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

Our assumptions

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

Our assumptions: Residents have sexual rights

Our assumptions

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

Resources are available https://ltcombudsman.org/issues/sexuality-and-intimacy-in-long-term-care-facilities

Capacity to Consent (Lichtenberg, 2015)

Where to start? Self-Assessment https://www.privacy.org.nz/assets/Uploads/Sexuality-Assessment-Tool-SexAT.pdf

Staff training: Use vignettes!!!!

Ground your efforts in preference-based living

LGBT Elders

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

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

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

The Impact of Policy

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

Aging as LGBT: Two Stories

Key Issues

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

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

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)

Special Topic: Long Term Care Houghton, Angela. Maintaining Dignity: Understanding and Responding to the Challenges Facing Older LGBT Americans. Washington, DC: AARP Research, March 2018. https://doi.org/10.26419/res.00217.001 Houghton (2018)

Special Topic: LGBT in LTC

What can be done?

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)

The Long-Term Care Equality Index with SAGE & HRC

Questions? Ann Steffen, PhD, ABPP 314-516-5382 ann_steffen@umsl.edu Dan Stewart, MSG 314-862-4900 Dan@PROMOonline.org