2S-LGBTQ+ Seniors: Our Existence is Our Resistance!

We are grateful to the Senior Pride Network Toronto for their tremendously important contribution – below – calling to recognize the human rights of older 2-spirit, lesbian, gay, bisexual, transgender, transsexual, queer and intersex (2S-LGBTQ+) people in the City of Toronto, in particular those who reside in a long-term care home. We hear the call of the authors that the first step is to acknowledge the existence of people who have been discriminated and ignored, and consequently have suffered the health impacts of that neglect. We hope this article makes a small contribution to that goal. The surveys mentioned in the article can be found here and here.

For our 2S-LGBTQ+ seniors, the COVID-19 pandemic is a cruel reminder that the long-term care (LTC) system in Ontario is neglectful of, or unresponsive to, our particular health issues, needs and concerns. Sadly, 2S-LGBTQ+ seniors are mostly invisible in LTC homes. Many homes claim to not have any 2S-LGBTQ+ residents. And data are unavailable on the number of 2S-LGBTQ+ residents, the number who contracted COVID-19 or those who died after contracting it. The measures and care protocols adopted to respond to COVID-19 generally do not acknowledge the existence of 2S-LGBTQ+ residents and do not consider the particular vulnerabilities, inter-related health issues and particular care needs of 2S-LGBTQ+ seniors.

As older persons and those with chronic health conditions or weakened immune systems, 2S-LGBTQ+ seniors who contract COVID-19 are at higher risk of developing more severe illness and complications, and of dying from it. Recent national surveys have found that 2S-LGBTQ+ people are more vulnerable to COVID-19 than other persons. Specifically, 

• 29% are living with a chronic health condition, compared with 15% of other people;
• 21% who identify as Black, Indigenous and People of Colour (BIPOC) have been admitted to the hospital for COVID-19 compared to 9% of both 2S-LGBTQ+ people in general and the national population;
• those who identify as BIPOC are more likely than the general population to know somebody who has died from COVID-19 (Egale and INNOVATIVE Research Group, 2020).

Research studies have shown that our 2S-LGBTQ+ populations are at greater risk of developing cardiovascular disease, cancers, kidney and liver diseases, HIV/AIDS and related co-morbidities, and respiratory diseases such as asthma. Caregivers in LTC homes need to be knowledgeable about underlying medical conditions and co-morbidities, their causes and their effects on 2S-LGBTQ+ seniors, and in particular on those who contracted COVID-19.

In addition, 2S-LGBTQ+ residents experience anxiety and worry about LTC staff. The staff, with few exceptions, are untrained, little-trained or ill-trained in these residents’ specific care issues and needs. 2S-LGBTQ+ residents also often experience, or have a fear of experiencing, discrimination, harassment and abuse (physical or verbal) in LTC homes. LTC staff may be uncomfortable with 2S-LGBTQ+ people or have biases or negative attitudes (including homophobia, transphobia and biphobia). These fears and concerns are intensified during COVID-19 outbreaks.

Many 2S-LGBTQ+ seniors are already socially isolated before moving into LTC homes. We have experienced rejection or denial by our biological families and are less likely to be in a spousal relationship or to have children or other “blood relatives” on whom we may rely for social and emotional support and care. Our biggest fear is dying alone and forgotten once we become residents of LTC.

In order to reduce social isolation and build personal support networks, 2S-LGBTQ+ seniors increasingly rely on our chosen families (surrogate, non-biological) or a circle of friends (e.g. partners, close friends, caregivers). However, we often discover that our relationships and chosen families are not recognized or respected by their LTC home.

Strict social distancing protocols and restrictions on visitors imposed during outbreaks of COVID-19 in LTC homes cause even greater social isolation for 2S-LGBTQ+ residents. As a result, we experience greater loneliness, depression, despair and a deterioration in our physical health and general well-being. To mitigate social isolation and provide emotional and social support for us, LTC homes must be required to recognize and respect 2S-LGBTQ+ spousal relationships, chosen family members and support networks for visitation and for providing essential care.

Critical improvements are required urgently to ensure that LTC homes are sensitive to and inclusive of the needs, care preferences, and life experiences of 2S-LGBTQ+ seniors. There is a pressing need to integrate awareness and inclusivity of 2S-LGBTQ+ seniors, and respect for them, in the LTC system and in the system’s response to COVID-19.

Ontario Senior Pride, an ad hoc coalition of The Senior Pride Network Toronto and six other Ontario groups, has made a submission to Ontario’s Long-Term Care COVID-19 Commission that addresses the many problems confronting 2S-LGBTQ+ seniors.  It makes 14 recommendations to the Commission and the Ontario Government that when implemented would help to make the LTC system more inclusive of 2S-LGBTQ+ seniors and more responsive to our needs.

We expect ALL LTC homes, service providers and levels of government in Ontario and Canada to acknowledge our existence. This simple action will improve and save our lives. We want and expect the basic human rights of kindness, caring, compassion, dignity, safety and RESPECT!