About Sue Westwood

Dr Sue Westwood is a lecturer at the University of Surrey, specialising in gerontology and the socio-legal aspects of ageing, gender and sexuality. She has published several papers and book chapters and has a monograph and three co-edited volumes currently under construction, including (with R. Harding and R. Fletcher) Cycles of Care: ReValuing the Possibilities of Connection; (with E. Peel and R. Harding) Ageing & Sexualities: Interdisciplinary Perspectives (Ashgate) and (with E. Price) Lesbian, Gay, Bisexual and Transgender (LGBT) Individuals Living with Dementia: Theoretical, practical and rights-based perspectives (Routledge).

Sue is co-organiser of the ESCR-funded seminar series ‘Older LGBT Adults: Minding the Knowledge Gaps’ and a member of the Centre for Research on Ageing and Gender (CRAG) and the International Care Ethics (ICE) Observatory. Sue is a member of the British Society of Gerontology, the Socio-Legal Studies Association and the Law and Society Association. She is also on the Executive Committee of the ‘Law, Ageing and Society’ Collaborative Research Network (CRN), Law & Society Association, and is a Global Affiliate of ‘The Vulnerability and the Human Condition Initiative’, Emory University, Atlanta, GA, USA.

Dementia, women and sexuality: How the intersection of ageing, gender and sexuality magnify dementia concerns among lesbian and bisexual women

The journal Dementia has just published a paper I have written, ‘Dementia, women and sexuality: How the intersection of ageing, gender and sexuality magnify dementia concerns among lesbian and bisexual women.’  The key points in the paper are as follows:

1. Lesbian, bisexual and heterosexual women are differently impacted by dementia and dementia services.
2. Heteronormative and heterosexist community and residential care provision can compound the difficulties experienced by lesbian and bisexual women living with dementia, in ways which do not affect heterosexual-identifying women with dementia.
3. Those women most likely to require community and residential care provision for individuals with dementia – lesbians and bisexual women – are least likely to have their identities recognised and supported.
4. This may be contrary to Equality and Human Rights legislation and UK social policies.

This is a very important issue, as yet un-addressed by policy-makers, service providers and advocacy organisations. Please spread the word far and wide to raise awareness!

If anyone would like a copy please email me.

Sue Westwood

Cycles of Care: Reflections on Strangeness

We recently held a fantastic event at Queen Mary School of Law in London, with presentations from a number of individuals based on the chapters they have written for our forthcoming edited collection. The papers highlighted how care operates in a wide range of contexts (Ireland-UK abortion travel; HIV/AIDs care in Africa; UK mental capacity regulation; parental leave regulation in Europe; carer regulation in the UK) and spaces (e.g. the home; older age residential care provision; provision for individuals with cognitive disabilities; rural communities; homeless street life; animal rescue centres) in many different ways (informal/formal; voluntary/paid; a blurring of each) and with different actors (e.g. human, animal, environment). Despite, or perhaps because of, this spread of spaces, places and players, a number of fascinating shared themes emerged, one of which, highlighted in particular by participant Donatella Alessandrini was that of strangeness, ‘strangering’ and unfamiliarity.

Ruth Fletcher spoke about stranger-care in the context of abortion travel, locating her analysis in the context of Sarah Ahmed’s work on strangeness (1); Sue Westwood spoke about the feared spatial dislocation into older age care spaces of strangeness and exclusion which concern older lesbian, gay and bisexual (LGB) people; Abigail Baim-Lance spoke about degrees of stranger care in local and extended communities, and the tensions which can exist between formal and informal stranger care; Rosie Harding spoke about the current constructions of UK mental capacity legislation which positions the individual as separate from, and almost a stranger to, her/his personal community/social network; Marie Fox spoke of the abandonment of animals by humans who are not strangers to them, and their care (even at the point of euthanasia) by humans who are; and Helen Carr spoke about companion animals and homeless individuals in the context of the ‘otherness’ of street life. All of these papers spoke to the importance of relationality, context, and the power dynamics which can operate in situations of both strangeness and familiarity.

At the same time the theme of resistance to strangeness also emerged. Ruth Fletcher showed how hosts of Irish women travelling to the UK for an abortion sought to make them welcome and at ease in their own homes and how supporters sought to make the process less unfamiliar (and so less daunting to them). Abigail Baim-Lance spoke of the control of state healthcare systems of informal community carers and the resistance of individuals with HIV/AIDS and their families to the use of formal medication regimes with the use of alternative (ineffective) herbal medicines. Marie Fox spoke of the resistance by volunteers in animal rescue shelters who try and rehome homeless dogs who would otherwise be put down. Helen Carr spoke of how companion animals and homeless individuals can become ‘home’ to one another and as such resist traditional, materialistic, notions of home. Rosie Harding proposed a return to relationally in mental capacity legislation, resisting notions of the autonomous adult. Sue Westwood suggested that a combination of the power dynamics of older age care spaces and age-related dependency upon others placed constraints on older LGB individuals’ capacity to resist heteronormativity and homophobia.

Each of these papers demonstrated in different ways how caring can be both a response to and resistance of strangeness, the unfamiliar, powerlessness and oppression. Marie Fox spoke, at the end of the day, about a man responsible for killing homeless dogs. She described how he both demonstrated a lack of care in his attitude towards killing them, yet a presence of care and compassion in how he did so, and a striking presence of care in how their bodies were incinerated afterwards, being concerned about its implications for our humanity and humane-ness. Marie’s paper highlighted the complexities of care and caring and how it can be a layered and nuanced thing, one which also requires – as all the papers at the event showed – similarly layered and nuanced analyses.

Ahmed, S. (2000) Strange encounters: Embodied others in post-coloniality. Psychology Press.

No Room at the Inn? Older LGBT individuals’ unmet housing needs

Stonewall Housing, in conjunction with Age UK, Opening Doors London and Rainbow Hamlets, is holding a major Older LGBT Housing conference on 18th June 2014. Entitled ‘Bona Latties’ (Polari for Good Housing) it aims to give voice to older LGBT individuals’ housing wants and needs and create a space to discuss them with providers. Older LGBT unmet housing needs are a problem in the following ways:

  • Mainstream housing provision for older people is perceived as heteronormative, homophobic, biphobic and transphobic(1)(2)(3);
  • There is a lack of specialist housing, i.e. housing run for older LGBT individuals, by LGBT individuals (4)(5)(6);
  • There is a lack of specific housing choices for older LGBT, e.g. those who want gender specific housing (e.g. men/women only), which many older individuals, especially older lesbians, want (7). It’s an outdated ‘one size fits all’ (8) approach;
  • There is a lack of specialist domiciliary care for older LGBT people, with the exception of Pride in Care UK. Many older lesbians and gay men in particular re-closet themselves in their own homes, for fear of prejudice from carers (9);
  • There is a lack of services to support older LGBT in setting up housing cooperatives where they provide one another with reciprocal support and/or buy in care which is respectful of, and meets, their needs.

As a result of these unmet needs, older LGBT individuals are left with a stark choice: ‘the prospect either of living alone without support or having to enter [sheltered housing and] care homes which will not meet their needs.’ (10) We say ‘it gets better’ to younger LGBT people. And for many that may be true. But the sad the truth is that in older age it gets worse. As much as we should address the needs of LGBT youth, we also need to address the needs of older LGBT individuals as well. Schools are a problem for LGBT youth. Sheltered housing and care homes are a problem for LGBT older people. We must tackle both.

References

(1) Ward, R., Pugh, S. and Price, E. (2010) Don’t look back? Improving health and social care service delivery for older LGB users. London: EHRC;
(2) Fredriksen-Goldsen, K. I., et al (2013) ‘Physical and Mental Health of Transgender Older Adults: An At-Risk and Underserved Population.The Gerontologist doi: 10.1093/geront/gnt021First published online: March 27, 2013;
(3) Jones, R. (2010) ‘Troubles with bisexuality in health and social care.’ In Jones, Rebecca L. and Ward, Richard (eds) LGBT Issues: Looking beyond Categories. Policy and Practice in Health and Social Care, pp 42-55, Edinburgh: Dunedin Academic Press.
(4) Musingarimi, Primrose (2008). Housing Issues Affecting Older Gay, Lesbian and Bisexual People in the UK: A policy brief. London: The International Longevity Centre – UK (ILCUK)
(5) Carr, S. and Ross, P. (2013) Assessing current and future housing and support options for older LGB people. York: Joseph Rowntree Foundation.
(6) LGBT Movement Advancement Project (MAP) and Services and Advocacy for Gay, Lesbian, Bisexual and Transgender Elders (SAGE) (2012) Improving the Lives of Transgender Older Adults: Recommendations for Policy and Practice. New York: Services and Advocacy for GLBT Elders and National Center for Transgender Equality.
(7) Westwood, S. (submitted): ‘“We see it as being Heterosexualised, being put into a Care Home”: Residential care concerns and preferences of ageing sexual minorities.’ Ageing and Society.
(8) Eaglesham, Phil (2010) ‘The Policy Maze and LGBT Issues: Does One Size Fit All?’, in R. Jones & R. Ward (eds) LGBT Issues: Looking Beyond Categories, pp 1-15. Edinburgh: Dunedin.
(9) Knocker, S. (2012) Perspectives on ageing lesbians, gay men and bisexuals. London: Joseph Rowntree Foundation.
(10) Guasp, A. (2011) Lesbian, gay and bisexual people in later life. London: Stonewall.

 

‘Counting the Costs? Resources, Austerity and Older LGBT People’

The ‘Minding the Knowledge Gap’ ESRC funded seminar series held its fourth seminar at the University of Surrey last week. This seminar, called ‘Counting the Costs? Resources, Austerity and Older LGBT People’ addressed the material, financial and social resource implications of lesbian, gay, bisexual and trans (LGBT) ageing, particularly in times of austerity. It was well-attended by participants from a range of backgrounds: LGBT individuals (in all their diversity, including some in older age); advocates and activists; academics; social policy makers; and the police. There were two speakers. Dr Noah Uhrig, from the Institute for Social & Economic Research, University of Essex, gave a fascinating talk on ‘Poverty and Material Well-being of LGBT elders’, somehow managing to make some very complicated statistic not only accessible but also enjoyable. Audience members gazed in avid fascinating and still wanted more at the end. The second speaker, Dr Martin Mitchell, NatCen Social Research presented on ‘Not just “a nice thing to do”: Marginalisation and hardship for LGBT older people in the context of austerity cuts.’

Noah spoke of recent research project on poverty and sexual orientation (constrained by the usual problems with representative sampling of a ‘hidden population’) which suggested significant material differences in later life for LGB individuals compared with heterosexual individuals, and between one another. A key feature was the suggestion that older lesbians were materially advantaged compared with both older heterosexual individuals and older gay men. Noah’s data – which he bravely presented, anticipating the response it would meet – were, not surprisingly, hotly contested by many of the lesbian members of the audience. They found the idea of older lesbian material advantage counter-intuitive. Discussions raised issues of: women’s relative lower earnings to men; women’s greater representation in (lower paid) public services work, especially care work; women (including lesbians!) taking time out of work to have children, and to perform other informal unpaid care work (including for parents and grandchildren); women being much more likely to be in part-time paid work (rather than full-time work) while also performing unpaid informal care work (1). Noah acknowledged the tensions provoked by the data, and plans on conducting further analyses. We look forward to hearing more!

Martin then spoke of the double-edged sword of austerity cuts. Older LGBT individuals are more likely to need support from those public and voluntary sector services (health and social care, informal and formal social support) which are currently subjected to drastic cuts in funding (2). Those cuts in services impose increased pressures on an already pressured cluster of minoritised individuals, meaning they have a greater need for services, at the very time when there are fewer services available. Lack of material and social resources have profound implications for the well-being of older LGBT individuals (3) (4).

Afternoon discussions returned to the issue of gender (again unsurprisingly) and to the need to continuously unpack the ‘LGBT’ acronym (5), to appreciate how older lesbians, gay men, bisexual women and men, and trans individuals are particularly affected by the material and social resource implications of later life. The plight of the Opening Doors London project, supporting 1,000 older LGBT individuals in the London area, and which has lost all of its funding, highlighted the lived realities of the implications of austerity cuts. Towards the end of the day two distinct responses to resourcing projects for older LGBT in later life: the neoliberal model of private and national state engagement; a more localist, communitarian approach involving local LGBT groups and local government. It was mentioned that in Australia and some parts of the USA, older LGBT have been designated a ‘special needs group’ (with all the complications of such a categorization) and as such are eligible for state funding for local projects.

Much food for thought, and much work to be done, but all-in-all, it was a stimulating and thought-provoking day, made so by the contributions of all who attended.

(1)    Arber, Sara (2006) ‘Gender and Later Life: Change, Choice and Constraints’. In J. Vincent, C. Phillipson and M. Downs (eds) The Futures of Old Age, pp. 54-61,London: Sage.

(2)     King, Andrew (2013) ‘Prepare for Impact? Reflecting on Knowledge Exchange Work to Improve Services for Older LGBT People in Times of Austerity.’ Social Policy and Society / FirstView Article / November 2013, pp 1 – 13 DOI: 10.1017/S1474746413000523, Published online: 19 November 2013

(3)    Fredriksen-Goldsen, et al (2013a) ‘Physical and Mental Health of Transgender Older Adults: An At-Risk and Underserved Population.’ The Gerontologist doi: 10.1093/geront/gnt021First published online: March 27, 2013

(4)    Fredriksen-Goldsen, Karen I., et al. (2013b). ‘The physical and mental health of lesbian, gay male, and bisexual (LGB) older adults: the role of key health indicators and risk and protective factors.’  The Gerontologist, 53(4):664-675.

(5)    Ward, Richard, Rivers, Ian. and Sutherland, Mike (eds) (2012). Lesbian, Gay, Bisexual and Transgender Ageing: Biographical Approaches for Inclusive Care and Support.  London: Jessica Kingsley

 

 

 

‘Preceptorship’ – helping newly qualified nurses ‘thrown in at the deep end’

Preceptorship is support for newly qualified nurses (NQNs) as they transition from studenthood to the demands, and responsibilities, of being a qualified nurse. Preceptorship refers to ‘a period of structured transition for the newly registered practitioner during which he or she will be supported by a preceptor, to develop their confidence as an autonomous professional, refine skills, values and behaviours and to continue on their journey of life-long learning’ (DoH 2010: 11). It is underpinned by a range of government policies and good practice guidelines, including A High Quality Workforce: NHS Next Stage Review which states: ‘A foundation period of preceptorship for practitioners at the start of their careers will help them begin the journey from novice to expert’ (DoH 2008: 72). Preceptorship aims to address how knowledge acquired in nurse training is recontextualised in practice (Evans et al 2010) and how newly qualified nurses (NQNs) adapt to the ‘real world of practice’ (Houghton 2014).

In addition to needing support in developing their clinical skills and self-confidence in their own nursing judgements, many NQNs find time-management in busy clinical contexts a challenge (O’Kane 2012) and, in parallel, experience difficulties in relation to delegation skills. Inability to delegate can lead to NQNs feeling overwhelmed, which can result in burnout and high staff turnover of NQNs. However, despite the need for registered nurses to be competent in delegating and supervising unregistered health care assistants, research suggests that their nurse education does not always equip them with the necessary skills (Hasson, McKenna and Keeny 2013). Preceptorship then becomes a vital means of supporting them in acquiring those skills.

Even though research repeatedly affirms the importance of preceptorship, it is not consistently available to NQNs cross the UK, nor, even if offered on paper, is it always reliably delivered in practice (Higgins Spencer and Kane, 2010) particularly at times where there are considerable restraints upon nursing budgets (Avis, Mallik and Fraser 2013). This means that many NQNs feel they find themselves in ‘Sink or Swim’ situations (Hughes and Fraser 2001). While many will swim, some inevitably will sink. This is a terribly waste not only of training, but also of people who want to be, and could be, competent and confident nurses, provided they are given sufficient support during their transition from student to qualified nurse. Investment in preceptorship can have huge benefits in supporting and retaining NQNs (Whitehead et al 2013) and as such should be made consistently and robustly available to nurses during their initial post-qualifying period.

References
Avis, Mark, Mallik, Maggie and Fraser, Diane M. (2013). ‘”Practising under your own Pin”–a description of the transition experiences of newly qualified midwives.’ Journal of Nursing Management 21(8): 1061-1071
Department of Health (2008). A High Quality Workforce: NHS Next Stage Review. London: Department of Health.
Department of Health (2010) Preceptorship Framework for Newly Registered Nurses, Midwives and Allied Health Professionals. London: Department of Health
Evans, Karen, et al. (2010) ‘Putting knowledge to work: A new approach.’ Nurse Education Today 30(3): 245-251.
Hasson, Felicity, Hugh P. McKenna, and Sinead Keeney (2013) ‘Delegating and supervising unregistered professionals: the student nurse experience.’ Nurse Education Today 33(3): 229-235.
Higgins, Georgina Spencer, Racheel Louise and Kane, Ros (2010). “A systematic review of the experiences and perceptions of the newly qualified nurse in the United Kingdom.” Nurse Education Today 30(6): 499-508.
Houghton, Catherine E. (2014) ‘”Newcomer adaptation”: a lens through which to understand how nursing students fit in with the real world of practice.’ Journal of Clinical Nursing: Advance access, http://onlinelibrary.wiley.com/doi/10.1111/jocn.12451/full
Hughes, Anita J., and Fraser, Diane M. (2011). ‘”SINK or SWIM”: The experience of newly qualified midwives in England.’ Midwifery 27(3): 382-386.
O’Kane, Catherine E. (2012). ‘Newly qualified nurses’ experiences in the intensive care unit.’ Nursing in Critical Care, 17(1): 44-51.
Whitehead, Bill, et al. (2013). ‘Supporting newly qualified nurses in the UK: A systematic literature review.’ Nurse Education Today 33: 370–377.

Empowering the Voices of LGBT Individuals with Dementia

A seminar in London organised by the Dementia Engagement and Empowerment Project (DEEP) and facilitated by myself, was attended by over 40 people this week, to discuss how we can give greater individual and collective voice to lesbians, gay, bisexual and trans (LGBT) people with dementia. Attendees included dementia service providers and advocates, older LGBT service providers and advocates, older LGBT people themselves, and academics working in the field of LGBT ageing and/or dementia. There were three excellent speakers: Rachael Litherland from DEEP; Sally Knocker (trainer, consultant and writer) and Dr Elizabeth Price (Senior Lecturer, University of Hull). Two short films were shown: one from Opening Doors London (which includes a gay men with memory problems in need of befriending and extra support) and a training clip from GenSilent (which features, among others, a gay couple dealing with one partner’s dementia; a lesbian couple pondering their future care needs; and a trans women who is dying, is estranged from her family, and lacks support). One of the most amazing things about the seminar was that it started without us! Many people arrived early, some by almost an hour, and struck up vibrant and deeply engaged conversations. These continued even after we introduced the planned bits of the seminar, and went on over the tea break, and into the group discussions which then followed.

LGBT individuals with dementia are not one homogenous group (1). As dementia is age-related and women outlive men, then older lesbians and bisexual women are likely to be disproportionately affected by dementia (women outnumber men with dementia 2:1) (2). This, together with relatively diminished social support in later life, means that older lesbians are likely to also be disproportionately represented in care homes for people with dementia. By contrast, gay and bisexual men who do find themselves in those spaces will be a minority in a minority due to both gender and sexuality. Many LGB people are impacted by the lack of recognition of LGB carers of someone with dementia (3) and of LGB health and social care service users, including in dementia provision (4). This is nuanced by gender: older women are particularly concerned about being around potentially sexually disinhibited behaviour of heterosexual men with dementia; and many older lesbians and gay men want integrated provision, but many also want gender and/or sexuality specific care. This is also nuanced by sexuality: many bisexual individuals suffer from the disappearing ‘B’ in LGBT (5), being assumed to be heterosexual if single or in a relationship with a person of another gender and being assumed to be lesbian or gay if in a relationship with someone of the same gender.

Trans individuals (who may or may not identify as LGB) are concerned with both shared and particular issues (6). Those particularities include: concerns about transphobia; being worried about not being able to cross-dress; being very concerned about receiving personal care if their physical bodies are not congruent with their gender performance; and, among those who have transitioned, being concerned that if they have dementia, as it progresses, they may no longer remember that they have transitioned, and may revert to performing according to the gender which they were assigned at birth.

A wide ranging number of themes emerged across the seminar. These included: the issue of how to ‘find’ LGBT people with dementia who may be hidden both by their dementia and by their sexualities and/or gender identities; the importance of making sure any project which aims to empower LGBT people with dementia is driven by LGBT people with dementia; concerns about heteronormativity, homophobia, biphobia and transphobia among dementia service providers and dementia service users; the importance of training and practice development among service providers (7); the importance of both mainstream providers and the LGBT ‘community’ taking responsibility for addressing these concerns; and the need to take into account the needs of queer/polyamorous/non-labelling individuals with dementia who can often be hidden in generic LGBT discourse.

All attending the seminar were agreed that it was a very successful and stimulating event, and hopefully would lead on to the development of a number of different projects which will give greater voice to LGBT individuals with dementia in the future. A range of possibilities were discussed, including making mainstream dementia advocacy more inclusive of LGBT individuals with dementia, and LGBT intergenerational projects, which would involve LGBT befrienders supporting LGBT individuals with dementia. DEEP will be keeping all those who attended informed in future developments. Anyone wishing to know more, should contact the Dementia Engagement and Empowerment Project (DEEP)

(1) Newman, R. and Price, E. (2012) ‘Meeting the Needs of LGBT People Affected by Dementia,’ in R. Ward, I. Rivers & M. Sutherland Lesbian, Gay, Bisexual and Transgender Ageing: Biographical Approaches for Inclusive Care and Support, pp183- 195, London: Jessica Kingsley. [Accessible via: http://bit.ly/1dGiQCb]

(2) Knapp, Martin, et al. (2007) Dementia UK: a Report to the Alzheimer’s Society. London: Alzheimer‘s Society.

(3) Price, E. (2012) ‘Gay and lesbian carers: ageing in the shadow of dementia’, Ageing & Society, 32: 516-532.

(4) Ward, R., River, I. & Sutherland, M. (eds) (2012) Lesbian, Gay, Bisexual and Transgender Ageing: Biographical Approaches for Inclusive Care and Support, London: Jessica Kingsley

(5) Jones, R. (2010) ‘Troubles with bisexuality in health and social care.’, in: Jones, Rebecca L. and Ward, Richard (eds) LGBT Issues: Looking beyond Categories. Policy and Practice in Health and Social Care (10), pp 42-55, Edinburgh: Dunedin Academic Press, pp. 42–55.

(6) Auldridge, A., et al (2012) Improving the Lives of Transgender Older Adults: Recommendations for Policy and Practice. New York: Services and Advocacy for GLBT Elders and National Center for Transgender Equality

(7) Suffolk Lesbian, Gay, Bisexual and Transgender Network (2012) Providing Quality Care to LGBT Clients with Dementia in Suffolk: A Guide for Practitioners; Alzheimer’s Society (2013) Supporting lesbian, gay and bisexual people with dementia. Alzheimer’s Society Factsheet 480. London: Alzheimer’s Society:

Older People’s Day – Including Older LGBT people

It’s Older People’s Day in the UK on 1st October, and it seems timely to flag the particular issues affecting older LGBT people, who are an under-recognised and under-served group of individuals. Yet their numbers are growing. It is estimated that between 5-7½% of the population have a ‘non-heterosexual’ identity. This means there are between 61,000 and 122,000 ‘non-heterosexual people’ over 60 living in the UK today, and this figure is set to rise to between 881,000 and 1,763,000 by 2030. Older LGBT share many of the issues and concerns of all older people, but their ageing can be made more complicated by their sexualities, gender identities and histories (1).

According to a recent UK survey comparing over 1,000 older LGB people and 1,000 older heterosexual people (2), older LGB people are more likely to be single and to live alone, less likely to have children and are less likely to see biological family members on a regular basis.  Older LGB people are also more likely to suffer from the consequences of a lifetime of minority stress (stigma and marginalisation) and as a result are more likely to drink alcohol, take drugs and smoke than older heterosexual people. They are more likely to have a history of mental health problems, and to have current concerns about their mental health, particularly depression. This can be linked to bereavement following the deaths of partners and/or close friends, which often goes unrecognised (3).  Many trans people are also estranged from their families, and continue to be regarded as mentally ill under the psychiatric diagnosis of ‘gender dysphoria’ making them particularly wary of engaging with mental health services (4).

With less intergenerational support than their heterosexual peers, older LGBT are more likely to need formal social care, and at an earlier age, than older heterosexual people. Yet at the same time, the majority of older LGBT people are very worried that health and social care providers will not be able to recognise or meet their needs.  Many feel they would have to hide their identities from care staff and/or fellow service users (the older people are, the more they carried the prejudices of the past, (5)). Many are worried that they will be unwillingly exposed by their own or a loved one’s dementia (6). Many are fearful that they will spend the final years lonely and isolated, estranged from loved ones, in care homes where their lives and identities are either not recognised or not valued and validated (7).

We need to ensure that all older people are recognised and respected for who they are, and that includes older LGBT people. We also need to know much more about the lives, needs and wishes of older LGBT people, and this is where the ‘Minding the Knowledge Gaps’ project comes in. This project is funded by the Economic and Social Research Council (ESRC) and is co-organized by Andrew King (PI), University of Surrey, Kathryn Almack (University of Nottingham), Yiu-Tung Suen (University of Oxford/Chinese University of Hong Kong) and Sue Westwood (Keele University). The project involves a series of six themed seminars followed by a final conference, aimed at exploring gaps in knowledge and research about LGBT ageing, and identifying ways to address those gaps. For more information, go to the ‘Minding the Knowledge Gaps’ project. A further project of interest is ‘The Last Outing’ . Based at the Sue Ryder Centre, Nottingham University, the study is exploring end of life care experiences and concerns of older LGBT people.

Both projects can be followed on Twitter: @LGBTageing and @TheLastOuting.

References

(1)  Ward, R., et al (eds) (2013) Lesbian, Gay, Bisexual and Transgender Ageing: Biographical Approaches for Inclusive Care and Support, London and Philadelphia: Jessica Kingsley.

(2)  Stonewall (2011) Lesbian, Gay Bisexual People in Later Life, London: Stonewall

(3)  Almack, K., et al. (2010) ‘Exploring the impact of sexual orientation on experiences and concerns about end of life care and on bereavement for lesbian, gay and bisexual elders.’ Sociology. 44(5): 908-924.

(4) Fredriksen-Goldsen, K., et al. (2013) ‘Physical and Mental Health of Transgender Older Adults: An At-Risk and Underserved Population.’ The Gerontologist doi: 10.1093/geront/gnt021First published online: March 27, 2013

(5)  Valentine, G. & Macdonald, I. (2004) Understanding Prejudice London: Stonewall

(6)  Price, E. (2012) ‘Gay and lesbian carers: ageing in the shadow of dementia’, Ageing & Society, 32: 516-532.

(7)  Ward, R., et al (2011) Don’t look back? Improving health and social care service delivery for older LGB users, London: Equality and Human Rights Commission.

Faith, religion, spirituality and care

Regrettably, I am still a reader of the Daily Mail online. Whilst often infuriating, it does occasionally have its good points. Recently, an article on a new book about ‘mind over body’ – ‘The cancer patient cured by a broken radiotherapy machine and the paralysed man who walked again after visiting Lourdes: New book shows incredible influence of the mind over the body’ reminded me of Louise Hay’s excellent ‘You Can Heal Your Life.’ Hay considers the psychological/emotional/spiritual meanings and connections of physical illness, and offers those dimensions as spaces to support healing. All of this, in turn, got me thinking about faith, religion and spirituality as sites of care practices, sources and resources of care, and, then, their relationship(s) with care ethics. I realised that we have not as yet tapped this seam in our critique of care, and so wanted to raise this as a topic, perhaps for further discussion/contributions. Here is a brief bibliography to help get us started:

Care to comment/ discuss?

 

Key authorship on older LGB carers

Brotman, Shari, et al (2007) ‘Coming out to care: Caregivers of gay and lesbian seniors in Canada’, The Gerontologist, 47(4), pp. 490–503.

Conaghan Joanne and Grabham, Emily (2007) ‘Sexuality and the Citizen Carer’ Northern Ireland Legal Quarterly, 58: 325-341

Concannon, Liam (2009) ‘Developing Inclusive Health and Social Care Policies for Older LGB Citizens’, British Journal of Social Work, 39: 403-417.

Corden, Anne and Hirst , Michael (2011) ‘Partner care at the end-of-life : identity, language and characteristics’, Ageing & Society, 31:  217–242.

Cronin, Ann, et al (2011) ‘Categories and their consequences: Understanding and supporting the caring relationships of older lesbian, gay and bisexual people’, International Social Work 54(3): 421-435

Fenge, Lee-Ann, and Hicks, Christina (2011). “Hidden lives: the importance of recognising the needs and experiences of older lesbians and gay men within healthcare practice.” Diversity in Health and Care 8(3): 147-154.

Hughes, Mark, and Kentlyn, Sue (2011. “Older LGBT people’s care networks and communities of practice: A brief note.” International Social Work 54(3): 436-444.

Manthorpe, Jill and Price, Liz (2005) ‘Lesbian Carers: Personal Issues and Policy Responses’, Social Policy & Society 5(1): 15–26

Munro and Karen-Leigh Edward (2010) ‘The Burden of Care of Gay Male Carers Caring for Men Living With HIV/AIDS’, American Journal of Men’s Health, 4(4) 287-296

Munro and Karen-Leigh Edward (2010) ‘The Burden of Care of Gay Male Carers Caring for Men Living With HIV/AIDS’, American Journal of Men’s Health, 4(4) 287-296

Newman, Roger (2005). “Partners in care – Being equally different: lesbian and gay carers.” Psychiatric Bulletin 29(7): 266-267.

Price, Elizabeth (2008) ‘Pride or Prejudice? Gay men, lesbians and dementia’, British Journal of Social Work, 38: 1337-1352.

Price, Elizabeth. “Caring for mum and dad: lesbian women negotiating family and navigating care.” British Journal of Social Work 41.7 (2011): 1288-1303.

Roseneil, Sasha (2004) ‘Why we should Care about Friends: An Argument for Queering the Care Imaginary in Social Policy’, Social Policy & Society 3(4): 409–419

Rosenfeld, Dana, Bartlam, Bernadette and Smith, Ruth (2012) ‘Out of the Closet and Into the Trenches: Gay Male Baby Boomers, Aging, and HIV/AIDS’, The Gerontologist  Special Issue: Baby Boomers, Advance access 31st January 2012, doi:10.1093/geront/gnr138, 0(0):1–9.

Ward, Richard, et al (2005) A kiss is still a kiss? The construction of sexuality in dementia care. Dementia: the International Journal of Social Research and Practice, 4 (1): 49–72.

Willis, Paul, Ward, Nickie and Fish, Julie (2011) ‘Searching for LGBT Carers: Mapping a Research Agenda in Social Work and Social Care’, British Journal of Social Work, 41: 1304–1320

Older lesbians in residential and nursing care

A central feature of care in the fourth age is the medicalisation of ageing bodies, the emphasis on collective bodily care and the power dynamics involved in that care1. An aspect of these dynamics that has not yet been explored is the intersection of age, gender and sexuality in the provision of personal care in residential settings for older people. Single, childless, older women are most likely to populate these settings2. These women are also more likely to be lesbians, both because older lesbians and gay men are earlier and disproportionate users of formal social care, and because older lesbians are more likely than older heterosexual women to be single and childless3. Lesbians have often found the processes of self-disclosure in health contexts a treacherous terrain to navigate in earlier life, many avoiding screening/treatment and/or choosing not to disclose their sexual identities to medical professionals, particularly during intimate physical examinations4. Some younger(er) lesbians also report feeling vulnerable to the heteronormative gaze in those gay commercial contexts frequented by heterosexual women5.

Residential care for older people – heteronormative at best, homophobic at worst6, is situated at the intersection between these two sites of vulnerability. It is also a site of social exclusion where ageing bodies are hidden away and where dependency can mean it is less likely someone will complain about their care or otherwise assert their rights, especially people from minority communities7.

Care spaces in the home or in sheltered accommodation or residential care have long been recognised as complicating the notion of the public-private divide, being both public work spaces and private home spaces. For an older lesbian this becomes even more complicated. Home care which goes public no longer affords the sanctuary of private identity performance and management. Yet at the same time, because it is home care, often in care spaces where the very old older person is hidden away from the public eye, some of the legal protections which she might have been able to mobilise for herself also do not apply, when the disciplinary norms of social relationships dominate. In this way an older lesbian can be disadvantaged in multiple ways by a home that has gone public and a public space that operates on private, heteronormative, lines.

(1)  Twigg, Julia. (2004) ‘The body, gender, and age: Feminist insights in social gerontology.’ Journal of Aging Studies 1891): 59-73.

(2)  Arber, Sara (2006) ‘Gender and Later Life: Change, Choice and Constraints’. In J. Vincent, C. Phillipson and M. Downs (eds) The Futures of Old Age, pp. 54-61, London: Sage.

(3)  Heaphy, Brian Yip, Andrew and Thompson, Debbie (2004) ‘Ageing In A Non-Heterosexual Context’, Ageing & Society, 24(6): 881-902; Stonewall (2011) Lesbian, Gay Bisexual People in Later Life, London: Stonewall.

(4)  Hunt, Ruth, and Julie Fish. “Prescription for Change: Lesbian and bisexual women’s health check 2008.” Stonewall and De Montford University (2008).

(5)  Casey, Mark (2004) ‘ De-dyking Queer Space(s): Heterosexual Female Visibility in Gay and Lesbian Spaces’, Sexualities, 7(4): 446-461

(6)  Ward, Richard, Pugh, Stephen and Price, Elizabeth (2011) Don’t look back? Improving health and social care service delivery for older LGB users, London: Equality and Human Rights Commission.

(7)  Aronson, Jane and Neysmith, Sheila M. (2001) ‘Manufacturing Social Exclusion in the Home Care Market’, Canadian Public Policy – Analyse De Politiques, 27(2): 154-165