A recent conference on how we can improve our care for older people in the LGBTQ+ community will leave a positive impression, but we need to keep up the momentum when Pride month is over.
Many patients from the LGBTQ+ community report difficulties accessing appropriate and respectful physical and mental health support, especially older patients. Psychological safety when using health services is vital to the trust any person needs to feel able to be their authentic self, to be heard and feel cared for. Older patients may require personal care in their homes, or care settings, which can be incredibly stressful due to past traumatic healthcare experiences.
For me, Pride 2022 kicked off with a conference on Healthcare for Older People in the LGBTQ+ Community. This event was notable for its focus on how the LGBTQ+ community interacts with healthcare services.
As with many elements of our society, the medicine and healthcare sectors in Ireland have much hurt and historical distrust to undo when it comes to members of the LGBTQ+ community.
I was saddened while listening to participants at the meeting who described a lack of respect and fear that was the hallmark of healthcare for people who did not follow what was regarded as the “traditional norms of our society”.
From the memories came a sense of hope at how things have changed for the LGBTQ+ community in healthcare access. Healthcare staff from several hospitals described the education and training they have done to facilitate compassionate care to LGBTQ+ people. Many healthcare staff are also part of that community. For far too long, they may have felt they had to hide who they were as they cared for others.
LGBTQ+ patients need openness, respect and specific measures to include all aspects of them as patients and partners in their own decisions and care.
Older LGBTQ+ people who faced prejudice and judgment in healthcare settings may have come across doctors who had ethical concerns about medical treatments offered to their community, such as gender-confirmation surgery. They may even have come across healthcare professionals who spoke about conversion practices.
I believe conversion practices are an inhumane treatment for anyone, including those who identify as transgender. Using the words “treatment” or “therapy” to describe this is wrong. It suggests there is something not right that needs to be fixed. As a physician and a parent, I could not support this as a course of action for anyone. It has no role in caring for members of the LGBTQ+ community.
The Medical Council’s guide to professional conduct and ethics encourages shared decision-making, open communication and a willingness to refer for a specialist opinion on any medical intervention. Awareness of each person’s individuality and right to be unique leads to inclusion and equality throughout public life. Changing how doctors, nurses and allied health professionals engage with the LGBTQ+ community will build understanding.
Sometimes the listening part of the conversation with our patients gets missed or shortened: be it the bleep going off or rushing to see another patient. Sometimes the exchange doesn’t occur due to nerves or fears, and occasionally it’s down to negative experiences in a healthcare setting.
Central Statistics Office figures indicate 65-year-olds in Ireland will total one million by 2031. LGBT Ireland estimates that up to 8pc of those may be lesbian, gay, bisexual or transgender. Visibility matters. LGBT Ireland, in partnership with the HSE, established the LGBT Champions Programme. It empowers participants with the understanding and skills needed to increase the visibility, respect, awareness and knowledge of issues facing older LGBTQ+ people.
The programme aims to address this by developing the awareness, confidence, competence and commitment among health and social care professionals working in older age services to transform the experience of older LGBTQ+ people into one of inclusion, respect and dignity.
All HSE staff working and supporting older people can participate in training to become LGBT Champions and join a national network. LGBT Champions receive a Champions rainbow pin, indicating to patients and families that they are happy to listen.
They may also choose to speak up for those too sick and exhausted from shouting for themselves. Many hospitals have participated in this programme, including Children’s Health Ireland. Noticing I was wearing my Champion pin, a teenager and their parent recently engaged me in a fantastic conversation. In wearing it, we are saying we understand, accept and care as healthcare professionals.
Opening the conference on healthcare for older people in the LGBTQ+ community, Minister for Older People Mary Butler said: “The voice and choice of every person needs to be heard.” It’s one we hear loud and clear in healthcare, and change is happening. These changes can’t be allowed to end just because the Pride month of June is over. We’ve got to support people accessing health services – from every walk of life – year round.
Paediatrician Dr Suzanne Crowe is Medical Council president and a board member of LGBT Ireland