Culture clash: responses to sexual diversity in residential aged care

Abstract

This paper explores attitudes of staff, residents and family members towards sexually diverse persons based on data from the first national study of its kind in Aotearoa New Zealand. The study was a two-arm mixed-method cross-sectional study using a concurrent triangulation design. The quantitative arm included the results of 433 staff surveys related to knowledge, attitudes, behaviours and beliefs about sexuality, intimacy and ageing. The qualitative arm included interviews with 77 participants including staff, residents and family members. This paper focuses only on sexual diversity. A generational cultural effect was noted among all respondents; younger participants expressed the most open and accepting views of diversity. Residents were aware that they mostly held the views of their generation; nonetheless they also looked to staff to set the tone. Staff held varying views and felt that residents would be less accepting; some staff felt the issue of intimate relationships was not something they were willing to discuss at intake. Facilities will want to establish policies about sexuality and intimacy and communicate those policies and practices to staff, residents and family members. Facilities may also wish to consider specific educational events about sexual diversity for residents.

Palliative Care, Intimacy, and Sexual Expression in the Older Adult Residential Care Context: “Living until You Don’t”

“…There is scant literature about this topic and of note our interviews showed that other residents and family members may contribute to the felt sense of alienation for residents whose lives do not conform to heteronormative views. Henrickson et al [ 23 , 55 ] noted that managers and staff were pivotal in setting the tone of a facility and how accommodating a facility would be for sexually diverse residents. They also demonstrated a clear generational effect in staff attitudes, with current attitudes of older staff shaped by prevailing attitudes of their formative years.…”

“…The partnership space integral to person-centred care is compromised in time-poor contexts [ 18 ]. However, substantial evidence indicates a person-centred focus is fragmented for reasons beyond care rationing, particularly in relation to residents’ expressions of intimacy and sexuality [ 19 , 20 , 21 , 22 , 23 ], a point we explore shortly.…”

“…Although there are pockets of excellence internationally, it is commonplace for a gulf between policies and practice to exist, and between aspiration and the necessary leadership and staff education to fully implement those policies [ 22 , 23 ]. More broadly New Zealand is a democracy with relatively liberal laws and social policies including marriage equality for gender and sexually diverse people and the decriminalization of homosexuality and prostitution [ 23 ]. Aged care regulations support rights around sexual orientation and expression [ 40 ] but policy implementation is fragmented [ 41 ].…”

“…Frail older adults in care are vulnerablised by the attitudes and anxieties of staff, families, and other residents. This vulnerability is made worse where cis-heteronormative assumptions mean that gender and sexually diverse residents fear or directly experience disenfranchisement, stigma, and discrimination [ 23 , 43 ], or feel forced into covert identities. The built environment additionally creates obstacles unless residential care homes are designed with intimacy and privacy rights in mind [ 44 ].…”

Religious‐based negative attitudes towards LGBTQ people among healthcare, social care and social work students and professionals: A review of the international literature

“…However, Henrickson et al. (2021, p.10), reporting on their study of attitudes of long‐term residential care staff, residents, and family members towards 'sexually diverse' people, described the following conversation with a male resident:

There was an assumption by some resident participants that new settler staff would probably have difficulty with same‐sex couples because of their religious or cultural norms:Q: Your sense is though, without really knowing, that if there was a gay person or couple, that that would be supported by staff members?A: Possibly. I don’t know whether that would challenge some of them.

…”