Older people who identify as lesbian, gay, bisexual, trans, queer or another minoritized sexual/gender identities (LGBTQ+) experience inequalities in health and care services relative to heterosexual, cis-gendered peers in the form of discrimination and exclusion. As a result, they are reluctant to access services and face poorer health outcomes. Public consultation work in Kent, Surrey and Sussex carried out by our team corroborated literature findings and revealed that older LGBTQ+ individuals are concerned about becoming dependent on long-term care. At the same time, they are more likely to live alone and experience a lack of social support networks, making them more reliant on long-term care services.
Evidently, there is a need for improved inclusivity and safety for LGBTQ+ elders in long-term care services. There are resources providing theoretical guidelines to increase LGBTQ+ inclusivity, appealing to commissioners to prioritise these in the planning of services. However, there is a lack of transparency as to what extent these guidelines and recommendations are employed in practice, and it is currently unclear what the role of commissioners is in improving the current state of inclusive practice. Furthermore, during our consultation work, commissioners indicated a need for more knowledge and practical advice on their role in improving LGBTQ+ inclusive practice in long-term care.
This project will present developing work examining the current and potential role of long-term care commissioners in realising LGBTQ+ inclusive long-term care for older people. The main objective is to produce practical recommendations specifically for long-term care commissioners. The project is carried out within Kent, Surrey, Sussex, but the developed guidelines aim to be implementable nationally.
The project takes a mixed-method approach, collecting data through an online survey aimed at long-term care commissioners, inquiring about 1) commissioning policies currently in place to promote LGBTQ+ care practice, 2) engagement with gender and sexuality inclusivity during the commissioning process, 3) examples of promising inclusive commissioning practice, 4) awareness of available guidance, and 5) areas for improvement. Additionally, online interviews with commissioners, providers of long-term care, and older LGBTQ+ individuals explore more in-depth the potential role of commissioners in improving LGBTQ+ inclusivity. Content of the interviews is analysed with thematic analysis. Data will inform the formulation of practical, experience-informed guidelines.
Preliminary findings suggest that the role of commissioners for the promotion of LGBTQ+ inclusivity in long-term care has thus far been relatively unexplored and that there is scope and interest for improvement in this area. It was generally agreed that inclusivity should be considered from the tendering stage, whereas currently, if it is considered, this happens at the point of care provision. Increased awareness and knowledge of LGBTQ+ issues amongst commissioners of long-term care could support the development and procurement of LGBTQ+ inclusive care. Data collection and analysis is ongoing, but themes are emerging, and preliminary findings will be shared.