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90 T.R.

JOHNSTON

CREATING SAFE SPACES AND PROVIDERS


My account of affirmation in combination with Bergson’s description of
embodied memory explains why LGBT older adults may not have inter-
nalized the positive changes that have occurred in the treatment of LGBT
people over the past decades, and also why simple policy changes (such as
including sexual orientation and gender identity into nondiscrimination
policies), while important, are not enough to convince them that they are
safe. Many LGBT older adults have experienced a lifetime of hostile affir-
mations telling them to be suspicious, guarded, and hypervigilant. These
affirmations have marked them psychologically and physically. They have
become habituated to assume that they are not safe. Being closeted is part
of how they move through the world, and undoing those years of fear
requires that care providers work hard to communicate inclusivity and
safety. I end this chapter by describing some commonly recommended
best practices and explain how they can be understood through the lens
of affirmation. These best practices are primarily drawn from the research
and training programs developed by the National Resource Center on
LGBT Aging and its partner organizations. These suggestions are not
exhaustive and should be seen as a representative sample of the kinds of
changes recommended by LGBT aging experts.
Staff must be trained in LGBT cultural competency. This training
includes learning which terms are considered safe and respectful, and
which terms should be avoided. Obviously slurs should be avoided, but
there are specific generational differences in what is considered safe ter-
Copyright © 2016. Palgrave Macmillan. All rights reserved.

minology. For many older adults the term homosexual still carries the con-
notation of a mental disorder and has a negative stigma. Similarly, younger
people have reclaimed the word queer as a positive identity, but many
older adults still consider that to be a very offensive term. If the person
conducting an intake interview casually uses the word queer, even as an
ally or to describe their own identity, the trauma associated with that term
may create an unsafe interaction and cause the older adult to withdraw.
Care providers should be familiar with the various terms LGBT people use
to describe themselves and their culture, and not visibly react when they
hear these terms being used. Respectfully using whatever terms the person
prefers is a strong way to affirm their identity and to indicate acceptance
of and comfort with that identity.
Intake forms and questions can be changed to reflect multiple gender
identities and sexual orientations (interviewees must know that answering

Johnston, Tim R.. Affirmation, Care Ethics, and LGBT Identity, Palgrave Macmillan, 2016. ProQuest Ebook Central,
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LGBT AGING AND ELDER ABUSE 91

these questions is optional), and staff may use open-ended questions when
doing intake interviews or interacting with older adults.3 Seeing these
questions on an intake form sends the message that your organization
understands that there are gender identities that are not captured by the
options of male and female, and that sexual orientation is a relevant part
of everyone’s experience. Similarly, intake questions should be framed as
open-ended questions. For many people the question “Are you married?”
implies heterosexuality. Rephrasing the question as “Tell me about the
important people in your life,” requests the same information without
making assumptions about sexual orientation, and gives the interviewee
the power to decide how much to reveal about their relationships. It also
provides an opportunity for the interviewee to describe alternative family
structures or support networks that might otherwise be missed by the
interviewer. By giving the interviewee the ability to describe their network
of support and relationships, you are allowing them to trace for you the
different affirmative feedback loops and affirming relationships that hold
them in their identity. Asking, “Are you married?” will likely end in the
single word “No,” whereas asking open-ended questions allows for the
interviewee to provide much richer information.
Legal protections and nondiscrimination policies are another important
tool for protecting LGBT older adults. It is not enough to simply include
sexual orientation and gender identity in these policies; they need to be
transformed into messages by making them clear, visible, and understand-
able. For example, providers should describe their nondiscrimination pol-
Copyright © 2016. Palgrave Macmillan. All rights reserved.

icy before beginning intake questions. Likewise, putting this policy into a
patient bill of rights, publishing it in advertisements and literature, posting
it visibly in waiting areas, and putting it on the top of intake forms sends a
clear and inclusive message and affirms the worth of diverse sexual orienta-
tions and gender identities.
When someone is moving into a new environment it is important that
they can import affirming feedback loops into that new environment. One
way to do this is to bring decorations, pictures, and whatever else will
help them feel at home. This psychological and physical feeling of being
at home is rooted in these affirmative feedback loops. LGBT older adults
often do not feel free to bring objects from home because they fear that
these objects will reveal their sexual orientation. Transgender or gender-
nonconforming people may fear dressing in the clothing that reflects their
identity, and may go back into the closet because they fear being abused.
Care providers can make it clear that any and all objects, reflecting any and

Johnston, Tim R.. Affirmation, Care Ethics, and LGBT Identity, Palgrave Macmillan, 2016. ProQuest Ebook Central,
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92 T.R. JOHNSTON

all relationships, are welcome, and that everyone can dress in whatever
clothing they prefer. In chapter 3 I described the importance of inani-
mate objects and physical environments in creating affirming spaces that
enable fluid mobility. Older adults’ physical movement will be very dif-
ferent from when they were younger, but the goal is still to create spaces
where they can feel as comfortable, fluid, and as much at home as pos-
sible, unrestricted by fear or self-conscious hypervigilance. Giving LGBT
older adults the freedom to express themselves through their gendered
self-presentation, as well as their decorations, is not just a matter of fashion
or interior design; it is a crucial way to ensure that their environments are
affirming and enabling.
Biological, legal, and also nontraditional families must feel welcome
in aging network services. Everyone has the right to determine who
can visit and who can participate in making medical decisions. Granting
someone’s close friends, relatives, and loved ones constant and easy
access allows those relationships to continue in this new setting,
importing existing affirmative feedback loops and holding the older
adult in their identity as other circumstances in their life continue to
change. It is important that service providers do whatever they can to
maintain the older adults’ existing affirmative feedback loops, including
making their visitors feel welcome and accepted as a part of the shared
environment.
Transgender people are often asked inappropriate questions about
their bodies and experiences. Many times these questions are asked to
Copyright © 2016. Palgrave Macmillan. All rights reserved.

satisfy someone’s curiosity. These questions reduce the transgender per-


son to their gender identity, only affirming a limited set of their experi-
ences and ignoring them as a whole person. Transgender status is often
medically relevant information, but providers should be able to clearly and
politely articulate a medical reason for needing this information before
asking questions about a person’s transgender status or medical history as
it relates to gender identity. The assignation of sex-segregated facilities like
bathrooms and living spaces should be made according to gender identity
and not surgical status, hormone use, or bodily morphology. Ensuring
transgender people access to spaces and services that accord with their
gender identity is an essential aspect of affirming their gender identity.
Providers should recognize that it is the transgender person, not other cis-
gender people, who is often most at risk of abuse or discrimination in sex-
segregated spaces. Any conflict that arises around LGBT identity or issues
(for example, someone refusing to share a room with an LGBT person)

Johnston, Tim R.. Affirmation, Care Ethics, and LGBT Identity, Palgrave Macmillan, 2016. ProQuest Ebook Central,
http://ebookcentral.proquest.com/lib/jyvaskyla-ebooks/detail.action?docID=4716322.
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LGBT AGING AND ELDER ABUSE 93

should be dealt with according to the organization’s existing guidelines


for conflict mediation and resolution, ensuring that the LGBT person
receives fair treatment.
Bisexual older adults may have been in different-sex relationships for
many years before entering into a same-sex relationship. This change from
different-sex to same-sex relationship might be immediately understood
according to the familiar narrative of “coming out.” This narrative has the
effect of casting the different-sex relationship as having been inauthentic,
unsatisfying, or deceptive. After the death of her husband, Peggy Seeger
began dating a woman. In a narrative of her experience she says:

My children took it well, albeit my daughter less well than my sons, one of
whom occasionally refers sympathetically to my “coming out” as if I had
always been a closet lesbian and was at last showing my true colors. Not
true. I was as heterosexual as a woman could be. I just happened to fall in
love with another woman at a crucial time in my life. (Seeger 2009, 116)

Imposing the coming-out narrative onto a bisexual person does damage


to their previous relationships by holding and affirming them according
to an inaccurate script, and can strain relationships with a previous part-
ner or children. Providers should be careful to not assume that same-sex
relationships are more authentic than different-sex relationships. Doing so
requires learning about and respecting the diversity of sexual orientations
as well as their fluidity across the life span, and respecting the different
relationships that make up the older adult’s personal history.
Copyright © 2016. Palgrave Macmillan. All rights reserved.

Finally, a number of important visual cues can help to enhance fluid


mobility. Remember that because the realization of memory in perception
is a bodily phenomenon, the quality of the memories and affirmations
in a given space will determine if we feel comfortable or threatened in
that space. Including pictures of LGBT people on advertising materials
and in decorations, rainbow flags and pink or purple triangles, LGBT-
themed activities, adding inclusive language to programming announce-
ments (for example, on a flyer announcing family visitation day including
the phrase “All families are welcome”), and celebrating Pride are all ways
to send an inclusive message. These cues have a very positive impact on
an LGBT person’s feeling of physical comfort and safety. These are ready-
made and easily understandable affirmations of LGBT acceptance, and
they provide the initial affirmations that can ease the transition into an
unfamiliar environment. Nobody wants a new resident, patient, or visitor

Johnston, Tim R.. Affirmation, Care Ethics, and LGBT Identity, Palgrave Macmillan, 2016. ProQuest Ebook Central,
http://ebookcentral.proquest.com/lib/jyvaskyla-ebooks/detail.action?docID=4716322.
Created from jyvaskyla-ebooks on 2018-06-28 06:26:27.

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