Delivering person-centred home care to LGBTQ+ clients

LGBTQ+ charity Stonewall says, “Lesbian, gay, bi and trans people in later life often experience specific forms of discrimination that go unnoticed by others around them, which can lead to isolation and even going back into the closet… It’s vital (that) health and social care staff are trained to understand and meet the unique needs of older LGBT service users.”

And with statistics suggesting that more than 1.4 million UK adults identified as LGBTQ+ in 2019 – social service providers must prepare for the oncoming wave of older adults nationwide that may require home-based care.

What issues do home care providers face in the delivery of domiciliary care to LGBTQ+ clients?

Many businesses – those in the care sector and beyond, may assert that they will ‘treat everyone the same’ regardless of sexual orientation or gender identity. Yet these well-meaning words critically miss out on the fact that it is through recognising and giving regard to difference, in a positive way, that services can distinguish themselves.

“What most lesbian, gay, bisexual and trans people want is simply to be respected for who they are –equal to heterosexuals and non-trans individuals, but with distinct identities and needs. Some needs will relate to being lesbian, gay, bisexual or trans while some might be related to other interests and preferences in their lives.” (Safe to be me – Age UK)

And while prejudice may come into play, in the Care Quality Commission’s Equality Objectives for 2019-21, a quoted report by Skills for Care suggests that it is “a lack of knowledge and confidence” in social care managers and staff rather than “conscious discrimination” that remains the biggest issue.

What can home care managers do to improve the delivery of care to LGBTQ+ clients?

The most significant influence in any service is the leadership of the manager and the ethos that they promote. In the same vein as building better culturally appropriate care and catering for those with disabilities, building staff confidence through a variety of training methods is crucial, but it can be through small changes as well as setting a good example with confidence and clarity that can make the biggest difference.

  • Challenge and address issues when hurtful or derogatory comments are made, even if they are shrugged off by LGBTQ+ employees or clients. It is important to set a standard as a service that you will not let negative comments or attitudes go unchallenged.
  • Build a culture in which it is ok to ask questions when you are unsure. Doing so is the best way to break down barriers. And this approach also provides care professionals with a firm platform to deliver care to the LGBTQ+ community.
  • Create opportunities to learn. Prejudice and unconscious bias will not change overnight so managers need to provide experiences to help their employees and service users develop. This could be through traditional training or by making LGBTQ+ books, magazines or access to digital resources available for staff.
  • Identify support networks. Look to partner with LGBTQ+ community groups or charities and ensure that service users can access the kinds of activities or support groups that they want to be part of. 
  • Make sure your message is clear. Include imagery and case studies in any marketing or literature that shows the diversity of your clients and your team – also consider adding pronouns to email signatures.
  • Listen to clients. How do they describe themselves and their lives? Value what they tell you. Respect that someone’s identity is private until they give permission for it to be shared. And don’t make assumptions based on your own bias. 
  • Make changes to your procedures. Forms should be as inclusive as possible – with open and inclusive questions, such as ‘Who would you like us to contact in an emergency?’ rather than ‘Next of kin’.
  • Use digital records to build more cohesive and in-depth care plans that cater to a clients LGBTQ+ interests/needs– ensuring that the care delivered to each client is truly centred on their lifestyle.

What is the CQC doing to support care for the LGBTQ+ community?

In its latest equality objectives 2021-2025, the CQC has placed LGBTQ+ care high on the agenda once again. In this report, the CQC has pledged to increase the amount of digital feedback available for LGBTQ+ service users. It will also run campaigns to reach specific groups of people, such as younger lesbian, gay, bisexual or trans people, and forge more national partnerships with organisations that represent people more likely to have a poor experience of care or have difficulty in accessing care.

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