by Scott Valentine

I had the pleasure to sit down with Elysia Chandler, who recently authored the City of Cambridge’s first report on healthcare for LGBTQ seniors in Cambridge.  In 2014, Elysia and the Cambridge GLBT Commission began assessing how the policies and practices of healthcare organizations in Cambridge support the needs of LGBTQ seniors. 

Released late last year, Elysia’s report highlights current best practices for LGBTQ inclusive patient-centered care and identifies areas for growth as healthcare organizations across Cambridge attempt to deliver more inclusive, comprehensive and compassionate healthcare for LGBTQ elders. As our conversation flowed, it was very inspiring to meet another young professional seeing the pressing need, social value and massive amount of work to be done to allow our LGBT seniors to age with dignity. 

How did you get involved with the GLBT Commission for the City of Cambridge?  

I was born and raised in Cambridge and care deeply about supporting and improving its wealth of resources, especially those that serve youth and elders.  Since my youth, I have always been involved with social services and various organizations that were passionate about creating inclusive communities.  After graduating from Mount Holyoke College, a very GLBT inclusive environment, I wanted to help extend my knowledge base as well as my work experiences. I wanted to be part of something that made a difference, and came across this position that seeks to create healthcare and long-term care environments in the City that better serve the needs of  LGBT elders. It was too perfect and I had to apply!  Several of my past experiences of working with local organizations and nursing facilities helped as well, and made my outreach efforts during the research process much easier to navigate.  It has been the best job ever, and I have learned so much from my extremely knowledgeable and dedicated supervisors and the Commissioners! But this project became a possibility, and eventually reality, largely due to the GLBT Commission’s co-chairs, Aren Stone and John Gintell. They developed this project, and advocated for an intern that could see it through. Their advocacy for improving the lives of LGBT residents of our community, especially marginalized and often forgotten age groups within this population, is truly inspiring.

Now that the report is complete, were there any standouts as far as gaps in services that surprised you? 

Oh definitely from the healthcare study we just finished! Also, I have not yet finished data collection for our current needs assessment on housing.   But so far, it is very interesting to see the interconnection between housing and healthcare; how they support one another based on the psychological needs that LGBT elders have to feel safe, and provide the security necessary for elders to have healthier aging experiences and life outcomes.

I am most concerned about the health disparities between LGBT individuals and their non-LGBT counterparts. It was most shocking through this process to learn about how many LGBT older adults fear their caretakers won’t understand them or will be prejudiced towards them. Even more, how vulnerable they are to the systems that seek to care for them, but may not fully understand how to do so in a way that is respectful and accepting of their LGBT identities.

We need to start reaching out to the highest levels in these organizations in order to create the best standards of care; creating an inclusive and equitable culture for all. I think management of healthcare and housing organizations, who often set the tone for what the values are within the communities they oversee, still need to grasp how powerful it is for LGBT elders to walk into a facility that explicitly acknowledges and affirms their presence. There needs to be more messaging on behalf of organizations, for example a rainbow flag or sticker in a front window, that sets a tone of acceptance. At the same time, it’s of equal importance to have policies and practices that back up this message.

How can providers create a better and more supportive community to quell the fear of LGBT seniors being outed? 

Well, to start with, we need to make sexual orientation and especially gender identity part of the intake form and health record information collection process. Because we know from previous research that  affirming healthcare is of a major concern for elders, it is important that this information is collected for healthcare providers to best identify the health needs of their patients and residents, and to know they exist and are relevant.  However, this is a difficult issue to solve because of confidentiality clauses. How can organizations allow an LGBT elderly patient to come out without feeling compromised, and who is able to see this information? That will be an important part of the equation to solve.

I just sat in on a lecture last week at the Harvard Medical School, and Dr. Callahan of UC Davis, a leader in LGBT elderly health, exclaimed, “more affirming care and accepting providers will allow for more successful healthcare outcomes for this community.”  To make this happen we need to start proposing and creating inclusive programing, proper training for staff and caretakers.  Lastly, what I think to be a very simple intervention is creating pamphlets presenting facts about this unique population from their lived perspectives so that other elders, their families, staff and caregivers can begin to better understand each other, and so LGBT elders can age with the dignity they deserve.

But where do we begin to address better training and education for staff members and caretakers?

We need to set a system in place of following up.  That is the key.  We need to let these organizations know what resources and training opportunities are out there, which many do not know already exist!  Same with housing, we need to have best practice guides, but that too will require a lot more data and research to establish what constitutes best practices for LGBT senior’s housing needs.  Services for Aging GLBT Elderly (SAGE) has been a great resource for understanding how to support healthcare agencies become inclusive for LGBT elders specifically. Additionally, they are planning to release a best practice guide for providers to make their housing establishments inclusive for LGBT elderly.

For our housing project, it would be great to have something similar to the HRC Health Index rating system, letting the community know they are inclusive. But this system of analysis is not as comprehensive as it could be. Their rating system only requires policy and minimal training in order for healthcare organizations to become deemed leaders in LGBT quality care. Our needs assessment focused on many more key areas of inclusive care; we looked at both policies and practices that are in place. Additionally, there is a need to establish a way to enforce this kind of system, and require more in depth training, allowing organizations to improve and adapt along the way with support and continual education and ideally self-assessment.

Now that this assessment is complete, is there any possibility to create another one, to follow through on the suggestions you have set forth?

It is a possibility, and a plan for the future.  We will always need to follow through in order to create change towards a more inclusive system for LGBT seniors.  It would wonderful to create annual assessments, and has been an interest expressed by many Commissioners!

How can providers gain more information about providing LGBT inclusive healthcare and housing? 

Oh! That is one of the more simple aspects to these projects.  In the report, we created a best practices guide, as well as supplied all the relevant information to allow healthcare and housing staffs to begin starting the process of self-learning. The Commission report is being circulated to all facilities we contacted and it can also be found here on our website. We have been working with other departments too so this report, and the information it contains, can be easily found and accessed through multiple channels!

Scott Valentine is a graduate student at the Harvard Graduate School of Design.

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