As Director of Programs for GRIOT Circle, a New York City advocacy and service organization for people of color in the LGBT (lesbian, gay, bisexual and transgender) community, Aundaray Guess often gives educational talks about LGBT issues. Yet his expertise still didn't prepare him for the unpleasantness he encountered a few years ago when he was recovering at home from knee surgery. A local home care agency had assigned him a home health aide for the first week. The aide was problematic right from the start --"He just wasn't into the job," recalls Guess -- but things took a turn for the worse when the aide began watching videos on his phone and making suggestive comments to Guess about the women on the videos.
"He obviously assumed I was heterosexual," says Guess, who is gay. He was offended by the aide's assumption and by his comments, but the bigger concern was that he sensed this person might become actively hostile if he became aware of Guess's sexual orientation. "Here this person was, sitting in my home," he says. "Even after the week was finally over, I was afraid to complain to his supervisor. I was worried that if I did, he might coming looking for me."
His experience is not uncommon, adds Guess. "In fact, we find at GRIOT that some of our older members actually go back into the closet for their own safety when they're getting home care --because now they're dependent on this person for their well-being, and they don't know how that person would react knowing they're LGBT."
Being the Executive Vice President of the largest not-for-profit home care agency in the nation, I know very well what an intimate decision it is to allow a health care worker into your home. But, as Guess's experience illustrates, for an individual who is LGBT, admitting a caregiver into your personal living space can carry an added fear: If that caregiver is not comfortable with the home care client's sexual orientation, the encounter is likely to be awkward at best and potentially dangerous at worst -- which is not only unfair to the client, but also works directly against the goals of the caregiver-client relationship.
That's why it's absolutely essential that home health care workers receive specialized training designed to ensure they are comfortable -- and knowledgeable -- about caring for LGBT patients, and familiar with the specific needs of this population. Fortunately, the New York-based organization SAGE (Services and Advocacy for GLBT Elders) has developed an excellent nationwide educational program called SAGECare that does exactly that.
"LGBT folks need home care providers who are completely competent, respectful and safe," says Hilary Meyer, who directs the SAGE Care program. "Our job on the training side is to make sure providers understand what being LGBT means, and how to work with LGBT clients in the most respectful way possible."
There are two levels of SAGECare training, one for frontline staff that focuses on personal care delivery, and a more far-reaching curriculum for an organization's management team and administrators. "The training begins by discussing what LGBT aging involves, starting with basic terminology and definitions," says Meyer. "To humanize the topic, we also share stories of real older LGBT adults and how they have interacted with society."
For the administrative course, SAGECare then moves into actual skills and best practices for improving service delivery across multiple departments such as policies and procedures, facilities management, and staff recruitment. The ultimate goal of the training is not only to enhance direct interaction between staff and clients, adds Meyer, but to overhaul the total administrative approach of healthcare organizations in order to make them more LGBT-friendly -- including marketing materials, programs and policies.
In addition to home care organizations, SAGECare is also available to staff at residential communities, skilled nursing facilities, rehab centers, senior centers, and hospices -- anywhere there are high concentrations of older adults. At the Visiting Nurse Service of New York, where I work, for example, our hospice division has gone through SAGECare training so that our at-home and Haven in-patient Hospice staff are equipped to deal with the oftentimes unique concerns and needs of LGBT patients. Our goal is to create a safe, welcoming and nurturing environment that is unique to the needs of every patient and their loved ones.
Even more exciting, SAGE recently launched a new national accreditation program, in which home care agencies and other healthcare organizations can reach the highest credential designation as LGBT-friendly once at least 80 percent of their staff has gone through the SAGECare training. "At the Platinum SAGECare level, this means an LGBT patient or client can be confident that at least 8 out of 10 employees in that institution can be considered trained and knowledgeable," notes Meyer. "For instance, we're hearing from LGBT clients in our credentialed residential communities that the staff members are no longer assuming everyone is heterosexual. This is very important, because it allows LGBT folks to feel more comfortable about being out and authentic."
The credential program is also getting an enthusiastic response from senior care organizations committed to providing quality personalized care for all patients and clients. "Companies that want to get the message out that they're LGBT-friendly are pleased," says Meyer, "because this lets them demonstrate in a credible way that they're committed to being inclusive."
I'm glad to note that SAGE is not alone in working to provide a safer, more secure environment for LGBT seniors to age in place. A number of other advocacy organizations across the U.S. have developed similar LGBT training programs for health care providers. The HEALE (Health Education About LGBT Elders) cultural competency curriculum is a medically oriented six-hour course offered by Howard Brown Health in Chicago, a leader in LGBT health care. Originally designed for nurses, HEALE has since been broadened to encompass all disciplines. The course includes a basic introduction to the LGBT community, plus units on health disparities and barriers to care for older LGBT people, sex and sexuality of older adults, legal concerns related to LGBT health care, the transgender experience, and HIV and aging.
"To date, we've done 16,000 hours of HEALE training at over 60 different sites in multiple states, including 18 Veterans Administration hospitals," says Cecilia Hardacker, RN, Director of Education at Howard Brown. "You'd be surprised how many health care professionals don't have anybody from the LGBT community in their life experience -- so even the most basic information is very foreign to them. We conduct tests before and after the course, and we're seeing excellent increases in knowledge. We're also hearing that our course graduates are being used as LGBT resources by their co-workers, which is wonderful." Even trainees who have religious issues around sexual orientation will eventually set these aside, she notes, once they understand that having a good comfort level around the LGBT lifestyle will make them more effective caregivers.
The HEALE curriculum includes a "train the trainer" component, where an organization can have its own employees become HEALE educators -- which Hardacker feels will be a key to expanding the program's reach. "Scaling is the challenge," she adds. "We need to get the funding and infrastructure so that we can begin offering these training programs on the national level."
What everyone agrees on is that while great progress has made in LGBT training for caregivers of older adults, there is still a long way to go. "The lack of LGBT-competent senior services continues to be a national problem, particularly for individuals who can't afford private pay care," says Hardacker. "How many low-income nursing facilities are there where I could pick up the phone right now and say, 'I'm looking for a place where my aunt, who is a lesbian, would feel comfortable and where your staff has been trained in LGBT competency'? Honestly, there are very few places that fully meet that criteria."
"We're on a terrific path right now, but in some ways we've just scratched the surface in the senior services industry," agrees Hilary Meyer at SAGE. "It's my hope that if we can continue on the positive trajectory of the past decade, then 10 years from now we'll see far more home care agencies and other senior care organizations providing LGBT training as a matter of course. That would be the ideal -- that at some point LGBT training becomes part of the standard operating procedure across the U.S., for any group that works with older adults."
For home health care providers, the goal is to deliver the best care possible to every single patient who needs and depends on our services -- and that includes being aware of and sensitive to sexual orientation and gender identity for members of the LGBT community. As our nation celebrates this month of PRIDE, we have an opportunity to strengthen our commitment to ensuring that all of our elder patients are able to age comfortably, safely -- and with dignity and pride.