Opportunities for older LGBTI Australians: national responses to healthy ageing and aged care

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1 Opportunities for older LGBTI Australians: national responses to healthy ageing and aged care Susan Ditter Chairperson National LGBTI Health Alliance Board of Directors Executive Officer Working it Out, Tasmania Lesbian, Gay, Bisexual, Transgender and Intersex Aged Care Forum: Addressing strategies for LGBTI ageing and aged care service delivery June 2013 Sydney Harbour Marriott Hotel

2 Acknolwedgements This speech draws on a range of documents prepared by the Alliance, Member Organisations, Individual Alliance Members and staff over a period of years. The contributions to these documents of Dr Catherine Barrett, Sujay Kentlyn, Dr Jo Harrison, Corey Irlam and Gabi Rosenstreich is particularly noted. * Terminology The Alliance uses LGBTI as an umbrella term to include lesbian, gay, bisexual, trans/transgender, intersex and other sexuality, sex and/or gender diverse people. Other groups and previous Alliance documents may use these and/or other initials in a different order. * The National LGBTI Health Alliance gratefully acknowledge the assistance of the Australian Department of Health and Ageing for Health System Capacity Development Fund support. * Contact PO Box 51 Newtown NSW Australia 2042 National LGBTI Health Alliance, June 2013 Opportunities for older LGBTI Australians Page 2

3 Contents 1. Introduction: opportunities for all of us 2. Individuals and communities working together 3. LGBTI health in Australia 4. LGBTI ageing in Australia 5. Living Longer, Living Better the Australian Government framework 6. National LGBTI Ageing and Aged Care Strategy 7. Conclusion: opportunities for the future References Opportunities for older LGBTI Australians Page 3

4 1. Introduction: opportunities for all of us I am pleased to have been invited to give the Opening Address at this national conference. Looking at the program for the next two days, I have no doubt that it will be a time of learning and sharing for all of us, as we examine the many dimensions of healthy ageing and aged care for LGBTI Australians. At the start I would like to acknowledge the traditional owners of the land, the Gaidigal people of the Eora clan, who have cared for this land in the past, presently, and for the future. At this particular event I want to also acknowledge our LGBTI elders lesbian, gay, bisexual, trasngender and intersex people, who have pioneered the way for many of us, often in adverse circumstances. They realised that not all Australians, individuals and couples, had the same opportunity to make informed decisions about health care and other services when ageing. I will not recount the history of that here. I strongly recommend that those of you who have not seen it, view Noel Tovey s talk at the launch of the National LGBTI Healthy Ageing and Aged Care Strategy last December. It is one person s testimony of individual courage and resilience at a time when sexual behaviour between people classified as male was a criminal offence. In mentioning Noel, I also want to honour Dr Jo Harrison, who, unfortunately is unable to be here today. Jo s pioneering doctoral research into LGBTI ageing remains a landmark in the field. Combined with deep seated compassion and a tenacious spirit, Jo Harrison is one of the key individuals who have contributed to the possibility of a conference such as this being held. I have been asked to talk about Austalia s National Strategy for LGBTI Ageing and Aged Care. There are many dimensions to the Strategy, the drivers for this significant policy development, and implementation in the aged care sector and the wider community. I can only touch on some of them this morning. The Alliance is co-ordinating the roll-out of a national training program in LGBTI aged care and I ll refer to that later. In responding to the topic I want to focus on opportunity a theme which underpins the National Strategy and many other initiavies. Opportunity for all of us. Many Australians have the opportunity to make plans for their retirement and what their twilight years might be like given the personal challenges of ageing itself, health and financial planning that most of us will face. Many LGBTI people lack the same opportunities. At its heart, the National Strategy is about changing that lack. Members of the National LGBTI Health Alliance played a key role in making the case for and writing the National Strategy. So, firstly, I will outline the role of the Alliance. Second, it is important to place the discussion in the context of LGBTI health more generally, before referring to LGBTI ageing and aged care specifically. Then I will consider the National Strategy and its implementation, in the context of current Government policy. In conclusion, I will outline steps for the future. A future full of opportunity, creativity and reward for all of us including LGBTI Australians. Opportunities for older LGBTI Australians Page 4

5 2. Individuals and communities working together The National LGBTI Health Alliance was launched at Australia s Parliament House in August 2007,one of the first organisations of its kind in the world..our founding Members have played a key role in LGBTI health in their respective States and Territories across Australia. They saw the need and the opportunity to establish a national organisation that works broadly across LGBTI health issues. The Alliance is not-for-profit public company, governed by a constitution and a Board of Directors. We are a member-based organisation community organisations and individuals working together. The Alliance provides a national framework supporting Members to collaboratively pursue our shared objectives. We currently have 70 member organisations and another 90 individual members. The Member Organisations vary considerably in size and scope, ranging from entirely voluntary local organisations to State-wide bodies receiving government funding for specific agreed activities. The majority of Member organisations are State or Territory based, but we also have a number of national Member organisations. Individual Members of the Alliance come from a wide range of backgrounds including involvement in community groups, professional involvement in LGBTI health, and academic research and writing of relevance to LGBTI health and well-being. Some individual Members bring many years of experience to their engagement with the Alliance. Our Vision is: an Australia free from stigma and discrimination in which all people and communities have the opportunity to live healthy lives including lesbian, gay, bisexual, transgender, intersex, and other sexuality and gender diverse people. As a national peak body our mission is to provide a national focus to improve health outcomes for LGBTI people through policy, advocacy, representation, research evidence and capacity building. Opportunities for older LGBTI Australians Page 5

6 3. LGBTI health in Australia Lesbian, gay, bisexual, transgender and intersex (LGBTI) people make up a significant proportion of the Australian population: 9% of adult men and 15% of women report either attraction or some sexual experience with people of the same sex (Smith et al. 2003), up to 1:1,000 people may be transgender (Department of Health 2008, Olyslager & Conway 2007) and up to 1:200 people may be intersex (Diamond 2004, Blackless 2000). We know from the research that even these figures are probably smaller than the actual number of LGBTI people in Australia, as there are barriers to accurate data collection and reporting. I will not address these here, but those who are interested can read the Alliance s LGBTI Data Report. Australia s National LGBTI Healthy Ageing and Aged Care Strategy estimates the total population number covered by the term LGBTI to be 11%. LGBTI people are part of all population groups, including Australians living in rural and remote areas, indigenous communities, and in culturally and linguistically diverse populations. LGBTI people have demonstrated considerable resilience in looking after themselves and their communities despite adversity. Many LGBTI people lead healthy and fulfilling lives contributing to their families, local communities, workplaces and society as a whole. Nevertheless, the experience of dealing with marginalisation and stigmatisation often impacts on people s health. For example, we know that LGBTI people have disproportionately negative mental health outcomes in comparison with the rest of the population, including depression and suicide. The use of alcohol, tobacco and other drugs is also higher than the wider population(aihw, 2011). Research demonstrates that these negative outcomes are not due to people s sexual orientation, their gender identity, history or experience, or their intersex status as such, but rather are related to the social determinants of health. In particular, these include experiences of discrimination, social exclusion and isolation, and the failure of generic health interventions and prevention strategies to be inclusive of LGBTI people and their needs (Couch et al. 2007, Dyson et al. 2003, Hillier et al. 2005). Very few government bodies in Australia, at either the State/Territory or national levels, offer and fund programs and policies which specifically include or target LGBTI people. The LGBTI health sector is seriously under-resourced, often reliant on unpaid voluntary efforts. Consequently the sector has remained uncoordinated and lacking in focus. This neglect is gradually beginning to change, but there remains a large number of health program areas where LGBTI health needs are not addressed. The Alliance is committed to supporting a comprehensive health system approach to improving the health and well-being of LGBTI Australians. The release of the Australian National LGBTI Healthy Ageing and Aged Care Strategy was, therefore, rightly hailed as historic. Ageing and aged care IS the first area of national government activity to have a LGBTI specific strategy. Some of the reasons for that are specific to the nature of LGBTI ageing, which I will now address. Opportunities for older LGBTI Australians Page 6

7 4. LGBTI ageing in Australia Since its inception in 2007, the National LGBTI Health Alliance has included ageing and aged care as a priority issue in its work, including various submissions to Government. The final report of the Productivity Commission inquiry into aged care, Caring for Older Australians, addressed the concerns of LGBTI older people in specific terms as a discrete group within the discussion of diversity issues. At a meeting between the Alliance and the Minister for Mental Health and Ageing in August 2011, Minister Butler raised the idea of holding a discussion with the LGBTI community regarding aged care related issues and the Productivity Commission report. We did that in Ocober 2011, convening Australia s first national Roundtable on LGBTI ageing and aged care. The key recommendation of that Roundtable was the development of a national strategy. That is why we are here today. Two fundamental issues underpinned the recommendations of the Rountable. First, the general invisibility of LGBTI older people within mainstream society and within LGBTI communities, including the widespread ignorance of their specific needs, histories and life experiences. LGBTI older people are the experts on their own lives, experiences and needs. Second, older LGBTI people have expereinced prejudice and discrimination (which may include bullying, harassment, verbal, physical, psychological and/or sexual abuse) over the life course, from government, agencies, faith-based organisations, health providers, businesses, LGBTI communities, families, friends, and individuals. This includes a fear of prejudice and discrimination, based on past both their expereince and the experience of others. These experiences cause LGBTI older people to: remain in or return to the closet; be reluctant to reveal their sexual orientation, their gender identity, history or experience, or their intersex status to government agencies and service providers; and be reluctant to make complaints when they experience prejudice or discrimination. I am pleased to see that these matters have received due attention in the National Strategy. As Minister Mark Butler states in the Foreward to the Strategy, there are three particular reasons for a Strategy. In the words of the Minister: there have been decades of inequitable treatment for LGBTI people. Many LGBTI people have suffered stigma, family rejection and social isolation; and many LGBTI people have had a life experience of fear of rejection and persecution, coupled with the impact of potential or actual discrimination. For these reasons, LGBTI ageing is a unique and important experience warranting particular attention. Having noted all of that, LGBTI individuals and couples have the same aspirations as every other Australian individual or couple who are ageing. There are concerns about finances, residential and community living options, loss of good health and independence. Equally, there s plenty of verve, and excitement that comes with the opportunity to learn new things, to slow down a bit, to travel, to do some voluntary community work, to spend more time with family and friends. Opportunities for older LGBTI Australians Page 7

8 5. Living Longer, Living Better the Australian Government framework Attendees at this Forum will be well aware of the Australian Government s Living Longer, Living Better reform package announced in April Some parts of that package are being debated in Parliament next week. As Australia s aged care service delivery evolves and in the lead up to the package the Alliance has maintained a clear focus on maximising opportunities for LGBTI people. We have been pleased to work with the members of the National Aged Care Alliance in doing that. The Government s announcements in April of last year included a number of LGBTI specific measures which the Alliance and its Members had been seeking for some years. I will refer to three of the key announcements. First, the Government announced that it will provide $24.4 million to assist older Australians with diverse needs, their families and carers to access information and aged care services that are sensitive to their backgrounds. These funds are covering people from culturally and linguistically diverse backgrounds; people who are homeless or at risk of being homeless; people who are care leavers that is people who have left out of home care; and lesbian, gay, bisexual, transgender and intersex (LGBTI) people. The first round of funding from this allocation is currently being negotiated with a range of organisations. Second, the Government announced that it will provide $2.5 million to support older people from the LGBTI communities by delivering specific sensitivity training for people who work in aged care. The Alliance has been awarded a contract for most of that work, building on the work undertaken by ACON and Aged and Community Services Australia in As is often the case in Australia, any national training will need to be sensitive to the nature of Australia as a federal system of government. Some States have already undertaken significant LGBTI training. Some have done very little. Third, it was announced that The Aged Care Principles Act would be amended to include people in the LGBTI community as a special needs group, to further enable access to appropriate care suitable to their needs. The regulations for the Act were amended in mid 2012, and the changes have now been made to the main Act. It is pleasing to see that this took place with multi-partisan support. Two months ago, the Shadow Minister for Mental Health and Ageing, Senator Fierra-vanti- Wells, expressed her views in an article published in the Alliance s monthly newsletter, LGBTI Health Update. Senator Fierravanti-Wells wrote at the time: We believe that older LGBTIQ Australians should be treated with the same respect, care and compassion when utilizing an aged care facility as any other member of the Australian community. We need a balanced and common-sense approach. With that balance, common sense and a practical approach, the reforms contained in Living Longer, Living Better will increase opportunities for LGBTI Australians. Opportunities for older LGBTI Australians Page 8

9 6. National LGBTI Ageing and Aged Care Strategy As you will be aware, the National Strategy was launched in November 2012 with the process of implementation commencing almost immediately. The Strategy was developed by a Steering Committee comprised of the Commonwealth Department, the aged care sector and community representatives nominated by the Alliance. At least two of those nominees are speaking at this Forum Dr Catherine Barrett who was Co-Chair of the Steering Committee, and Corey Irlam. The Alliance was supported to conduct 16 community consultations on the Strategy, covering each capital city and a number of regional areas. Over 350 individuals participated in those discussions. I am more than pleased, to place on the record the Alliance s appreciation for the officers of the Department of Health and Ageing who worked on the Strategy. Led by Mr Russell de Burgh, the Departmental officials worked in a professional and thorough manner at all times, listening to and being aware of community concerns. The Strategy is admirably brief, being underpinned by a set of principles and goals. Both will provide guidance in the coming years. The principles are inclusion, empowerment, access and equity, quality and capacity building. They are summarised as follows. Inclusion the rights and needs of older LGBTI people, their families and carers are included in the development of Australian Government aged care policies and programs. Empowerment older LGBTI people, their families and carers are supported with the knowledge and confidence to maximise their use of the aged care system. Access and equity all areas of aged care understand the importance of, and deliver, LGBTI-inclusive services. This means understanding LGBTI people s specific needs rather than assuming that they are identical to those of the general population. Quality care and support services provide quality services that meet the needs of older LGBTI people, their families and carers and are assessed accordingly. Opportunities for older LGBTI Australians Page 9

10 Capacity building LGBTI individuals and communities have the capacity to both articulate their aged care needs and be involved in the development of services and the workforce to meet these needs. * The Strategy has six specific goals, each with detailed actions. Many of these actions will be discussed in greater detail today and tomorrow. They are: GOAL 1 LGBTI people will experience equitable access to appropriate ageing and aged care services. Again, this means understanding LGBTI people s specific needs and concerns, not a onesize-fits-all approach. GOAL 2 The aged care and LGBTI sectors will be supported and resourced to proactively address the needs of older LGBTI people. GOAL 3 Ageing and aged care services will be supported to deliver LGBTI-inclusive services. GOAL 4 LGBTI-inclusive ageing and aged care services will be delivered by a skilled and competent paid and volunteer workforce. GOAL 5 LGBTI communities, including older LGBTI people, will be actively engaged in the planning, delivery and evaluation of ageing and aged care policies, programs and services. GOAL 6 LGBTI people, their families and carers will be a priority for ageing and aged care research. It is very important to note that the Department has responsibility for annual reporting, with the first report planned for October of this year. We all know about reports and strategies that simply accumulate dust. I am confident, however, that there is sufficient capacity and goodwill, in government and the aged care and community sectors, to ensure that this does not happen for this Strategy. The principles and goals are well-formulated and comprehensive. With practical implementation they provide a very sound basis for increasing opportunities for older LGBTI people in Australia. In early 2014 the Alliance will be holding our second National LGBTI Ageing and Aged Care Roundtable, and a major focus of that meeting will be considering progress in the implementation of the National Strategy. Opportunities for older LGBTI Australians Page 10

11 7. Conclusion: opportunities for the future In conclusion, therefore: We have a National Strategy. We have an aged care sector ready and willing to give opportunities for high quality care for all. We have multi-partisan support. We have any number of LGBTI individuals, including couples, with the capacity to contribute productively to Australian society as they age. As Australians we deserve to have the opportunity to live with the dignity and respect we accord to all. Let s seize this opportunity, in four main ways. First, the process of education and training has barely commenced. There will be training through the Alliance and its Member Organisations. I appreciate that for many of you it can t come soon enough. LGBTI training DOES need to be an ongoing part of all mainstream aged care education, training and setting of standards. Being inclusive of older LGBTI people is not an optional extra for the aged care sector. Second, there needs to be increased awareness within our own LGBTI populations. Many do not, as yet, know of the changes which are seen in the National Strategy. And we need to change the way we talk about and treat older people within our own communities and organisations! Third, we need to keep government, and by that I mean all governments Local, State/Territory and Federal - open and transparent in their implemenmtation of the National Strategy. As I have indicated above, with the practical and constructive contribution of officials from the Australian Department of Health and Ageing, we are off to a very good start. Let s build on that. Finally, there is a personal opportunity for each one of us today. This Forum is comprised of LGBTI people, or members of our families or workplaces, who are LGBTI people. I am looking forward to spending the time with you, learning from the various preentations, and the equally important discussions outside of sessions. The opportunity is ours. To ensure that LGBTI people, no less than all Australians, can live longer and live better. * Thank you. Opportunities for older LGBTI Australians Page 11

12 References Australian Department of Health and Ageing (2012) National Lesbian, Gay, Bisexual, Transgender and Intersex (LGBTI) Ageing and Aged Care Strategy, Canberra. Australian Institute of Health and Welfare(2011),2010 National Drug Strategy Household Survey report. Drug statistics series no. 25. Cat. no. PHE 145. Canberra: AIHW. [Accessed 15/03/2012]. Blackless, M. et al. (2000) How Sexually Dimorphic Are We? Review and Synthesis. American Journal of Human Biology, 12: Couch, M. et al. (2007) TranZnation a report on the health and wellbeing of transgender people in Australian and New Zealand.Australian Research Centre in Sex, Health and Society, LaTrobe University. Melbourne. Department of Health (2008) Trans; A practical guide for the NHS.Department of Health. London. [viewed 16/4/2011]. Diamond, M. (2004) Pediatric Management of Ambiguous and Traumatized Genitalia. Contemporary Sexuality, 38(9): i-vi. Dyson, S et al. (2003) Don t ask, don t tell. Report of the same-sex attracted youth suicide data collection project. Australian Research Centre in Sex, Health and Society, LaTrobe University. Melbourne. Hillier, L. et al. (2005). Writing themselves in again: 6 years on - the 2nd national report on the sexuality, health & well-being of same-sex attracted young people. Australian Research Centre in Sex, Health and Society, LaTrobe University. Melbourne. The Yogyakarta Principles Up Close, An Activist s Guide to the Yogyakarta Principles. National LGBTI Health Alliance (2009) Submission to the Department of Health and Ageing Review of the Accreditation Process for Residential Aged Care. Submission-Accreditation-Process-Residential-Aged-Care-July-2009.PDF National LGBTI Health Alliance (2009) Submission to the Department of Health and Ageing, Office of Aged Care Quality and Compliance, Review of the Aged Care Complaints Investigation Scheme. Opportunities for older LGBTI Australians Page 12

13 National LGBTI Health Alliance (2010) Submission to the Productivity Commission Inquiry into the Aged Care System in Australia Caring for Older Australians. Alliance-Submission-Aged-Care-System-Productivity-Commission_0.PDF National LGBTI Health Alliance (2011) Response to the Productivity Commission Draft Report: Caring for Older Australians. data/assets/pdf_file/0017/108224/subdr645.pdf National LGBTI Health Alliance (2011) Comment on the draft service charter Our Service Commitment, Aged Care Complaints Scheme, Department of Health and Ageing. 17 June AgedCareComplaintsScheme.pdf National LGBTI Health Alliance (2011) Comment on the Aged Care Service Improvement and Healthy Ageing Grants Fund Discussion Paper on the Development of Fund Guidelines, Department of Health and Ageing. National LGBTI Health Alliance (2011) National Lesbian, Gay, Bisexual, Transgender and Intersex (LGBTI) Ageing Roundtable, A Joint Initiative of ACON and the National LGBTI Health Alliance, funded by the Australian Department of Health and Ageing, Participants Record of Meeting, 18,19 October 2011, Newtown. National LGBTI Health Alliance (2012) Strategic Plan: 2012/ /15, Newtown. National LGBTI Health Alliance (2012) Consultations Report, National LGBTI Ageing and Aged Care Strategy, Newtown. Olyslager, F. and L. Conway (2007) On the Calculation of the Prevalence of Transsexualism. Paper presented at WPATH 20th International Symposium, Chicago, Illinois, Sept [viewed 16/4/2011]. Pitts, M. et al. (2006) Private Lives: A report on the wellbeing of GLBTI Australians, Australian Research Centre in Sex, Health and Society, LaTrobe University, Melbourne. Smith, A. et al. (2003) Sex in Australia: Sexual Identity, Sexual Attraction and Sexual Experience Among a Representative Sample of Adults, Australian and New Zealand Journal of Public Health, 27(2): Suicide Prevention Australia (2009) Position Statement, Suicide and self-harm among Gay, Lesbian, Bisexual and Transgender communities, Leichardt. Opportunities for older LGBTI Australians Page 13

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