1. Gender Minority Elder Care: Issues That Affect Transsexual, Transgender, Gender Variant, and Intersex (TGI) Elders
Yisrael Malotte-Berger, Lifelines Rhode Island & The University of Rhode Island

2. TGI Foundational Knowledge & Concepts ©2008 Y
TGI Foundational Knowledge & Concepts ©2008 Y. Gavriel Ansara Lifelines Rhode Island With thanks to Grace Sterling Stowell at BAGLY for the first simple triangle

3. The Complex Triangle Designated at birth by external genitalia
Ignores genetic, gonadal, and/or
kinesthetic sex (“hardwiring”)
Male or Female options only;
Intersex and other variance often
treated with surgery
SEX

4. The Complex Triangle Gonadal Genetic Neurological/Kinesthetic
(“brain sex” or “hardwiring”)
Biochemical (hormonal)
Genital appearance at birth
SEX

5. The Complex Triangle GENDER Assigned by genital appearance at birth
Girl (woman) or boy (man) options
only; other variations treated as
pathology
Affects social rules and development
SEX
Genital appearance at birth

6. The Complex Triangle GENDER Boy designated male at birth
Boy designated female at birth
Girl designated female at birth
Girl designated male at birth
Boy and girl (either designation)
Not boy or girl (either designation)
Third gender children and youth
(either designation)
Kothi, kathooey, berdache, butch,
genderqueer
Dual-gender
Pangender
Gonadal
Genetic
Neurological/Kinesthetic
(“brain sex” or “hardwiring”)
Secondary sex characteristics
Biochemical (hormonal)
Genital appearance at birth
SEX

7. The Complex Triangle SEXUAL ORIENTATION GENDER Boy attracted to girls
Boy attracted to boys
Boy attracted to girls & boys
Boy attracted to gender variant (GV) children
Girl attracted to boys
Girl attracted to girls
Girl attracted to girls & boys
Girl attracted to GV children
GV child attracted to girls
GV child attracted to boys
GV child attracted to GV children, Etc….
Boy designated male at birth
Girl designated female at birth
SEX
Genital appearance at birth

8. The Complex Triangle SEXUAL ORIENTATION GENDER Boy attracted to girls
Girl attracted to boys
Boy designated male at birth
Girl designated female at birth
SEX
Genital appearance at birth

9. The Complex Triangle SEXUAL ORIENTATION GENDER Boy attracted to girls
Boy attracted to boys
Boy attracted to girls & boys
Boy attracted to GV children
Girl attracted to boys
Girl attracted to girls
Girl attracted to girls & boys
Girl attracted to GV children
GV child attracted to girls
GV child attracted to boys
GV child attracted to GV children, etc….
Boy designated male at birth
Boy designated female at birth
Girl designated female at birth
Girl designated male at birth
Boy and girl (either designation)
Not boy or girl (either designation)
Third gender children and youth
(either designation)
Kothi, kathooey, berdache, butch,
genderqueer
Dual-gender
Pangender
SEX
Gonadal, genetic, neurological/Kinesthetic
(“brain sex” or “hardwiring”), biochemical (hormonal)
Genital appearance at birth
Male, Female, Intersex (various)

10. The Complex Triangle SEXUAL ORIENTATION GENDER Boy attracted to girls
Girl attracted to boys
Boy designated male at birth
Girl designated female at birth
SEX
Genital appearance at birth

11. The Complex Triangle SEXUAL ORIENTATION GENDER
Designation at birth: Female
Insurance: Male
State ID: Male
Gonadal: Female
Biochemical: Male
Interpersonal: Male
SEX

12. The Complex Triangle SEXUAL ORIENTATION GENDER Assigned gender:
Girl/ young woman
Gender identity:
Boy/ young man
Gender expression:
Feminine
Perception (appearance):
Girl
SEX

13. The Complex Triangle SEXUAL ORIENTATION GENDER
Perception (appearance):
Lesbian
Self-described
Sexual Orientation:
Gay man
Sexual/romantic partners:
Gay and bisexual men
(trans and cis)
SEX

14. Population Estimates RI population TGI people TGI in RI 65+ in RI
1,067,610
1:50 to 1:100
10700 to 21400
13.9%
1500 to 3000

15. RI Anti-Discrimination Laws
§ Discriminatory practices prohibited. – No person, being the owner, lessee, proprietor, manager, superintendent, agent, or employee of any place of public accommodation, resort, or amusement shall directly or indirectly refuse, withhold from, or deny to any person on account of race or color, religion, country of ancestral origin, disability, age, sex, sexual orientation, gender identity or expression, …

16. Ways to Accommodate
If you are unsure of a client’s preferred name or pronoun, ASK
Allow TGI clients access to changing rooms, bathrooms, segregated halls, etc. according to their stated gender
Ask, do not assume, what gender person the client wishes to bathe, toilet, etc. them
Ask what style bedpan/urinal the client would be most comfortable using

17. Ways to Accommodate
Avoid using gendered language to refer to TGI people’s genitals; ask for the client’s terminology and USE IT
Use gender-neutral and TGI status-neutral language for insurance billing and inter-office communication
Do not disclose a client’s TGI status, former (or sometimes currently legal) name, genital configuration, etc. without proper cause

18. Ways to Accommodate
Ensure that anyone who will see the client undressed knows their stated gender and preferred name/pronoun (and will respect them!)
Do not make remarks such as “It’s so big!” or “Wow, are those real?” in reference to TGI people’s body parts.
Do not tolerate TGI jokes or any behaviour you would not tolerate regarding other underprivileged populations.

19. Lifelines Rhode Island
Y. Gavriel Ansara, Executive Director
(617)