Eleanor Feldman Barbera, Ph.D.

Last week, McKnight’s staff writer Tim Mullaney wrote about the new Medicare guidance that guarantees that same-sex married couples can live in the same nursing home. Perhaps, like many of our current opposite-sex married couples, they’ll share the same room or apartment. Is your staff prepared to offer them the same respectful service they’re providing for your male/female couples? Are you prepared to lead the way, regardless of your personal beliefs regarding homosexuality? I’ll bet you’re not.

Why do I say this? Maybe your religion denounces homosexuality, yet you strive to be open (and have your facility open) to people from all walks of life. You might take a “live and let live” approach.  But even if you are openly gay yourself and comfortable with your sexuality, chances are excellent that there are people on your staff who feel very uncomfortable with homosexuality and will need additional training in order to be able to successfully assist gay couples. 

I say this because I worked with a well-meaning aide who, despite knowing nothing about my background really, repeatedly thought she had to try to “save” me through conversion to her (anti-gay) religion. As a psychologist, I could read and deflect her good intentions, but I doubt a gay couple under her care would feel the same way. I also worked with Flora, who told me that the same-sex marriage laws were a sign of the impending apocalypse. I spoke with a younger coworker from Flora’s country, who said that this was a common belief for those in Flora’s generation and that the only person they knew who was gay was the nurse on the 6th floor. (Ralph represented gayness for an entire 400-bed facility.) 

I say this because when New York State legalized same-sex marriage, there were as many residents railing against the decision in their psychotherapy sessions as there were those applauding it, and your staff will have to handle the residents’ reactions on top of their own.  And because a same-sex couple sharing a room will likely be the “Ralphs” of your facility, the only ones who are different in that way. They’ll need staff support to protect them from the disapproval of residents who have different beliefs and lifestyles.

Aside from standard policies and procedures, which likely already preclude discrimination on the basis of sexual orientation, your facility can prepare itself in the following ways:

  • View with your staff the award-winning documentary Gen Silent.  It highlights the experiences of lesbian, gay, bisexual, and transgender (LGBT) elders and their concerns about interacting with healthcare professionals after facing a lifetime of discrimination.  The film provides a way for staff members to “meet” LGBT people and understand their perspectives.
  • The Gen Silent site also offers cultural competency training based on the film.   
  • If problems arise, consider offering special training for staff working directly with LGBT elders in your facilities.  For example, I once facilitated a staff discussion on how to handle the interactions with a female resident’s transgender spouse, who often came to visit the nursing home dressed in women’s clothing.  
  • Be aware of issues arising between residents and attuned to the possibility of senior bullying.
  • Given that many LGBT seniors are “silent” about their sexual orientation, consider offering psychological services to residents who might be very reserved and withdrawn from their peers.  (A good idea anyway, whether or not they’re LGBT.) After several weeks of psychotherapy, for example, Felicia “came out” to me and we were able to discuss her lifestyle and her perceived need to remain “in the closet” at the facility.  She stayed in the closet during her time there, but consistently expressed relief at having someone with whom she could be fully herself.
  • Use the tools you currently employ to combat discrimination against other minority groups.  Making your organization a place where people can safely be themselves is good for staff and residents alike.

Eleanor Feldman Barbera, PhD, the author of The Savvy Resident’s Guide, is an accomplished speaker and consultant with over 16 years of experience as a psychologist in long-term care. This blog complements her award-winning website, MyBetterNursingHome.com, which has more on how to create long-term care where EVERYBODY thrives.