When we are talking about people who are lesbian, gay, bisexual, trans and gender diverse and intersex we are talking about people who have diverse sexualities, relationships, genders and bodies. We use the acronym LGBTI as it’s easy and understood within the aged care sector and across many other sectors, but we acknowledge that this acronym excludes those who do not describe or identify themselves using those words. We also acknowledge that there are many other words people use that are part of their culture, for example brotherboys and sistergirls in some Aboriginal communities. We also, at this stage, do not use the word queer, as we have been told by many LGBTI elders and older people that they do not like this word. But again, we also acknowledge that this word is being increasingly used by many others to describe themselves.

The major raft of changes to inclusive practice in ageing and aged care happened quickly over a two-year period from August 2011, beginning with release of the Productivity Commission Report “Caring for Older Australians” to 2103 with the launch of the LGBTI Ageing and Aged Care Strategy in 2013.

It’s important to understand how quickly change happened. As with any fast-paced change some aged care providers immediately changed their practices, some started to think about what they needed to do, and others are still grappling with the reality that there could be LGBTI elders and older people in their services. So, the experiences of LGBTI elders and older people with aged care providers are diverse, some have wonderful experiences but unfortunately some still face discrimination, and some are still fearful of accessing any type of aged care service.

However, there are many initiatives in place to not only help aged care providers but also to protect the rights of LGBTI elders and older people. There were two significant legislative changes in 2012 and 2013 that provide protections for LGBTI elders and older people. In mid-2012 the Aged Care Principles ACT 1997 was amended to include LGBTI people as a special needs group. Then in 2013 the Sex Discrimination Amendment (Sexual Orientation, Gender Identity and Intersex Status) Act 2013 was implemented. All aged care providers that receive government funding are required to comply with this legislation and cannot discriminate in the delivery of services to LGBTI peoples.

Other initiatives being put in place to help aged care providers meet the needs of LGBTI peoples include:

• Silver Rainbow LGBTI Awareness training that is delivered nationally through state and territory based LGBTI organisations to ageing and aged care providers and aged care workers. Currently Silver Rainbow are also developing 5 specific modules that will provide in-depth information about the needs of each of lesbian, gay, bisexual, trans and intersex older people.
• Diversity Framework – this is a government document developed by the Aged Care Sector Committee Diversity Sub Group (ACSC DSG) that provides high level principles and actions that aged care providers can take in meeting the needs of older people with diverse needs and life experiences.
• LGBTI Aged Care Action Plan – this document is part of a suite of resources being developed for aged care by the ACSC DSG
• Rainbow Tick – this is an LGBTI accreditation process and supports organisations to understand and implement LGBTI inclusive service delivery.

In terms of palliative care there is still much work to do for LGBTI elders and older people. In 2017 the National LGBTI Health Alliance and Palliative Care Australia released a position statement on inclusive palliative care. To quote from that statement "although there have been increasing levels of social acceptance and legislative improvements, LGBTI people continue to experience prejudice and discrimination in healthcare settings and often feel compelled to hide their sexuality, gender identity (including their history of having lived in another gender previously) or intersex status for fear of negative responses.”

Therefore, it is essential that health and aged care staff treat LGBTI people in a respectful, person-directed manner, maintaining their physical, social, cultural, spiritual and emotional wellbeing. It is essential that the importance of all partners be recognised particularly in their roles as primary carer/s in providing holistic care. This includes recognising the person’s self-designated family or family of choice, and that this may differ from biological relatives who they may or may not consider to be family.

There is increasing recognition of the needs of LGBTI elders and older people accessing palliative care. Many palliative care services and organisations already include the needs of LGBTI elders and older people in their end of life and palliative care resources. However, this is an area that requires further work and consideration in helping LGBTI elders and older peoples experience good palliative care.

Other Useful Resources
palliAGED LGBTI evidence
Safeguarding the End of the Rainbow (This is a Victorian resource but many parts of it can apply in other states and territories)
The Rainbow Makers: Cultural Safety and older LGBTI Australians
Silver Rainbow LGBTI Inclusive Ageing and Aged Care





Samantha Edmonds, Silver Rainbow - National Project Manager, National LGBTI Health Alliance