Lesbian, Gay, Bisexual, Transgender and Intersex (LGBTI) Individuals

Lesbian, Gay, Bisexual, Transgender and Intersex (LGBTI) Individuals

Care approaches have often assumed that people are heterosexual and gender conforming. Yet estimates suggest that up to 11% of Australians are of diverse sexual orientation, sex or gender identity.

The following resources can support more inclusive care.

Key Resources

LGBTI (CareSearch Review Collection)

LGTBI Ageing and Aged Care Resources (Department of Health and Aged Care)

Resources for LGTBI Carers (Carer Gateway)

Support for older Australians of diverse sexual orientation and gender identity (My Aged Care)

Silver Rainbow (LGBTIQ+ Health Australia)

Practice issues

Action plan for older lesbian, gay, bisexual, trans and gender diverse, and intersex elders: a Guide for Aged Care Providers 2019 (Currenty freely available)
This guide presents actions address specific barriers and challenges faced by this group. It includes case studies, links to existing resources, and a separate consumer-focused document.

Barrett C. My people: A project exploring the experiences of gay, lesbian, bisexual, transgender and intersex seniors in aged-care services. Matrix Guild Victoria and Vintage Men Inc. 2008. (freely accessible 363kb pdf)
This document is a report of the first program stage that explores the experiences of GLBTI seniors in aged-care services to guide the aged care sector to make changes in the care of GLBTI individuals. Key findings of the study can be grouped by theme and include impact of historical experiences of discrimination, invisibility as an impact of discrimination, identity concealment, impact of dementia, enabling sexual and cultural expression and inadequate standards of care.

Barrett C, Harrison J, Kent J. Permission to speak: Determining strategies towards the development of gay, lesbian, bisexual, transgender and intersex friendly aged care services in Victoria. 2009. Matrix Guild Victoria Inc. and Vintage Men Inc. (freely accessible 511kb pdf) 
This report presents the experiences of aged care services providers regarding GLBTI-friendly aged care services in Victoria.

Barrett C. We live here too: A guide to lesbian inclusive practice in aged care. 2011 Matrix Guild Victoria Inc., Melbourne (freely accessible 3.4MB pdf)
This guide has been adapted from a report developed by the Ministerial Advisory Committee for GLBTI Health and Wellbeing in Victoria called 'Well Proud: a guide to gay, lesbian, bisexual, transgender and intersex inclusive practice for health and human services' (2008). The aim of this guide is to provide information to residential aged care services to meet the needs of older lesbians living in care facilities.

Barrett C, Stephens K. Beyond: 'We treat everyone the same' a report on the 2010-2011 program: How to create a gay, lesbian, bisexual, transgender and intersex inclusive service. Gay and Lesbian Health Victoria, La Trobe University, Melbourne 2012. (freely accessible 570kb pdf)
This report is based on a training program to support participants to plan, implement and evaluate changes in their service to enhance GLBTI inclusive practice in their organisation. Sections include barriers to change, the role of enablers to promote change, stories from the field and program logic models.

Barrett C, Whyte C. Creating Lesbian, Gay, Bisexual, Transgender and Intersex (LGBTI) inclusive residential aged care services (The RAC Pack): draft. 2013. (freely accessible 965kb pdf) 
This resource has been developed for Residential Aged Care Services to assist them in meeting the needs of lesbian, gay, bisexual, transgender and intersex (GLBTI) clients. The aim of this resource is to assist service providers to develop the awareness, practical skills, guidance and confidence to provide LGBTI inclusive services.

Cartwright C, Hughes M, Lienert T. End-of-life care for gay, lesbian, bisexual and transgender people. Cult Health Sex. 2012;14(5):537-48.
This exploratory study aimed to achieve an initial understanding of these issues to inform the development of a larger study involving gay, lesbian, bisexual and transgender service users. Participants reported barriers to health care service access due to discrimination, inappropriate care and lack of knowledge among both consumers and health care workers of legal rights at the end-of-life. The study highlighted the need for education for gay, lesbian, bisexual and transgender people and health and aged care providers on existing legal provisions to prevent discrimination in end-of-life care.

GLBTI Retirement Association Incorporated (GRAI) and Curtin Health Innovation Research Institute Best practice guidelines: Accommodating older gay, lesbian, bisexual, trans and intersex (GLBTI) people. 2010. (freely accessible 2.19MB pdf)
These guidelines aim to provide practical strategies to the providers of retirement and residential aged care, so that they are better able to recognise, understand and meet the specific needs of GLBTI people whilst supporting existing best practice frameworks used by providers of retirement and residential aged care.

Harding R, Epiphaniou E, Chidgey-Clark J. Needs, experiences, and preferences of sexual minorities for end-of-life care and palliative care: A systematic review. J Palliat Med. 2012 May;15(5):602-11.
The aim of this paper was to identify and appraise the existing evidence for the needs, experiences, and preferences for palliative and end-of-life (EOL) care in lesbian, gay, bisexual and transgender (LGBT) populations. After examining 4483 articles, existing evidence is explicit and indeed repetitive in highlighting the educational needs of health care professionals to explore sexual preferences, avoid heterosexist assumptions and recognize the importance of partners in decision making. There is also a significant need to research LGBT experiences and refine services for patients and their caregivers.

Hughes M, Cartwright C. LGBT people's knowledge of and preparedness to discuss end-of-life care planning options. Health Soc Care Community. 2014 Sep;22(5):545-52. 
This paper reports findings of a survey of 305 LGBT people living in New South Wales, which examined their knowledge of and attitudes towards end-of-life care. The focus of this paper is their preparedness to discuss with healthcare providers any end-of-life care plans. The paper highlights the importance of education strategies to raise awareness of the end-of-life care planning options among LGBT people, as well as strategies for increasing health providers' preparedness to discuss these issues with LGBT patients.

Lisy K, Peters MDJ, Schofield P, Jefford M. Experiences and unmet needs of lesbian, gay, and bisexual people with cancer care: A systematic review and meta-synthesis. Psychooncology. 2018 Feb 20. doi: 10.1002/pon.4674. [Epub ahead of print]
A systematic review of care received by lesbian, gay and bisexual (LGB) people with cancer, shows a need for training of health care professionals to provide culturally-appropriate care. Highlighting an often heterocentric approach that isolates LGB patients and their families, six major themes emerged from the review: disclosure; homophobia; health care professional behaviour; heterocentric care; support groups; and unmet needs such as information on and discussion of treatment options. A useful list of recommendations for practice and policy are provided to support improved LGB cancer care.

Rawlings D. End-of-life care considerations for gay, lesbian, bisexual, and transgender individuals. Int J Palliat Nurs. 2012 Jan;18(1):29-34.
This article takes a brief look at some of the issues specific to the end-of-life care of GLBT individuals, using a case study as an illustrative example. Holistic care at the end-of-life is a familiar concept to palliative care nurses, but it is important to place greater emphasis on considering competence in aspects of care relating to sexuality.

Policy and management considerations

Barrett C, Stephens K. GLBTI inclusive practice: working with rural communities. 2012. Gay and Lesbian Health Victoria (freely accessible 863kb pdf)
This document outlines the issues and opportunities for rural health and human services implementing the National Standards for gay, lesbian, bisexual, transgender and intersex (GLBTI) inclusive practice. This document is intended to complement the National Standards for GLBTI inclusive practice developed by Gay and Lesbian Health Victoria.

National Lesbian, Gay, Bisexual, Transgender and Intersex (LGBTI) ageing and aged care strategy. 2012 Department of Health (freely accessible 4.0MB pdf)  
This Strategy aims to ensure that LGBTI people have the same opportunities and options in aged care that are available to other members of the community. It is designed to not only raise awareness of the issues but also to improve the ageing and aged care experience of LGBTI people. Aged care services need to ensure that they provide a consumer directed approach to meeting the care needs of older LGBTI people, resulting in appropriate and targeted services. It is essential for aged care services to support the lives of older LGBTI people, their families and carers to continue to contribute to and engage with their communities.

Ministerial Advisory Committee on Gay Lesbian Bisexual Transgender and Intersex Health and Wellbeing (Victorian Government, Department of Health) Well proud. A guide to gay, lesbian, bisexual, transgender and intersex inclusive practice for health and human services. 2011. (freely accessible 409kb pdf)
Evidence based recommendations for supporting services to be more responsive to issues of sexual orientation, gender identity and intersex conditions. These guidelines include recommendations for specific health care settings, GLBTI subgroups and health and wellbeing needs.

Associated materials

ELDAC Project Australia’s ageing LGTBI population. Current (freely accessible website)
This page provides an overview of issues ad potential considerations for care at the end of life for the LGTBI population.

The Mosaic app assists LGBTI people to better plan their ageing, assist care teams to better know their clients and to build safe inclusive practice. Mosaic allows organisations to benchmark and market their safe inclusive care and to learn how to build a safer, more inclusive service for LGBTI people.

ACON Health LGBTI Aged care training e-learning module. Current (freely accessible online resource)
This e-learning module is funded through the Department of Social Services and the National LGBTI Alliance, the aim of this online training module is to better meet the needs of LGBTI seniors through educating and supporting the aged care sector to provide inclusive health and support services.

Information for Nurses - Lesbian, Gay, Bisexual, Transgender and Intersex (LGBTI). CareSearch Current (freely accessible website)
Overview of issues in relation to palliative care for gay, lesbian, bisexual, transgender and intersex individuals. Includes links to further information, consumer resources and one-click topic searching of evidence through to PubMed database.

Cartwright C, Lienert T, Beck K. Knowledge about and attitudes towards end-of-life care for gay, lesbian, bisexual and transgender people Phase 2, Stage 1: State-wide survey. 2010. ASLaRC, Southern Cross University.
Stage 1, which is the subject of this Report, is a state-wide hard copy and on-line survey and a series of in-depth interviews. Survey questions include topics regarding GLBTI individuals experience with Advance Care Planning options, experience with serious illness, health care provider/end-of-life care discussions, substitute decision-making and preferred place to die.

Rainbow Health Victoria online resource library. Rainbow Health Victoria Current (freely accessible website)
The Rainbow Health online library has extensive information about GLBTI health and associated subjects. Searches can be completed using pre-defined search topics or by entering keywords or resource type.

LGBTI Ageing and aged care. LGBTIQ+ Health Australia Current (freely accessible website) 
LGBTIQ+ Health Australia is the national peak health organisation in Australia for organisations and individuals that provide health-related programs, services and research focused on lesbian, gay, bisexual, transgender, and intersex people and other sexuality and gender diverse (LGBTI) people and communities. This website provides information on health related programs, services and research on GLBTI issues.

Ageing Intersex Human Rights Australia (IHRA)
Intersex people are born with physical sex characteristics that don’t fit medical norms for female or male bodies. We have many different kinds of bodies and life experiences. IHRA is a national body by and for people with intersex variations.

Page updated 17 January 2020