1. Sex, Drugs and Rock n' Roll in Long-Term Care
Ann Steffen, PhD, ABPP
Dan Stewart, MSG

2. Our assumptions

3. Our assumptions
Sexuality is a part of the human experience across the lifespan

4. Our assumptions: Residents have sexual rights

5. Our assumptions

6. So, this is complicated!!!
-Sexual Consent in the context of cognitive impairment
-Privacy
-LGBTQ+ affirming care and support
-Risk management (STDs, sexual assault, physical harm, short term relationships)
-Family opinions/concerns
-Integrating sexual & gender expression/behaviors into care plans
-Staff reactions/training
-Policy development & practice

7. Resources are available

9. Capacity to Consent (Lichtenberg, 2015)

13. Where to start? Self-Assessment

14. Staff training: Use vignettes!!!!

15. Ground your efforts in preference-based living

19. LGBT Elders

20. Current 50+ Estimate: 2.7 Million 2030 Projection: 7 million (50+)
Who and Where the LGBTQ Population Is nationally/Missouri
Current 50+ Estimate: 2.7 Million
65+: 1.1 million
2030 Projection: 7 million (50+)
Growth Factors:
Aging nation
Visibility
Generational differences
Movement Advancement Project, 2019

21. LGBT older adults are less likely than their heterosexual peers to reach out to providers, senior centers, meal programs, and other entitlement programs because they fear sexual orientation- or genderbased discrimination and harassment.
Nearly one-third of transgender people do not have a regular doctor and report poor general health
LGB older adults have higher rates of poor physical health and mental distress
*41 percent of LGBT older adults report having a disability, compared to 35 percent of heterosexual older adults
9 percent of lesbian, gay, bisexual and queer people report that a doctor or other health care provider used harsh or abusive language while treating them 21 percent transgender people

22. Lack of Inclusive Policy Discrimination & Stigma
LGBTQ
Health
Barriers to Care
Lack of Inclusive Policy
Discrimination & Stigma
Disparities
Negative experiences in healthcare and social service settings
25% of Trans individuals have to educate
70% of Trans individuals have had negative experience
Lack of information and knowledge about LGBTQ needs and risks
Lack of LGBTQ-specific research, policies and procedures
Risk of poverty, homelessness, underemployment

23. The Impact of Policy

24. Missouri Policy Missouri Human Rights Act (MRHA)
Sexual orientation and gender identity not protected categories
Housing
Employment
Public Accomodations
15 municipalities have inclusive non-discrimination ordinances
SB43 increases the burden of proof on behalf of the plaintiff, so that the discrimination at hand must be the motivating factor not just a contributing factor

25. Aging as LGBT: Two Stories

26. Key Issues

27. Healthcare Less likely to have health insurance coverage
More likely to delay or not seek medical care
40% not out
Less likely to receive preventative care
41% have a disability
47% had at least one disability
Lesbian and Bisexual women - greater odds:
Poor mental health
Obesity
Disability
Gay and Bisexual men - greater odds:
Poor physical health
Transgender older adults - great odds for:
Poor physical and mental health

28. Caregiving
More likely to need care and provide it than non-LGBT individuals
Nine Percent of US Caregivers
Peer-to-peer care
Less likely to have family of origin support
2x more likely to be single
4x less likely to have children
Legal recognition of partnership
Family Medical Leave Act
Social recognition of partnership
Peer-to-Peer caregiving

29. Social Isolation
40% of LGBT older adults say their social networks have become smaller
27% for non-LGBT
Negative impact on health and mental health
Increase in mortality
Loneliness increases the likelihood of mortality by 26% (Holt-Lunstad, 2015)
The effect of loneliness and isolation on mortality is comparable to the impact of well-known risk factors such as obesity, and has a similar influence as cigarette smoking (Holt-Lunstad, 2010)
Loneliness is associated with an increased risk of developing coronary heart disease and stroke (Valtorta et al, 2016)
Loneliness increases the risk of high blood pressure (Hawkley et al, 2010)
Lonely individuals are also at higher risk of the onset of disability (Lund et al, 2010)

30. Special Topic: Long Term Care
Houghton, Angela. Maintaining Dignity: Understanding and Responding to the Challenges Facing Older LGBT Americans. Washington, DC: AARP Research, March
Houghton (2018)

31. Special Topic: LGBT in LTC

32. What can be done?

33. Health Equity Index Scoring Criteria (HRC, 2018)
Utilization of the HRC Equality Index; PROMO’s success in healthcare → have continued to do this work based on these priciples
Health Equity Index Scoring Criteria (HRC, 2018)

34. The Long-Term Care Equality Index with SAGE & HRC

35. Questions? Ann Steffen, PhD, ABPP 314-516-5382 ann_steffen@umsl.edu
Dan Stewart, MSG