Moving into a care home – advice for lesbian, gay and bisexual people
Making the decision to move into a care home is never easy, for the person with dementia, their partner or relatives - whatever the person's sexual orientation. However, in spite of recent improvements in law to protect their rights, lesbian, gay and bisexual people can still find moving into a care home particularly difficult due to fears of homophobia or of not having their specific needs met. This factsheet provides some advice on choosing a suitable care home and suggests things to think about when the person moves in.
For general information about choosing a care home, see factsheet 476, Selecting a care home.
Your legal rights
It is illegal for someone providing a service, such as a care home, to treat anyone unfavourably - to discriminate against them - on the grounds of sexual orientation. The Equality Act 2010, which applies in England and Wales, also requires providers such as care homes to actively promote equal opportunities for lesbian and gay clients.
These areas are covered by a different law in Northern Ireland - the Equality Act (Sexual Orientation) Regulations (NI) 2006.
Choosing the right place
First reactions are often a good indication of whether the home will be appropriate. Does it feel like home? Is it busy and cheerful? Do members of staff seem happy? How do they deal with questions? How long have staff worked there? Are certificates displayed that show the training received by staff?
Does the culture of the home give you confidence that the person's sexuality will be respected? Do brochures include pictures of lesbian or gay couples? Are there private areas for visitors to talk to residents? Will you be able to express your relationship without threat and be given the same respect as opposite-sex couples?
If you have lesbian or gay friends, ask them if they are aware of the home you are considering. Has anyone you know been a resident? Do you know of any lesbian or gay members of staff who work at the home? The existence of lesbian and gay members of staff does not guarantee a gay-friendly environment but it might give you some confidence.
If it seems that the sexuality of the person moving into the home may be an issue, you may want to make this evident from the outset. Don't be afraid to ask to see the home's equal opportunities policy - it may provide insight into the attitudes in the home and the responses you might get should you choose to be open about your sexuality. Ask about training: care homes should train staff on working with lesbian and gay people.
Every home should have an anti-discrimination policy and you can ask for evidence that the policy has been put into practice. Ask how the home would handle any hostility or homophobia towards residents or visitors from other residents or visitors.
You can also ask to see a copy of the home's most recent inspection report. The Care Quality Commission (CQC) regulates health and adult social care services in England, whether they're provided by the NHS, local authorities, private companies or voluntary organisations. It provides information on the quality of care services to help people who use those services and their carers to make informed decisions about their care. The CQC has recently published good practice guidelines as to how regulated organisations should work with lesbian and gay clients.
Note that the equivalent regulators of care outside England are the Regulation and Quality Improvement Authority (RQIA) in Northern Ireland and the Care and Social Services Inspectorate Wales (CSSIW). See 'Useful organisations' below for details.
The first weeks in a care home are often difficult for both the person with dementia and their carer. Feelings of doubt about the choice of home often surface at this time. You may feel that other people have taken over and that they do not understand the person's needs as well as you do.
Give yourself time and stay calm. This settling in period is similar to moving home or starting a new job. Visit regularly and don't be afraid to ask questions or make requests. Keep assuring the person with dementia how much you care for them.
If you take lesbian or gay friends with you when you visit, they may well be noticed. The relatives and friends of other residents will make contact and will want to place you in context. In other words, if you haven't already, you will face the challenge of 'coming out'. You might want to consider letting your sexuality be known at least to a few selected people. It will help staff to get to know you and your partner better and this may affect the care that your loved one receives. Before they enter the home, try to discuss how the person with dementia might like to approach this.
Wherever possible, ensure that you involve other members of the person's family in matters related to their care. They need to take some responsibility. Should difficulties arise later, they will be less likely to complain if they were consulted. Where a partner is concerned, everyone should regard you as the next of kin.
Recognise where your priorities lie. The person with dementia is the first priority. The home is simply an agent employed by you to provide care. The excellent quality of the care you have provided and may continue to provide in the home should be fully recognised.
If you are a partner
When the decision is taken to go into a care home, it is important to consider what you are going to tell staff and residents about your partner and what you are going to say about your relationship. However, your partner needs to make their own decisions, and the dementia can make this more difficult.
Some people want to be fully recognised as same-sex partners, either from the start or after a period of settling in. Some couples would rather avoid the issue. They do not wish to discuss their sexuality and do not invite questions. The carer becomes known as the resident's 'friend' and care continues on that basis.
Ideally, people in long-term relationships will have considered these issues well before the situation arises and will have agreed on their response.
Be aware that, even if the person was previously very private about being gay, dementia can cause a loss of inhibitions and so the person's sexuality may be more evident.
If you are a friend
When a close friend is in a home, you may face similar challenges to those faced by a partner, although the demands of being 'out' may not be so intense. For example, it may be noticed that most of your friend's visitors are of the same gender, and conversations may be overheard by staff and residents.
If you are a relative
It may seem unnecessary and irrelevant for a carer to 'come out' when their relative goes into a home. However, the person living in the home may be asked questions about the carer's married status and the nature of their relationship with friends who accompany them on visits, for example. People will draw their own conclusions but it is important that those close to the person are treated politely and with respect.
Further readingCare professionals may find factsheet 480, Supporting lesbian, gay and bisexual people with dementia, helpful.
Care and Social Services Inspectorate Wales (CSSIW)
Encourages the improvement of social care, early years and social services in Wales by regulation, inspection and providing professional advice.
Care Quality Commission (CQC)
Regulates, inspects and reviews all adult social care services in the public, private and voluntary sectors in England.
Regulation and Quality Improvement Authority (RQIA)
Monitors and inspects the availability and quality of health and social care services in Northern Ireland.
A charity that works to achieve equality and justice for lesbians, gay men and bisexual people of any age.
Last reviewed: February 2012
Next review due: February 2015
Reviewed by: James Taylor, Health Officer, Stonewall and Stacey Halls, LGBT Campaigns and Policy Officer, Opening Doors London
A list of sources is available on request.