnerability. For people who have fought discrimination throughout their lives, it can be difficult to believe that mistreatment will not recur. Given these experiences, many elders from LGBTI populations do not disclose their sexual orientation, relationship status, gender history or experience, or having been born with intersex characteristics. This silence often renders their needs and experiences invisible until unwanted disclosure or crisis. Erasure, under-identification and general ignorance around LGBTI issues lead many service providers to believe that ‘we don't have any of those people here’ or that problems do not exist because ‘we treat everyone the same’. Yet legislation has shifted to prohibit indirect discrimination; unintentional exclusion through ignorance is unlawful 5. The National LGBTI Health Alliance, which was launched at Australia's Parliament House in August 2007, is one of the first organisations of its kind in the world. Our founding members have played a key role in LGBTI health in their respective States and Territories across Australia. They saw the need and the opportunity to establish a national organisation that works broadly across LGBTI health issues. The Alliance is a not-for-profit public company, governed by a constitution and a Board of Directors. We are a member-based organisation – community organisations and individuals working together. Since its inception in 2007, the National LGBTI Health Alliance has included ageing and aged care as a priority issue in its work, which includes various submissions to Government. The final report of the Productivity Commission inquiry into aged care, Caring for Older Australians, addressed the concerns of older LGBTI people in specific terms as a discrete group within the discussion of diversity issues. At a meeting between the Alliance and the Minister for Mental Health and Ageing in August 2011, Minister Mark Butler raised the idea of holding a discussion with LGBTI communities regarding aged care-related issues and the Productivity Commission's report. In October 2011, the National LGBTI Health Alliance convened the first National Roundtable on LGBTI Ageing and Aged Care. The key recommendation of that Roundtable was the development of a national ageing and aged care strategy for older LGBTI people. The Australian Government's ‘Living Longer, Living Better’ reform package was announced in April 2012. As Australia's aged care service delivery evolved and in the lead up to the package, the Alliance maintained a clear focus on maximising opportunities for LGBTI people. We have been pleased to work with the members of the National Aged Care Alliance (NACA) in that endeavour. The Government's announcements included a number of LGBTI-specific measures that the Alliance and its members had been seeking for some years. First, the Government announced that it would provide $24.4 million to assist older Australians with diverse needs, their families, and their carers to access information and aged care services that are sensitive to their backgrounds. These funds cover people from culturally and linguistically diverse backgrounds; people who are homeless or at risk of being homeless; people who are care leavers (i.e. people who have left out-of-home care); and LGBTI people. Second, the Government announced that it would provide $2.5 million to support older people from LGBTI communities by delivering specific sensitivity training for people who work in aged care. The Alliance has been awarded a contract for most of that work, building on the work undertaken by ACON and Aged and Community Services Australia in 2010–2011. As is often the case in Australia, any national training will need to be sensitive to the nature of Australia as a federal system of government. Some States and Territories have already undertaken significant LGBTI training, while others have just begun. Third, it was announced that Allocation Principles of the Aged Care Act 1997 would be amended to add LGBTI people to the ‘special needs groups’ whose needs must be considered in planning and implementation of Commonwealth aged care allocations. This change, which was implemented in mid-2012, further enabled access to appropriate and suitable care. The main Act was amended accordingly. These beneficial changes had multi-partisan support. The National LGBTI Ageing and Aged Care Strategy (the Strategy) was launched in November 2012. Implementation commenced almost immediately. The Strategy was developed by a Steering Committee that comprised the Commonwealth Department, the aged care sector, and community representatives nominated by the Alliance. The Alliance was supported to conduct 16 community consultations on the Strategy. Over 350 participants contributed to discussions covering each capital city and multiple regional areas. Inclusion – the rights and needs of older LGBTI people, their families and carers are included in the development of Australian Government aged care policies and programmes. Empowerment – older LGBTI people, their families and carers are supported with the knowledge and confidence to maximise their use of the aged care system. Access and equity – all areas of aged care understand the importance of, and deliver, LGBTI-inclusive services. This means understanding LGBTI people's specific needs rather than assuming that they are identical to those of [non-LGBTI populations]. Quality – care and support services provide quality services that meet the needs of older LGBTI people, their families and carers, and are assessed accordingly. Capacity building – LGBTI individuals and communities have the capacity to both articulate their aged care needs and be involved in the development of services and the workforce to meet these needs'. The release of the National Strategy has been hailed as historic. Ageing and aged care is the first area of national government activity to have an LGBTI-specific strategy of which Consumer-Directed Care (CDC) is an integral part. In the Strategy, the Commonwealth Government explained that CDC ‘incorporates many of the principles of person-centred care, while putting the consumer in charge of decisions about their care’ 1. In addition, the Sex Discrimination Act 1984 was amended to include sexual orientation, relationship status, gender identity and intersex status. From 1 August 2013, federal law has prohibited direct and indirect discrimination on the basis of a person's sexual orientation, relationship status, gender identity (including gender-associated history, characteristics and expression) and intersex status 5. All aged care providers must comply with this legislation. However, religious organisations that provide Commonwealth-funded aged care services are exempt from these provisions of the Sex Discrimination Act in all areas except service delivery and intersex status. After decades of seeking recognition, LGBTI elders' rights have significantly improved in just over three years. While more work remains, these recent changes have led to increased knowledge and understanding across all levels of Australian society and continue to improve the lives of older people across Australia.