No Place Like Home
Creating safe & affirming homes for LGBT+ elders in Long-Term Care
Though many are well-intentioned, LTC staff and healthcare practitioners claiming to treat everyone equally actually contribute to the erasure of LGBT+ identities by failing to acknowledge and accommodate their unique health needs and relationships.
Photo by Roberta SA on Canva @diversifylens
About 'No Place Like Home'
No Place Like Home ensures that every LGBT+ elder can live with dignity, knowing they are valued and respected in their long-term care environments.
Having endured a lifetime of struggle against repressive laws and societal rejection, today's older LGBT+ individuals have fought tirelessly for recognition and rights. As they approach the later stages of their lives, many carry the weight of decades of adversity, calling for our compassion, support, and immediate action. No Place Like Home answers this call.
One of the main concerns this program addresses is the fear and experiences of “forced re-closeting” for LGBT+ older adults in long-term care. This reluctant concealment of their sexual orientations and gender identities is often adopted to avoid discrimination or inferior care. While this may offer some protection from overt mistreatment or subtle neglect, it also leads to increased anxiety and social isolation.
Transgender older adults are especially fearful of discrimination and loss of autonomy in LTC settings, with high rates of reported mistreatment exacerbating these anxieties. Meanwhile, because their bodies may not conform to conventional gender expectations, many trans elders in LTC are unable to protect themselves through non-disclosure. The absence of transgender-inclusive policies in LTC facilities and staff resistance to trans-affirming care pose significant mental health challenges for transgender residents.
No Place Like Home tackles these issues by providing training for LTC staff, promoting practices that respect and affirm LGBT+ identities, and fostering a culture of compassion and support. By recognizing and addressing the specific needs of LGBT+ older adults, we aim to set a standard for truly inclusive and equitable care.
Photo by Alessandro Biascioli on Canva Pro @alessandrobiascioli
Photo by Lina Vanessa Merchán Jimenez on Canva @diversifylens
We worry about actual physical harm happening to us. Not only from staff, but from other residents, because remember, those straight people who were harassing us and beating us back then are now our ages too, right? Now we are the same age in long-term facilities together. That kind of hatred doesn't just disappear.
- Leslie Lee Kham, LGBTQ activist, Ottawa ON
Lezlie Lee Kham, LGBTQ activist. (Nick Purdon/CBC)
Photo by Pablo Merchan on Canva @diversifylens
How 'No Place Like Home' Helps
Photo by InspirationGP on Canva
Inclusive Advance Care Planning (ACP) Workshop
Research shows that heteronormative biases in ACP can discourage LGBT+ participation, as many documents assume traditional family structures that often don’t apply to LGBT+ experiences. Despite the availability of legal tools in many Western countries like enduring power of attorney and advance healthcare directives to protect LGBT+ people’s wishes, there is widespread confusion and a lack of awareness among LGBT+ seniors about these options.
Inclusive ACP ensures that same-sex and same-gender partners are treated as legitimate decision-makers, and that chosen families are included in the ACP process. In this workshop, we ensure that LGBT+ residents know how to exercise their rights and document their care preferences, giving them some peace of mind in the event that they lose the capacity to communicate their wishes.
Photo by Laura Fuhrman on Unsplash
LGBT-affirming "Life in Review" Workshop & Workbook
The "Life in Review" workshop and workbook provide LGBT+ residents in long-term care facilities with a meaningful opportunity to plan their legacies and reflect on and celebrate their lives. This workshop/workbook honours the rich histories and unique experiences of LGBT+ individuals, acknowledging the struggles and triumphs that have shaped their journeys.
Legacy planning is a deeply personal process, encompassing how you want to be remembered and what you wish to pass on to future generations. Guided by a trusted advocate familiar with LGBT+ experiences, workshop participants can safely document their personal values, write letters to loved ones, and make decisions about inheritance and charitable donations.
Meanwhile, the workbook not only helps in planning legacies but also serves as a testament to the courage and resilience of LGBT+ elders, ensuring their stories are cherished and remembered.
Image on Canva Pro @graphicphotoart
LGBTQ2S+ Death Doula Support
LGBTQ2S+ Death Doula Support is a crucial component of the No Place Like Home program, providing specialized care for LGBT+ residents in LTC facilities as they navigate their end-of-life journey. Our trained Death Doulas are skilled in supporting within the four domains of care: planning, legacy, vigil, and grief.
Becoming an integral part of the care team, our Death Doulas work directly with the individual facing death, their loved ones, and other care team members. Their role is to ensure that every aspect of the end-of-life experience is handled with dignity, compassion, and culturally sensitive human connection. This comprehensive support helps to create a more affirming and comforting environment, addressing the unique needs of LGBT+ individuals.
Photo by Nuttapong Punna's Images on Canva Pro @nuttapong-punnas-images
At the Bedside Care
'At the Bedside' care ensures that LGBT+ residents in LTC facilities are not alone in their final moments. Our dedicated LGBTQ2S+ Death Doulas offer respite care and vigil sitting for those with limited family, friends, or community support. This service directly supports individuals who are facing death, providing comfort and companionship in their last hours and minutes.
Many LGBT+ older adults experience profound isolation due to a lifetime of societal and familial rejection and the loss of their chosen family and community connections in later life. 'No Place Like Home' addresses this isolation by ensuring that every individual has a compassionate presence by their side, honouring their identity and life story until the very end. Our goal is to provide dignity, support, and human connection, so no one has to face death alone.
Photo by David Petrus Ibars on Canva Pro
Compassionate Companioning Training for LTC Staff & Volunteers
As part of this program, we offer end-of-life training for staff and volunteers in LTC facilities using HHA's Compassionate Companioning Training. To ensure that these caregivers possess the knowledge and skills necessary to address the specific needs of the LGBTQ2S+ community at the end of life, we also include customized training modules focused on creating LGBT-inclusive environments and delivering LGBT-affirming care.
The 'No Place Like Home' Program Team
Get Involved
Join or support our "Dorothy's Dream Team" walking in support of the 'No Place Like Home' Program in this year's Moonlit Memory Walk fundraiser.
By joining or making a donation to our team, you will help ensure funds are available to educate staff and volunteers of LTC facilities and allow us to offer direct support to LGBT+ elders living in LTC settings.
Do you work at an LTC facility? Partner with 'No Place Like Home' to ensure inclusive and equitable end-of-life care for all your residents. Your facility can benefit from our staff training, LGBT+ affirming workshops, integration of Death Doulas, and vigil support for actively dying residents. Together, we can create a truly supportive community for everyone!
Photo by Georg Arthur Pflueger on Unsplash
Our Partners
We are incredibly thankful for the meaningful collaboration and generous support of our partners!
References
Brotman, S., Ryan, B., & Cormier, R. (2007). The health and social service needs of gay and lesbian elders and their families in Canada. The Gerontologist, 47(2), 192-202. https://doi.org/10.1093/geront/43.2.192
de Vries, B., Mason, A. M., Quam, J. K., & Acquaviva, K. D. (2019). End-of-life preparations among LGBT older Canadian adults: The missing conversations. International Journal of Aging and Human Development, 89(1), 39-56. https://doi.org/10.1177/0091415019836738
Fasullo, K., McIntosh, E., Buchholz, S. W., Ruppar, T., & Ailey, S. (2021). LGBTQ older adults in long-term care settings: An integrative review to inform best practices. Journal of Aging Studies, 50, 100813. https://doi.org/10.1080/07317115.2021.1947428
Fredriksen-Goldsen, K. I., Kim, H.-J., Emlet, C. A., Muraco, A., Erosheva, E. A., Hoy-Ellis, C. P., Goldsen, J., & Muraco, A. (2014). Physical and mental health of transgender older adults: An at-risk and underserved population. The Gerontologist, 54(3), 488-500. https://doi.org/10.1093/geront/gnt021
Knochel, K. A., & Flunker, D. (2021). Long-term care expectations and plans of transgender and nonbinary older adults. Journal of Applied Gerontology, 40(11), 1542–1550. https://doi.org/10.1177/0733464821992919
Lintott, L., Beringer, R., Do, A., & Daudt, H. (2022). A rapid review of end-of-life needs in the LGBTQ+ community and recommendations for clinicians. Palliative Medicine, 36(4), 609–624. https://doi.org/10.1177/02692163221078475
Pang, C., Gutman, G., & de Vries, B. (2019). Later life care planning and concerns of transgender older adults in Canada. International Journal of Aging & Human Development, 89(1), 39–56. https://doi.org/10.1177/0091415019843520
Purdon, B., & Palleja, C. (2021). 'We're going back into the closet': LGBTQ seniors wary of being 'out' in long-term care facilities. CBC News. Retrieved from https://www.cbc.ca/news/canada/lgbtq-seniors-long-term-care-homes-discrimination-1.4721384
Putney, J. M., Keary, S., Hebert, N., Krinsky, L., & Halmo, R. (2018). “Fear runs deep”: The anticipated needs of LGBT older adults in long-term care. Journal of Gerontological Social Work, 61(8), 887-907. https://doi.org/10.1080/01634372.2018.1508109
Rainbow Health Ontario. (2019). Creating LGBTQ inclusive care: A guide for long-term care homes. Toronto, ON: Rainbow Health Ontario. Retrieved from https://www.rainbowhealthontario.ca/wp-content/uploads/woocommerce_uploads/2019/06/RHO_LTC_Report-8.5x11_WEB_s.pdf
SAGE. (2020). Inclusive services for LGBT older adults: A practical guide to creating welcoming agencies. National Resource Center on LGBT Aging. Retrieved from https://www.lgbtagingcenter.org/resources/pdfs/Sage_GuidebookFINAL1.pdf
Simpson, P., Almack, K., & Walthery, P. (2016). “We treat them all the same”: The attitudes, knowledge, and practices of staff concerning older lesbian, gay, bisexual, and trans residents in care homes. Ageing & Society, 1-31. https://doi.org/10.1017/S0144686X1600132X
Stein, G. L., Beckerman, N. L., & Sherman, P. A. (2010). Lesbian and gay elders and long-term care: Identifying the unique psychosocial perspectives and challenges. Journal of Gerontological Social Work, 53(5), 421-435. https://doi.org/10.1080/01634372.2010.496478
Stinchcombe, A., Wilson, K., Kortes-Miller, K., & Chambers, L. (2018). Staying out of the closet: LGBT older adults’ hopes and fears in considering end-of-life. Canadian Journal on Aging / La Revue canadienne du vieillissement, 37(1), 22-31. https://doi.org/10.1017/S0714980817000514
Sussman, T., Brotman, S., MacIntosh, H., Chamberland, L., MacDonnell, J., Daley, A., Dumas, J., & Churchill, M. (2018). Supporting lesbian, gay, bisexual, & transgender inclusivity in long-term care homes: A Canadian perspective. Canadian Journal on Aging, 37(2), 121–132. https://doi.org/10.1017/S0714980818000077