'I was refused service by two health professionals' - Ageing poses particular problems for LGBT people
From dealing with transphobia and social isolation to the difficulties in accessing vital medical care, Caomhán Keane gets the inside story
Statistics from the Visible Lives study in 2011 showed that 40pc of the older people surveyed were not 'out' to their health care provider and many feared that healthcare staff would not understand or would discriminate against them because they were LGBT (lesbian, gay, bisexual, and transgender).
There is little evidence to show that that figure has improved following the same-sex marriage referendum in 2015. Some 14pc of calls to the LGBT Helpline last year were from older LGBT+ people. Of that figure, 77pc were based in rural Ireland and many were distressed over the lack of social supports, isolation, and loneliness.
"A straight older person might go into a church or join the retirement club," says Paula Fagan, CEO of the LGBT Helpline.
"The people we are talking to don't feel comfortable doing this. They are less likely to be out, feel disconnected from straight people of a similar age and LGBT services weren't available in their area. We deal with a lot of internalised homophobia and transphobia."
After the Visible Lives survey was published, the LGBT Helpline tried to reach out to the people mentioned in the report. But a lot of the organisations responsible for the elderly didn't see it as an issue.
Paula adds that after the Marriage Equality referendum passed, providers realised they didn't have LGBT people in their services because members of the LGBT community didn't feel comfortable speaking to them. "And that was a problem," she says.
To help target this invisibility, the LGBT Helpline has launched a National Poster Campaign, in conjunction with Nursing Homes Ireland, Sage Advocacy, Alone, and Age & Opportunity, to raise awareness of the helpline and support services available to older LGBT people.
"So much of this is based around the fact that the current language and imagery is heteronormative," says Paula.
"From the minute you walk in the door of a nursing home or a clinic, what you see is pictures of heterosexual couples smiling at each other. The medical forms are framed in a male-female context, assuming that the person will have been in a hetero relationship.
"The next of kin is assumed to be a spouse or biological family. LGBT people are the ones that have to bring their sexuality to the fore.
"And for the generation we're talking about, the over-65s, who have lived through a time where they have experienced extensive discrimination and stigma, they are more likely to be cautious as they age and as they go into mainstream services."
This isn't helped by their own interactions in nursing homes where someone will ask for the TV to be switched off because of a gay kiss. "We heard one heartbreaking story of a man in a hospice, visiting his partner who was dying, and the person in the other bed asked to be moved to another bed," says Paula.
"Our aim is to equip the staff with the knowledge that 8-10pc of their clients will be gay, whether they are open or not. How do you make them comfortable about this fact?"
Caomhán Keane spoke to five members of the community to discover what issues they face as they age.
'I was refused service by two health professionals'
For Philippa Ryder, who represented Ireland in the Gay Games as a cyclist this past summer, getting older is a bit annoying. "I feel it's everyone's own responsibility to look after themselves to the best they can, to mitigate against the effect of ageing. I watch my diet, my health, I keep as fit as possible.
"But getting older is not like one day you wake up and you can't do what you could do yesterday. It's those little niggles that cured themselves 10 years ago, no longer doing so, so they slow you down and ensure you can't do as much as you once could."
She's in her late 50s, but says she is in denial about it.
"Everyone takes a pill for something. But being trans brings its own issues as you're on medication over and above what everyone else is on, to reduce your testosterone. We're also only now looking into the long-term medical effects of being trans, as to whether it can be damaging or not. That's an added stress or worry that the cis population (whose sense of personal identity and gender corresponds with their birth sex) don't have."
Another is the ignorance of those in the medical profession. "I was refused service by two health professionals, not to my face, but to my GP, who was trying to get a small procedure for me. In both cases, the people she asked were unwilling to treat me, as they weren't familiar with what was needed for a trans person."
While Philippa has a wife and a daughter, she does sometimes fear for the future. "When you get into a nursing home, you never know how it's going to be. If you are presenting as you should be, and suddenly some of the other women, who have been raised a particular way, start to get uncomfortable, how do you get through that situation? It's one thing to educate a 30-year-old, but to a 70-year-old who has dementia?"
⬤ TRISH O'CONNELL
"The shock, for me, when I think about being 58, is that I only feel about 40," says Trish O'Connell, who has been openly trans since 2013. "Then there is the rate at which the world is changing and the changes that have accrued over the last 30 years, mostly in the area of technology. A lot of older people, we can't keep up with it. Facebook was enough of a challenge. Then there was Twitter. Now it's Instagram. It can be a bit overwhelming."
The culture of abusing transgender people - whose sense of personal identity and gender does not correspond with their birth sex - has soured the joys of technological advancement for Trish. "Personally I am on Facebook, but very restricted. I had a bad experience with someone trolling. I know a few trans people who removed themselves all together. If you put yourself out there, you get unwanted attention from people who don't understand what it is to be trans. They think it's a sexual thing, and they are looking to hook up."
When it comes to medical and mental health, trans people have challenges that cisgendered people (whose sense of personal identity and gender does correspond with their birth sex) don't encounter.
"First of all, GP aside, local medical care in rural Ireland is a desert. I have to go all the way to Dublin for a 10-minute appointment."
First-hand Trish has experienced a GP recoil when, pre-transition, she brought photographs of herself in to explain her situation. "He said 'you mean you dress up in women's clothes, make-up and all," as if I was committing a sin. He failed to put me forward for voice therapy, while I've been told by other doctors that I will have to wait longer than other women for a procedure because they do the 'real women' first."
Trans people are regularly 'outed' by people in the medical community, says Trish.
"A friend of mine has mobility problems and needed a reserved space for wheelchair access. The doctor has to sign off on it and he stated that she was trans, when it had no bearing whatsoever on the situation.
"When another friend was dying in hospice, it stated trans on her file, which was left exposed. The cleaner, who saw it, started to refer to her as he. Imagine having to go through that in your final days."
The fear of not presenting as your true gender has resulted in Trish delaying medical care. "I had an accident at home, I fell out in my garden and landed on my back. I broke three vertebrae and I was just lying there. I was thinking, 'I am not going to call an ambulance', as I had clothes on me that were neither male nor female, and I kept thinking 'I can't be seen like this'. You have this fear, warranted or not, that all the nurses are going to be coming down to get a look at 'the tranny' on ward three. So I got myself up and presentable as the fear of presenting to hospital in overalls on me was too frightening."
⬤ TONIE WALSH
"Becoming HIV positive at 45 is a curse," says Tonie (57), a gay activist, founder of the Irish Queer Archive and treader of the boards. His autobiographical play I Am Tonie Walsh ran at the Project Arts Centre at the end of November and will tour the country in 2019.
"It's not good, I hate it, and I don't feel proud to be 'pos' in middle-age. But I am not ashamed either. It forces you to be a lot more aware of your health."
Being HIV positive and ageing presents a whole host of problems. "I can take my antiretrovirals, which dampens down HIV and stops it running rampant and turning into Aids. But taking them for a long time brings with it the risk of multiple organ failure, heart disease and depression. There can be a loss of sex drive; a loss of appetite… there's a long list of side effects."
The gáire on Walsh's gallows is so diverting you don't realise you're being affected by the horror he unfolds until you're left shaking, not from laughter, but from the after-effects of hearing how a whole generation of gay men was wiped out by Aids. "It's about me losing my lovers, my friends and how, 20 years later, we are still having to debunk the shame and stigma that came with the disease."
Having survived the Aids 'war', Tonie feels that society, both straight and gay, needs to acknowledge the brutalisation of his generation. "Most have never been given the tools to recover from that marginalisation, never been allowed to grieve. Never had their choices respected.
"We created alternative family or community structures. How we negotiated desire and intimacy required a different framework then what most heterosexuals wanted and had access to. That hasn't changed as we have gotten older. We need to start looking at how we can facilitate like-minded people who want to live together and look out for one another."
While he understands why, he feels that the community was 'straight-washed' to reflect a heteronormative view of relationships during the Marriage Equality campaign.
"Any discussion of alternative families, relationships, desire and the way we negotiate it simply had to be jettisoned because we need to buff ourselves up for mainstream societies consumption. But now we need to stop making ourselves palatable for heterosexual consumption."
In particular, he feels the gay community need their #MeToo moment. "So many of us have been on the receiving end of violence or been in abusive same-sex relationships, which we need to acknowledge in public without fearing that all gay relationships will be tarnished. We've had to be superhuman to be accepted by mainstream society. We have been so earnest about being fabulous that we haven't had time to reflect on how we have been abused and exploited."
⬤ ARTHUR LEAHY
"When I was 20 I thought there could be no possible reason to age past 30," laughs Arthur, a long-term and renowned gay activist. "But as far as I am concerned, things get better and better. I have been blessed with really good health, bar the odd twinges. The wealth of experience I now possess means I just enjoy things at a quality level far beyond what I ever did before. I don't have the angst that I had for the first half of my life."
Openly gay since leaving Ireland at 16, Arthur (58) admits he landed on his feet. "I went from a large supportive Irish family to a vibrant, political London, where the squatting and housing movements were taking off, the gay and feminist movements were beginning and I got to develop politically and sexually in a way most Irish people of my generation could not.
"Many went through torturous relationships and divorces and most wouldn't have been out completely to everyone in their lives, which left them far more isolated, predominantly single and without the support networks around them that, say, my brothers and straight friends would have had."
He reckons only about 10pc of his generation of gay men are left in the country. The rest were lost to emigration and Aids. "Fifty per cent of the gay people I knew growing up have probably died and that's a huge factor of the visibility of the current generation."
This is why it bothers him that within mental health services, sexuality isn't given the space it deserves. "It is seen as a side issue, it's not important, you have to keep taking your tablets, when it's actually very often a significant issue."
Those who were out may choose to go back into the closet when they enter a rest home.
"If you were sharing a room with somebody, you would negotiate that situation, which might often mean keeping quiet about your sexuality, as that's the easiest way to go.
There are a number of doctors in Cork that Arthur would not recommend other gay people go to should they fall ill.
"The medical profession generally is known for its arrogance and it is very often the most conservative in terms of change. When you are under the weather, the last thing you want to do is argue with your specialist, who may be religious, homophobic or never had any training in dealing with issues relating to sexuality."
⬤ MARIANNE MCGIFFIN
For many, the country's pub scenes can become less inviting when you hit a certain age. But for those who have just come out, it can seem like the only way to meet new people. One club filling the niche, for older women at least, is OWLS (Older Wiser Lesbians), an online group for gay women over 50 who meet regularly for meals, films, walks, theatre, etc.
Marianne McGiffin (68) is its coordinator.
"Essentially, OWLS is about getting together to enjoy each other's company. A lot of us weren't into the pub scene in the first place. We would be more used to going to houses for meals."
And a lot of women may have had issues with alcohol from being in the closet for such a long time. Says Marianne: "A lot of the women I spoke to said drinking helped them stay in denial about being gay. They drank to excess to numb the pain of being in the wrong place (marriage) or in the 'wrong' sexual orientation as the church told them it was 'disordered' and sexual acts arising from it 'sinful'."
OWLS gives support, when necessary, to older women exploring their sexual orientation and considering coming out for the first time, to themselves and, then, to others.
They may be married, they may have kids, they may have reared a family and finally started looking at their orientation.
"It's scary stuff. When I was growing up, sexuality wasn't something you talked about. You wondered where you were going to find like-minded people. You may have heard of a group but you were too scared to join them.
"I was speaking to one woman who was thinking about coming out recently, who was about to turn 70 and she said, 'I don't want to die without someone knowing who I really am'."
Health & Living