Tim R. Johnston, Ph.D., senior director of national projects for LGBT elder advocacy organization SAGE, spent a year and a half working on his new book, “Welcoming LGBT Residents: A Practical Guide for Senior Living Staff.” He recently answered some questions for me about the book and its subject matter as well as his work at SAGE.

Q: What prompted you to write a book on this topic? And why now?

A: During my time at SAGE, I’ve conducted hundreds of SAGECare LGBT cultural competency trainings all around the country. I have experience working with a wide variety of providers from different geographic, political and religious backgrounds.

My goal was to take that experience and write a book that recognizes everyone has a different level of familiarity with the topic of LGBT inclusion, and is a friendly and accessible resource for anyone working in a senior living community. There are a lot of great resources out there, and I thought a concise guide that is easy to reference would be another useful tool for administrators and other senior living staff.

Q: Overall, what’s the most important thing senior living providers can do to create a more affirming environment for LGBT residents? Is there a best place to start?

A: The most common thing I hear when I talk about our work is, “Wow, I never thought about LGBT people getting older!” What this suggests to me is that your staff don’t know what they don’t know, which is why I believe that staff training is the most important place to start. The majority of staff want to provide excellent care to all residents, and effective training can help them do their job to the best of their ability.

This is also a topic that is still stigmatized and often ignored. I always tell people that you never know who will champion efforts to be more inclusive, and who will push back. The only way to learn where people stand is to start training and discussing LGBT inclusion.

Q: The book description says that the LGBT older adult population represents one of the fastest-growing subpopulations within the aging society. Can you share some statistics related to that?

A: Because most census tools do not ask questions about sexual orientation and gender identity it is difficult to know how many LGBT older adults live in the United States. Conservative estimates suggest that by 2030, there could be more than 5 million LGBT people who are over the age of 50.

Additionally, many older people who are not LGBT have LGBT-identified family members and loved ones. Creating communities where all of these people feel welcomed and supported is an excellent way to distinguish your community and services.

Q: What are the trends regarding LGBT older adults moving into senior living communities?

A: We see that some folks are fearful or apprehensive about moving into a senior living community. This is particularly true for people who may be entering a congregate living community or rehabilitation building after being hospitalized. These folks have often not been able to “shop around” for a community where they feel more comfortable. Some folks might be out of the closet from the first day, and others will wait until they hear clear messages from staff and other residents that they will be safe and respected if they choose to disclose their identity.

A recent survey of AARP members found that “the possibility of being forced to hide one’s identity as a condition of receiving care is a concern for just under half of lesbian, gay and bisexual respondents and for 70% of transgender and gender expansive respondents.” There is very real fear out there, which means that as providers and advocates, we need to be intentional about how we create safer services.

Q: What are the biggest misconceptions you’ve uncovered through your work regarding senior living providers creating a more affirming environment for LGBT residents?

A: There are many misconceptions! The first is that all of the other residents will react poorly to a community becoming more LGBT inclusive. Many non-LGBT residents have friends and family members who identify as LGBT and may welcome your efforts to be more inclusive because it will help their loved ones to feel more welcome. Yes, some residents might raise concerns, and staff should be prepared to address those concerns as they come up.

The second misconception is that if we “treat all residents the same,” we will be meeting the needs of LGBT people. The fact is that for many reasons, LGBT older people often need some additional care, consideration and outreach if they are going to feel comfortable. As I note in the book, there is a big difference between treating people equally and treating them equitably.

Lastly, some people think that making communities better for LGBT people is only focusing on a small subset of residents. While it is true that LGBT people are not the majority of your residents, the recommendations in the book are in line with general tenets of cultural change and person-centered care, which means that these changes can benefit all residents and staff.

Q: How has your work with SAGE — for instance, SAGECare — been affected by the pandemic? Is SAGE still training people who work in senior living right now?

A: We have been working hard to continue supporting senior living providers who are working on the front lines of this pandemic. The biggest change is that we now offer all of our training sessions as online learning modules or hybrid trainings that include online modules and live video meetings with SAGECare trainers. I am incredibly impressed by the dedication and care demonstrated by those working in senior living, and we remain here to support our clients however we can.

Q: In addition to your book, what recommendations would you have for operators who want their communities to be more welcoming, diverse and inclusive?

A: Train your staff, update your nondiscrimination policies and procedures to be LGBT inclusive, think about affirmative outreach and programming to reach LGBT people, and build relationships with local LGBT community groups and advocacy organizations. There is no one-size-fits-all set of recommendations, so be ready to hear feedback, adapt and share your journey with others in your network.

Q: What else would you like McKnight’s Senior Living readers to know?

A: At SAGE, we are lucky to work with a broad network of passionate advocates and activists, and I want to affirm that everyone has a role to play in supporting LGBT residents. None of us professional advocates could do our work without the support of allies and others who may not themselves identify as LGBT but who help to make the world more inclusive every day. There is room for all of us in this movement!

Learn more about the book here.

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