Trans Women’s Perceptions of Residential Aged Care in Australia

Abstract

Many older people in trans communities in Australia and elsewhere have experienced long histories of violence and discrimination in the health and social care sectors, making some of them fearful of interacting with contemporary health and social care providers. This study explored older trans women’s perceptions of these services. It involved a qualitative, thematic analysis of semi-structured, one-on-one audio-recorded interviews with ten trans women aged sixty years and older in Australia. Participants expressed a number of concerns about using residential facilities for older people in Australia, including potential for abuse and discrimination as a result of being trans, and not having access to appropriate treatments. Participants indicated a range of alternatives in using services, such as renovating the home, relocating to areas with greater access to trans-inclusive services and potential euthanasia. Participants perceived that service providers were not adequately trained for trans and gender diverse needs, and highlighted a number of ways aged care services could better support the trans and gender diverse community. The findings provide important information to assist health and social care professionals, including social workers, as well as residential care service providers, in supporting the health and well-being of older trans women.

A narrative review of literature on the use of health and social care by older trans adults: what can United Kingdom services learn?

“…Internalised stigma (Siverskog, 2014;Porter et al, 2016;Johnson et al, 2018) is also relevant (for more on this issue, see Puckett and Levitt, 2015). Invisibility is a word sometimes applied to trans people within health and social care (and more widely) (Fredriksen-Goldsen et al, 2014;Siverskog, 2014;Witten, 2014Witten, , 2017Page et al, 2016;Porter et al, 2016;Walker et al, 2016;Michael et al, 2018;Pang et al, 2019;Waling et al, 2020). Bouman et al (2016) use the term double discrimination, referring to the discrimination attached to being trans plus the discrimination linked with being older, although Warren and Steffen (2020) suggest that older trans adults may be more likely to attribute discrimination to gender identity than to age.…”

“…In terms of economic challenges, in some economies a lack of insurance to fund care is a concern (Ferron et al, 2010;Finkenauer et al, 2012;Waling et al, 2020), and this is in a context of possible historical economic instability for older trans adults who may have experienced discrimination and barriers in education and employment, and who are at increased risk of poverty and homelessness (Finkenauer et al, 2012).…”

“…It is not surprising then that training and educating staff is widely regarded as both helpful and important in the literature reviewed and this applies across health and social care (Fredriksen-Goldsen et al, 2014; Siverskog, 2014; Mahan et al, Ageing & Society 17 2016; Walker et al, 2017;Waling et al, 2020). Training is understood to indicate, as a minimum, that agencies recognise the importance of gender diversity and acknowledge the need to train their staff in order to provide non-discriminatory care for trans service users.…”

“…Whether training changes attitudes and behaviours and how it changes practice remain to be established. The literature identifies a need for training and education in a number of areas, including: current definitions, concepts, terminology and trans issues relevant to practice (Bachmann and Mussman, 2015;Warren and Steffen, 2020); knowledge and skills regarding trans-inclusive care across all health and social care staff and professions (Finkenauer et al, 2012;Waling et al, 2020); a lifecourse/biographical approach to care (Porter et al, 2016); organisational leadership (Latham and Barrett, 2015a); and co-design approaches to involving trans service users at all levels (Michael et al, 2018).…”

‘I'm going to live my life for me’: trans ageing, care, and older trans and gender non-conforming adults’ expectations of and concerns for later life

“…From a UK survey of TGNC adults, 65 per cent of respondents had experienced worries about ‘growing old alone’ (McNeil et al , 2012). However, research on TGNC lives has tended to focus more on younger gender-diverse people's experiences of puberty and early adulthood (Waling et al , in press), while research on TGNC adults has primarily focused on interactions with clinical and medical settings (Toze, 2018).…”