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LTC and LGBT Individuals I Mount Saint Vincent University LTC and LGBT Individuals i Mount Saint Vincent University Department of Family Studies and Gerontology The Experience of Living in Long-Term Care for LGBT Individuals: Perspectives from Residents and Stakeholders by Maureen Green A Thesis submitted in partial fulfillment of the requirements for the degree of Master of Arts in Family Studies and Gerontology April 2016 Halifax, Nova Scotia Maureen Green, 2016 © LTC and LGBT Individuals ii Mount Saint Vincent University Department of Family Studies and Gerontology The Experience of Living in Long-Term Care for LGBT Individuals: Perspectives from Residents and Stakeholders by Maureen Green Approved: ____________________________________________________________ Áine Humble, PhD, CFLE Thesis Advisor Associate Professor of Family Studies and Gerontology, Mount Saint Vincent University ____________________________________________________________ Matthew Numer, PhD Assistant Professor of Health Promotion, Dalhousie University ____________________________________________________________ Linda Caissie, PhD Assistant Professor of Gerontology, St. Thomas University LTC and LGBT Individuals iii Dedication This thesis is dedicated to my incredibly supportive family, near and far: Carol Green (mom), Ralston Green (dad), Jacqueline Green (twin), Rachel Green (sister), Carmel Smyth (nana), Carl Smyth (papa), Simone Smyth (cookie nana), Alphée Smyth (grampy), Doris Green (granny), and Norman Green (grampy) LTC and LGBT Individuals iv Abstract Because older lesbian, gay, bisexual, and transgender (LGBT) individuals face challenges due to ageism, homophobia/transphobia, and/or heterosexism, hiding their sexual identity may be a common coping mechanism to avoid discrimination. Due to these multiple forms of marginalization, sexual minority individuals are more likely to live alone than heterosexual individuals. They are also at greater risk of entering long-term care (LTC) facilities where they may feel they have no other choice but to hide their sexual identities, but little is known about their experiences. This study used qualitative, descriptive methodology and was guided by the ecological perspective, minority stress theory, and intersectionality theory. In- depth, semi-structured interviews were completed with two LGBT residents, two LGBT activists, and two LTC workers. Interviews focused on their subjective, personal understanding of their experiences and the experiences of LGBT individuals in LTC. Three themes emerged in the analysis. First, LTC residents were hesitant to reveal their sexual identity due to potential discrimination from residents and staff members in their facilities. Residents had heard of stories about other residents being maltreated on the basis of their sexual orientation, and their health-related vulnerability enhanced their fears. This feeling was validated by the stakeholders, who had also heard similar negative stories. Second, fear of discrimination was buffered by positive relationships with others within and outside of the LTC facility. Support networks were important in LTC and LGBT Individuals v providing a positive environment for the residents, and this feeling was echoed by the stakeholder participants. Access to supportive services was important, and the participants worried about the availability of such services for those residing in smaller cities or rural areas. Third, the environments with which LGBT participants interacted played a big part in their overall experience in LTC. Having to move from their home into an institution meant they had to give up control over the timing of day-to-day activities and who cared for them. The political climate of the LTC facility also factored into their experiences, where living smaller, rural areas (for example) made it more difficult to access supportive services. Finally, participants also felt positively about the idea of having an LGBT-friendly LTC facility available, though one had reservations about it, feeling it was unnecessarily contributing to segregation and not dealing with the root of the problem. LTC and LGBT Individuals vi Acknowledgements This thesis has taken me a long time to complete and I have so many people to thank for the push that I required in order to do so. Firstly, my thesis advisor Dr. Áine Humble, who was extremely helpful and compassionate during our long time working together. She understood when I needed tough love, and knew when it was more appropriate to be gentle with me. I also want to deeply thank Dr. Linda Caissie and Matthew Numer for being on my thesis committee and helping me make the changes that would improve my thesis drastically. I am forever grateful for all of your insight and endless help. Next, I need to thank my parents, Carol and Ralston Green, for not only helping me work through this project, but also for encouraging me to always be curious. Without having parents who had faith that I could accomplish whatever I set my mind to, I might have limited my abilities to be far less than what they have become. I also have two incredibly intelligent and wonderful sisters, Jacqueline and Rachel Green, who were fantastic examples of successful go- getters. They set their mind on a particular achievement and did it, and I am so proud to have them as siblings and be able to look up to whatever they set out to accomplish next. I would like to thank members of my extended family, notably my grandparents, Carl and Carmel Smyth (A.K.A. Nana and Papa), who always kept me in their hearts, no matter how far away I was. Receiving their love and support has given me hope in accomplishing all my goals, including this thesis. I need to thank my closest friends, even though they were on very different life paths, they were always supportive of my own journey, allowing me LTC and LGBT Individuals vii to take time off from our shared business to complete this thesis. You know who you are, and you are the best. I love you all endlessly and cannot wait to keep squeezing you tightly throughout these next (non-paper) chapters. I must also graciously thank the Nova Scotia Health Research Foundation (NSHRF) for their generous ($10,000) Scotia Scholar grant that they awarded to me. Finally, I could not have completed this research without the altruistic participation of my six subjects, all of whom were brave enough to share their stories with me. You are the salt of the earth, and deserve every ounce of love and respect you are granted (and even more). I cannot thank you enough. LTC and LGBT Individuals viii Table of Contents CHAPTER 1: INTRODUCTION………………………………….............……...1 CHAPTER 2: LITERATURE REVIEW…..………………..…………………….5 Long-Term Care…………………………………………..….…………..……..…5 Canada’s Changing Family Context…….…………………...…..……….…5 Changes in Long-Term Care…………………………………......................7 Entering and Living in Long-Term Care………………………….……….10 Experience of Aging for Older LGBT Adults……….………………………..…14 Historical Context……………………………….………….……………15 Health and Well-Being…………………………………………………..18 Coping Mechanisms………………………………….…………………..23 Support……..…………………………………………………………….25 LGBT: Accessing Care…………………………………………………………..30 Experiences with Health-Care Practitioners………………..……..……..31 Long-Term Care: Thoughts and Fears………………………...................34 Experience of Living in Long-Term Care……………………………….39 Conclusion…………..……………………………………………..………….…42 CHAPTER 3: THEORETICAL FRAMEWORK...……...……………………....46 CHAPTER 4: METHODOLOGY…………………………………………….…53 Sample……………………………………………………………………………54 Data Collection…………………………………………………………………..56 Analysis………………………………………………………………………..…61 Ethical Considerations………...…………………………………………………63 LTC and LGBT Individuals ix CHAPTER 5: FINDINGS……………………………………………………….68 In the Closet………………………….…………………………………………..68 Fear of discrimination………………….…………………………………..68 Stories being passed around………………..……………………………...70 Vulnerable position………………………………………………………..72 Relationships with Others………………………………………………………..75 Staff………………………………………………………………………..76 Residents………………………………………………………………...…78 Loved ones outside the home……………………..……………...………..81 Changing Environments and their Impact……………………………………….82 From home to institution……………………………….……...…………..83 Lack of control……………………………………………...……………..85 Political climate…………………………………………..…….………….88 LGBT homes……………………………………….…….………...…..….93 Conclusion………………………………………………..………………..….…96 CHAPTER 6: DISCUSSION…………………………..……………..………….98 Recommendations………………………………….…………………..……….107 Limitations……………………………………………………………………...111 Future Research………………………………………………………………...113 CHAPTER 7: CONCLUSION...……………………………………………….116 REFERENCES…………………………………………………………………119 APPENDIX A: RESIDENT INTERVIEW GUIDE…………....…….…..…….135 APPENDIX B: STAKEHOLDER INTERVIEW GUIDE………….………….137 LTC and LGBT Individuals x APPENDIX C: INFORMED CONSENT FORM……………………………...139 LTC and LGBT Individuals 1 CHAPTER 1: INTRODUCTION The number of Canadians over the age of 65 will reach 10.4 million by 2036 (Statistics Canada, 2010a). Nova Scotia in particular has the highest percentage of seniors than any other province, totaling 16.5% of its population in 2011 (Statistics Canada, 2012a). By 2036, that number is expected to grow to 28.6%, more than a quarter of the total population. In 2009, the Canadian Community Health Survey, became the first national survey in Canada to include a question on sexual orientation (Statistics Canada, 2010a). Approximately 1% of individuals between the ages of 18-59 reported they would consider themselves homosexual, while 0.9% reported considering themselves to be bisexual
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