Non-Heterosexual Aging

Presentation to a Networking Seminar
Reading, August 30th, 2003
Sally Middleton, Opening Doors in Gloucestershire

Introduction.

My background is in social work, most recently as a planning and policy officer, looking at Best Value issues, training strategies (ie joint commissioning) and strategic/consultation issues with an emphasis on partnership working in relation to older people, and other adult client groups.

In October 2002 I worked with SAGE New York, for two weeks, observing the services they deliver, then gave an address at Age Concern Gloucestershire's Opening Doors conference on LGB ageing, in November 2002. I have been a member of Age Concern Gloucestershire's Opening Doors steering group since its inception.

I quit social work in November, 2002, and now advise a local government department, in Gloucestershire, on how to tackle social exclusion.

I've made contact with Brian Heaphy, at Nottingham Trent University, and was asked to comment on the policy papers his team will be writing, as a result of their research, during 2003-2004, on non-heterosexual ageing.

I also do a variety of non-paid work around community action/community development, work as a mentor and write for several professional publications and websites on good practice in social inclusion.

These are the reasons why I was asked to make this presentation on Brian's research report.

Purpose of my presentation.

Rather than spending time concentrating on the minutiae of Brian Heaphy's research report ("Non Heterosexual Ageing") I want to:

1. Give some context to services for older people, which are rapidly changing here in the UK
2. Discuss some ways in which we may make use of the evidence in the report to make an impact on providers - what I call "sharing the lessons".
3. Identify some practical things you can do in order to effect change " your efforts to get the issues onto the agenda of service providers both locally and nationally.

But, first, a personal comment on my response to Brian's research report. On first reading it, I was struck by 4 things:

1. How moved I was. When I tried to "unpick" this, I decided that it moved me because (a) there is a general paucity of research into our lives as LGBs as we age (apologies - I will use the terms "our" and "us" meaning LGBs, although I realise not everyone here, today, is non-heterosexual!) and (b) that so much of what it says is actually meaningful to me, personally, in a way that so few things are - this speaks of my experience, and that is moving simply because there are so few opportunities to engage with anything that is accurately representational of our lives.
2. The resourcefulness of my (our) community. The report is extremely eloquent about this, especially where it talks about how older LGBs have enjoyed, indeed celebrated, their sexual identity despite the culturally mediated sanctions against same sex relationships with which they grew up. I felt proud of this ageing community of which I am a part. In this sense, the report was - for me - about positive images of LGB ageing. I do not ordinarily have a sense of pride in this way - our community is not only resourceful, but also pioneering, inimitable, strong, proud and irrepressible, despite all. It confirmed (for me) that older people have much to offer is simply "telling it like it is", and just how much we can learn from that process.
3. That it confirmed much of what might be called a "collective wisdom" (until now, of course, largely anecdotal) about our lives - especially the sense of what I would call "non-traditional" families, and that 'kinship' is whatever you want it to be or mean: that although the notion of "family" is socially constructed to mean something that is, by definition, heterosexual, we know (because we now have the evidence) that LGBs have a strong sense of an "alternative" (or unorthodox) family, whereby emotional attachments are to do with community/identity, as much as to do with life partners or traditional kinship relationships. But the report also challenged many of our assumptions about LGB ageing, and there were a few surprises along the way!
4. An enduring sense of just how much there is, still, to do - the challenges ahead. In this sense, it was both inspiring and motivational. I also had a sense of - at last! At last we have some firm evidence about our needs, concerns, circumstances, issues and experiences of growing old as gay, lesbian or bisexual individuals.

The Presentation

Contextualising Brian Heaphy's Research Report.

The following bullet points give you some context and useful background around services for older people:

• Services to older people are undergoing a period of change, whereby - more so than ever before - the key providers (Health & Social Services) are expected to work together (one example of this is the Single Assessment Framework). These changes are being driven by the National Service Framework for Older People. There are 8 Standards in the NSF, including:
  1. Challenging age discrimination
  2. Person-centred care
  3. Intermediate care
  4. General hospital care
  5. Stroke
  6. Falls
  7. Mental health
  8. Promoting an active & healthy life in older age

  Those in bold are the Standards that would seem particularly, and specifically, relevant to LGB ageing issues.

• Underpinning all of these 8 Standards is an emphasis on equality, embracing diversity and responding to individual needs. Primary Care Trusts (PCT's) and NHS Trusts will have posts dedicated to implementing these NSF Standards as part of a bigger HiMP (Health Improvement Plan) locally. Familiarise yourselves with the language (terminology) used by service providers, as you will need to communicate with them.
• The demographic profile in the UK is changing - the proportion of older people will rise sharply over the next 3 or 4 decades (roughly doubling in that time). For statistical evidence, see the Age Concern England (ACE) website, or Department of Health (DoH) website. But it is a fact that Britain is getting older, and this is both a strategic and operational concern of statutory providers, especially Health and Social Services. Find out who is responsible - in your PCT's area - for implementing the NSF.
• Local government is being directed to tackle social exclusion, and this includes what I would call "thematic communities" or "communities of interest", such as LGBs. Even my own professional milieu - Libraries - are stocking, for example, Queer Choice book stock (Brighton's library service is particularly good at this) or planning oral history projects with older LGBs.
• Alongside this, is the Government's push towards partnership working. Statutory sector services will be only too pleased to work in partnership with voluntary organisations. Your locality will almost certainly have an LSP (Local Strategic Plan) which both statutory and voluntary sector providers will have signed up to, regarding 3 to 5 year strategic targets (e.g. things like community safety, healthy ageing, etc) and it's worth making contact with your County Council/Unitary Authority to get LGB issues on to their agenda (ask about their equal opportunities policy; what there corporate objectives are; who is responsible for adult care services/services to older people; if they have any formal links with older people's advocacy groups; how they consult with older people; whether or not they have an elected member responsible for services to older people; whether they have a community plan; how they tackle social exclusion; etc).
• Several key legislative changes are on the horizon, not least employment rights and civil partnerships, which will have an incremental impact on both service providers and attitudinal barriers. These legislative changes will also bring other LGB issues into sharper focus (e.g. same sex partners' rights to survivor benefits/pensions). The single Equalities Commission may also have an impact, although insiders are saying it won't work because of the "hierarchy of oppression" debate, which could sabotage the work of a single Equalities Commission by allowing partisan issues to become polarised, factional and divisive.
• Political awareness amongst the newly old generation of LGBs will have an impact as we see an expanding proportion of older people. For the first time we are beginning to see a growing number of "out" and politically "savvy" LGBs who simply demand that their relationship/lifestyle/sexual identity is acknowledged. They will demand that health and care services meet their specific needs.
• The impact of "new" technology is exciting, and offers greater opportunities than ever before to both disseminate information and reduce social isolation. If your LGB group cannot sustain a real (physical) community centre, then a "virtual" community centre is indeed possible " through websites, networking, emails, chat rooms, etc.
• Service providers will often ignore the demand for LGB-specific services on the basis that there is "no need" or that there is not a "critical mass" in terms of numbers (ie not enough demand). This is simply not a logical argument. We don'at say this about people with physical disabilities " we actually legislate for individual needs (the Disability Discrimination Act 1995). The same is true of the needs of individuals from BoME (black and other minority ethnic) communities. Perceived needs (on the part of service providers) is often about visible minorities/visible difference, so of course meeting the needs of LGBs (because our communities are largely hidden) is going to be problematic, but this is NOT a persuasive, or even logical, argument for simply doing nothing! Anyway, providers are becoming more skilled in consulting with hidden (or thematic communities) and, indeed, are required to do so more and more. They will be keen to work with you.
• There are issues around "educating" service providers in relation to LGB awareness. In part, this is difficult because of societal assumptions which serve to "de-sexualise" older people per se (whatever their sexual orientation!). But it is also to do with ignorance " I have heard providers claim, on many occasions, that LGBs are simply not a group with special needs. We would not say this about people from BoME communities (although, in my locality, they constitute less than 3% of the population, whereas LGBs will make up around 10% (based on Kinsey and Masters & Johnson). We do not, yet, legislate in terms of sexuality, although the impact of things like the Human Rights Act will become increasingly significant, and we may see what is already happening in the U.S. " that LGB issues are part of a general commitment to "cultural competence" which is primarily to do with individual/group cultural identity and allowing the possibility for diversity (the different, therefore equal, debate). Many theorists are already arguing in favour of "diversity training", rather than "equal opportunities" and are using this argument in terms of basic human rights. What do I mean by 'allowing the possibility for diversity'? Well, it starts with language. Bolton PCT, for example, has produced a leaflet for health professionals on the sexual health needs of lesbians and gays which gives common-sense guidance on doing clinical interviews sensitively with patients whereby professionals are encouraged to use gender-neutral language. So, for example, when interviewing women prior to a gynecological investigation, they will ask not about boyfriends/husbands, but about life/sexual partners. This followed a report by Jayne Mugglestone (Bolton PCT) on why so many lesbian women were avoiding preventive health care (such as routine cervical smears). The conclusion was that lesbian women avoided health care as it was perceived to be "too heterosexist", despite clinical research which suggests lesbian women, as they age, may experience a higher incidence than straight women of certain life threatening illnesses. Research done elsewhere in the UK, and the US, also suggests that - especially for older LGBs - it can simply be too emotionally challenging to repeatedly face "coming out" to providers. Coming out is a process we negotiate, and re-negotiate, daily, and for older LGBs it is especially problematic or even fraught. The Navajo Project (Blackpool Health Authority) also concentrates on making primary health care more accessible to lesbians and gays. These reports/projects can be cited as evidence of what other PCT's/Health Authorities are already doing around accessibility for LGBs when you approach your local service providers, asking them to take these issues on board. Your local PCT will have a sexual health promotion unit. Your local NHS Partnership Trust will have mental health and substance abuse workers - research done in the US points to LGBs having specific risk-factors around poor mental health and substance abuse. Mental health is regarded as a major issue for older people, owing to their typical age-related life circumstances (bereavement, social isolation, loss of mobility/physical abilities, etc). Make contact with these Health care personnel, as they may well become your allies.

Lessons we can share from Brian Heaphy's research report.

Service providers, especially Health and Social Services (and I'm concentrating on these as they are the most-used statutory services that older people, LGB or straight, will come into contact with) will only ever provide services if there is a proven need to do so. Because of scarce resources, providers make no assumptions about need " they look for evidence of need. If you can prove there is a NEED, then you will persuade providers to allocate resources to meet those needs. Part of this is to offer statistical ("hard") data, or evidence. Brian's research report goes some way to addressing this (and remains, although a relatively small study, the best evidence we have of need). I want to concentrate on some of the hard data that I think you could persuasively use! (remember that the paradigm we're using, to 'hang' this data onto, is the National Service Framework, because it is this plan that will determine Health/Social Services operations and strategies for the next decade or so).

Of all the key messages from Brian's report, the most hard-hitting facts (the "lessons we can share" with providers) are:

Practical ways in which YOU can get LGB ageing issues on to the agenda.

• Disseminate the research report (or my summary of its key messages) as widely as possible (Brian has agreed to this, and approved my summary as an accurate representation, although you should ask Brian's permission, in writing, before putting the report onto your website). If you have not already done so, email it to your local service providers: NHS Trusts, PCT's, Social Services, Housing, voluntary organisations.
• Make links with local colleges/universities that provide counselling courses or social work training (the DipSW course). Offer to speak to groups of students about LGB ageing issues.
• Apply to grant making trusts for funding for your specific projects, citing some of the key facts and figures from the research report. For help and advice on how to fill in grant forms, talk to your local CVS (Council for Voluntary Service) " there will almost certainly be one in your area, and they often have a grants officer in post to give small voluntary organisations the help and support needed in chasing funding for specific projects.
• Ask Brian for copies of the forthcoming policy papers, then distribute these widely.
• Appeal to the local media " radio and newspapers " to cover the issues. Do an interview on local radio!
• Ask you local library to stock the report, and a range of other LGB resources (book stock, videos, information leaflets, links to your website, etc).
• Set up a website for your community group.
• Network with others.
• Get the issues discussed in your local voluntary organisations that older people are likely to use " the Samaritans, the WI, Cruse, hospices, Age Concern, etc.
• Offer service providers awareness training in LGB ageing issues.
• Host a high profile event like a conference on LGB ageing, and get providers to sign up to an action plan " ask them what they are currently doing to address the needs of ageing LGBs, and what they could further do.
• Work together to produce a source-book of ideas and good practice around delivering appropriate services to older LGBs.

References:

1. Age Concern England website: www.ageconcern.org.uk
2. Bolton PCT contact: Melanie Ibbitson (Senior Health Promotion Specialist), tel. 01204 360053 (for copies of Jayne Mugglestone's 'Report of the Bolton and Wigan Lesbian Health Needs Assessment: Are You Sure You Don't Need Contraception? February 1999)
3. Brian Heaphy: brian.heaphy@ntu.ac.uk (author of 'Lesbian, Gay and Bisexual Lives Over 50', by Brian Heaphy et al, 2002)
4. Department of Health website: www.doh.gov.uk (click on links to NSF Older People)
5. SAGE New York's website: www.sageusa.org

For a comprehensive list of grant-making trusts that will fund LGB projects, please see:

1. "Opening Doors: Working With Older Lesbians and Gay Men - Service Development Resource Pack", Age Concern England, July 2001 (p. 70).
2. 'Reaching Out " A Guide For Trusts and Foundations on the Charitable Needs of Lesbians and Gay Men', Gill Goodby & Gerard Lemos, 1999, published by the Association of Charitable Foundations, ISBN 1-987916-16-7.
3. Association of Charitable Foundations website: www.acf.org.uk.

Sally Middleton, August 2003.

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