In the margins or the mainstream? Future directions and innovations in providing inclusive accommodation and support for older LGBTI adults

In the margins or the mainstream? Future directions and innovations in providing inclusive accommodation and support for older LGBTI adults

Article Type: Guest editorial From: Quality in Ageing and Older Adults, Volume 17, Issue 1.

Paul Willis, Trish Hafford-Letchfield and Antony Smith

The health, social and economic wellbeing of older adults who identify as lesbian, gay, bisexual, transgender and intersex (LGBTI) has received ever-increasing attention from public bodies, third sector organisations and academic communities over the last 15 years within the UK and other economically advantaged nations. Concerted efforts in research and practice communities have drawn attention to the cumulative impact of “coming of age” prior to the decriminalisation of homosexuality in 1967 across parts of the UK. This includes greater recognition of historically oppressive moral discourses that situate homosexual relationships as sinful and degenerate and biomedical discourses that have classified homosexuality as a subject of mental health diagnosis and treatment (prior to its removal from the Diagnostic Statistical Manual of Mental Disorders in 1973) (Fish, 2012). At the centre of research and policy outputs is the objective to produce inclusive and responsive health, social care and civic services that are attuned to the impact of historical and institutional homophobia on older LGBTI people’s lives. This equates to services that are sensitive to older individuals, couples and people living in families of choice who live with apprehension about the receipt of homophobic, transphobic and heterosexist responses when seeking help with meeting their needs in later life. Inclusion of older LGBTI adults in service planning and provision requires recognition of the differing relationships and kinship ties many older adults have experienced across the life course. Indeed, many older LGB adults have entered and exited heterosexual relationships during their lifetime and continue to fulfil parenting and grand-parenting roles (Willis et al., 2014; Gabrielson and Holston, 2014). Recognition of the life-stories, significant relationships and future preferences of older LGBTI service users can be confounded by two discriminatory factors: the discourse of ageist erotophobia (Hafford-Letchfield, 2008; Simpson et al., 2015) that positions older people’s sexual expressions and relationships as abnormal and unnatural; and, the combined impact of ageism, cisgenderism and heterosexism which overshadows the lives of non-heterosexual and non-cisgender older adults.

As guest editors we are pleased to bring this special issue to readers of the journal for two reasons. First, the authors within this issue identify fundamental concerns attached to ageing, housing and care in later life for LGBTI adults as a frequently neglected group in ageing research. Second, this collection of articles brings new arguments to the table about the role of innovation in creating new housing and social care services that alleviate the concerns of this cohort. Oxford English Dictionary (2015) defines innovation as a “new method, idea and product”. In the present context, we are committed to stimulating discussions about the ways in which current housing and social care providers, commissioning bodies and policy makers can engage with and meet the diverse needs of older adults across the LGBTI spectrum through “new methods, ideas and products”. Westwood (2015) in her recent research reminds us that currently the UK lags behind other Western nations, such as Germany, Australia and the USA, in providing specialist housing and aged care services for older LGBTI adults. Meeting the housing and care needs of this cohort means thinking beyond a one-size-fits-all model and prioritising a personalised model of care in later life. Unsurprisingly for such a heterogeneous group, the preferences of older LGBTI adults vary considerably between those advocating for the enhancement of mainstream housing and care provision to others arguing for the delivery of specialist housing and aged care services according to differences in gender and sexual identity (Westwood, 2015). While deploying the catch-all label “LGBTI” in this special issue, we recognise that this cumbersome abbreviation on its own is not a reliable concept for driving forward equality and person-centred care in housing and social care sector. Indeed, this special issue contains numerous variations of the “LGBTI” abbreviation – we have avoided specifying a definitive version of this abbreviation in recognition that imposing this brings the risk of excluding particular identities and groups.

While this special issue contains perspectives from across Western nations, its publication in the UK context is timely as it parallels the implementation of the Care Act 2014 in England, the Social Services and Wellbeing Act (Wales) 2014 and the Public Bodies (Joint Working) (Scotland) Act 2014, which all aim to improve the way in which older people’s needs are met through radical integration of services at every level. These statutory frameworks set out new directions for care providers in co-creating and commissioning services that are anchored in community asset-based approaches and encourage new forms of person-centred (citizen-directed in Wales) provision between user groups, local government bodies and third sector agencies. Arguably, this is a pivotal time within the UK to put the diverse needs and interests of older LGBTI adults on the social care agenda and to invite policy makers and leaders in the sector to consider fully and to greater effect how mainstream services can be more responsive to the different life-trajectories of older LGBTI adults. This includes recognising the legacy of criminality and social exclusion referred to above.

One cross-cutting theme in this issue is the ways in which social stratifications in class, income and wealth shape the social networks and ties of older lesbian and gay adults and present opportunities for different approaches to future care for some and limited options for others. The impact of socioeconomic divisions cannot be ignored in any discussion about future housing and social care provision as the privilege of wealth brings with it increased choices, stability and life-opportunities that are not afforded to economically disadvantaged groups or older adults living in poverty, inclusive of older LGBTI adults. Through his international research, Robinson examines older gay men’s fears and anxieties attached to ageing – his narrative findings indicate that gay men’s fears about later life overlap with other older adults’ concerns about isolation and diverge into more specific worries about heterosexist encounters from service and accommodation providers. Robinson argues that class and time are two mediating dimensions that cut across gay men’s anticipated futures about ageing. Proposed solutions include the development of friendships across generations to bolster social and support networks and to alleviate loneliness in later life.

The significance of social ties and networks is a binding thread running through a number of articles in this issue. Drawing on the sociological work of Robert Putnam and Pierre Bourdieu, King and Cronin provide a fascinating theoretical discussion about the under-recognition of social capital in older LGB adults’ lives. These authors put forward new arguments about the ways in which LGB identities can both facilitate and hinder social connections with others. Fundamentally, King and Cronin argue that we need to redefine social isolation as a lack of opportunities to build connections, networks and relations of trust and reciprocity with others. In the context of aged care housing, service providers and commissioners need to be attuned to the ways in which long-term care environments prevent LGB adults from forging connections with others in the same living environment and inhibit individuals from continuing to invest in the social ties shared with other LGB adults.

If social services in the UK are expected to refocus their attention on enhancing individual wellbeing, then the importance of social capital cannot be ignored. In keeping with this theme, Jill Wilkens’ interview-based research provides rich insights into the historical and contemporary significance of social groups as safe and validating spaces for older lesbians and bisexual women. Wilkens argues that women’s groups have helped reduce isolation and loneliness and foster a sense of belonging. Wilkens’ article also provides critical reading of gender as a defining social characteristic that is inseparable from discussions about sexual identity; her findings highlight the interpersonal tensions that can arise around issues of mixed-gender membership and the contested inclusion of trans-women in women’s groups that bring to the fore historical disputes about gender as an essentialised concept. Wilkens sees a future need for resourcing and supporting cross-sexuality and intergenerational alliances in women’s groups that can benefit both younger and older non-heterosexual women. Both Wilkens’ and King and Cronin’s articles reinforce the importance of thinking critically about the concept of kinship as pivotal to older adults’ lives and the ways in which older LGB adults may develop kinship ties with significant others that can supplement and complement existing ties with biological family.

In parallel to these integral discussions of social networks, Dylan Kneale’s and Marcus Green’s quantitative studies highlight the ways in which LGBT social lives diverge from heterosexual patterns of social interaction and connection to significant others. Both articles reflect innovation in their research approach through the use of secondary data contained in cohort studies to develop a greater understanding of the social networks and bonds that matter to older LGB individuals in Great Britain. Through his analysis of data from the Understanding Society Wave 3 survey, Green argues that older LGBT adults (aged 50 and over) live with weaker kinship networks than their heterosexual counterparts and therefore more attention is needed on building their “social convoy” as an essential source of companionship in later life. Based on his analysis of data from the English Longitudinal Study of Ageing, Kneale contends that geography matters when assessing the strength of older LGB adults’ social networks and that older LGB adults’ friends may not be as accessible geographically as their heterosexual peers. Kneale’s findings emphasise the need for social care services to promote social contact among older LGB people. This paper will appear in a later issue of the journal and we would encourage readers to keep an eye out for this thought-provoking article.

The recognition of older trans adults’ needs and interests in future care provision is sorely missing from current ageing and sexuality research (Bailey, 2012). We are delighted here to include a qualitative article from Serena Jones (co-authored with Paul Willis) that captures the voices of trans activists from across Western nations to more fully explore what the future concerns may be for older trans adults about receiving aged care services. This paper poses the important question of “are you delivering trans positive care?” for the consideration of aged care providers in planning services that are trans-friendly and equipped to deal with transphobia and provide gender-sensitive services. Trans activists are more often than not fully-versed in their legal rights and entitlements. As older adults, they will bring high expectations for care providers to deliver trans-friendly services that encompass their health care needs, including issues attached to undergoing gender transitioning in earlier years.

LGB & T-affirmative housing provision is one solution to meeting the needs of trans and LGB adults in old age and in this vein Paul Ross provides a highly comprehensive discussion of the current range of LGBT-specific long-term care and housing services available to this population across economically advantaged nations. Ross’ thorough exploration of LGBT-affirmative housing in the international arena is essential reading for policy makers and providers in the housing sector in planning future services that are better tailored to diverse generations of older adults.

In the English context, the new Care Act’s emphasis on wellbeing and the co-production of social care services brings with it new opportunities for creative and community-led development of housing and support services that can deliver safe, affordable and affirmative housing for older LGBTI people. The article authored by John Crossland (appearing in a subsequent issue of the journal) explores this potential. Crossland argues that the Care Act 2014 in England brings with it optimum conditions for social care workers to act as street-level bureaucrats and to commission new services that specifically target the housing needs of this older cohort. We strongly recommend this paper as an essential learning resource for social work and social care students, educators, professionals and commissioners in getting to grips with the implications of the new Act in England and indeed with the ramifications of working in co-production with third sector agencies and user groups to redefine services for sexually and gender diverse older citizens. Crossland concludes that the new Act paves the way for joint commissioning of services with user groups and innovative thinking is the key here. Indeed, a central theme that runs through many of the articles in this collection is that the solutions to providing inclusive housing and support services often already exist within the social networks, ties and communities long-established within LGBTI older adults’ everyday lives. Therefore, delivering innovative services can only be achieved through co-production with these groups and with user-involvement at the heart of future service planning and provision.

As we have compiled a collection of articles that mark out new policy and practice directions in this domain, we are cognisant of the gaps in current research that we have not adequately addressed here. Across the older LGBTI spectrum, older individuals who identify as trans, intersex and non-gender conforming (see Bailey, 2012) and bisexual adults (see Jones, 2012) remain neglected cohorts whose needs and interests in later life have not received the same level of attention as older lesbians and gay men. These are priority groups for future research in LGBTI ageing. In parallel the social and sexual lives and relationships of black and ethnic minority LGBTI adults and older same-sex attracted adults living with physical, mental and learning disabilities are sorely neglected in the wider terrain of ageing and sexuality studies. We are also mindful of the restraints present in conducting social research in this field in which there are barriers to obtaining representative samples from the broader population that reflect LGBT adults’ interests in their fullest sense, and the continuing reliance on smaller “opt-in” samples. This collection draws attention to potential subject matter for future research, not only of communities’ needs but of the whys and wherefores of providers’ responses. We know, for example, that LGBTI communities that have experienced discrimination often survive (indeed, thrive) by developing great resilience, but what can we learn from and how can we build on that? And while we know the UK lags behind other Western nations in providing specialist LGBT housing and care options, we need to look further into the causes, especially in light of the UK’s consistent positioning at the top of comparative tables of LGBT rights generally, such as the International Lesbian and Gay Association’s Rainbow Europe Index.

We have selected reviews from the growing scholarship in LGBTI literature to illustrate the increasing capacity for the academic, policy, practice and the LGBTI community for taking forward the agenda on ageing and stimulating debate. Both of the books selected here reflect the need for multidisciplinary, interprofessional and service user led texts which should be core for any professional education and for all of those engaged in providing support for LGBTI ageing. The edited collection by Witten and Eyler (2012) and the Ward et al. (2012) both exemplify the high standards of empirical data, qualitative and quantitative research and particularly the importance of narratives and biographies in person centred support. Additionally, and to encourage as broad a response as possible to this agenda, we have invited contributions from older LGBTI people themselves. Taking three films that either feature lesbian or gay characters or explore episodes from our communities’ histories, our reviewers provide an insider’s insight to the historical, but still shifting, circumstances and attitudes that continue to influence how older LGBTI people are understood and valued today and how their needs are recognised.

Finally, not all of the contributors were able to be included in this special edition given the quality and range of issues we needed to cover and convey in one place and, as flagged above, there are two further articles that will be rightly placed in future issues. We hope that this special edition encourages you to read these contributions as much as we enjoyed editing them.

Paul Willis is based at School for Policy Studies, University of Bristol, Bristol, UK.

Trish Hafford-Letchfield is based at School of Health and Education, Middlesex University, London, UK.

Antony Smith is based at Age UK, London, UK.

References

Bailey, L. (2012), “Trans ageing: thoughts on a life course approach in order to better understand trans lives”, in Ward, R., Rivers, I. and Sutherland, M. (Eds), Lesbian, Gay, Bisexual and Transgender Ageing: Biographical Approaches for Inclusive Care and Support, Jessica Kingsley Publishers, London, pp. 51-66

Fish, J. (2012), Social Work and Lesbian, Gay, Bisexual and Trans People: Making a Difference, Policy Press, Bristol

Gabrielson, M.L. and Holston, E.C. (2014), “Broadening definitions of family for older lesbians: modifying the Lubhen social network scale”, Journal of Gerontological Social Work, Vol. 57 Nos 2-4, pp. 198-217

Hafford-Letchfield, P. (2008), “‘What’s love got to do with it?’: Developing supportive practices for the expression of sexuality, sexual identity and the intimacy needs of older people”, Journal of Care Services Management, Vol. 2 No. 4, pp. 389-405

Jones, R.L. (2012), “Imagining the unimaginable: bisexual roadmaps for ageing”, in Ward, R., Rivers, I. and Sutherland, M. (Eds), Lesbian, Gay, Bisexual and Transgender Ageing: Biographical Approaches for Inclusive Care and Support, Jessica Kingsley Publishers, London, pp. 21-38

Oxford English Dictionary (2015), Oxford English Dictionary (OED), Oxford University Press, Oxford available at: www.oed.com/ (accessed 1 December 2015)

Simpson, P., Horne, M., Brown, L.J.E., Brown Wilson, C., Dickinson, T. and Torkington, K. (2015), “Old(er) care home residents and sexual/intimate citizenship”, Ageing and Society, pp. 1-23. doi: 10.1017/SO144686X15001105 (accessed 14 October 2015)

Ward, R., Rivers, I. and Sutherland, M. (2012), Lesbian, Gay, Bisexual and Transgender Ageing: Biographical Approaches for Inclusive Care and Support, Jessica Kingsley Publishers, London

Westwood, S. (2015), “ ‘We see it as being heterosexualised, being put into a care home’: gender, sexuality and housing/ care preferences among older LGB individuals in the UK”, Health and Social Care in the Community, pp. 1-9. doi: 10.1111/hsc.12265 (accessed 24 August 2015)

Willis, P., Maegusuku-Hewett, T., Raithby, M. and Miles, P. (2014), “Swimming upstream: the provision of inclusive care to older lesbian, gay and bisexual (LGB) adults in residential and nursing environments in Wales”, Ageing and Society, pp. 1-25. doi: 10.1017/S0144686X14001147

Witten, T.M. and Eyler, A.E. (2012), Gay, Lesbian, Bisexual, and Transgender Aging: Challenges in Research, Practice, and Policy, John Hopkins University Press, Baltimore