Care of elderly trans people

elderly care

Picture the scene.  You look into a room and see a care worker struggling to help an elderly woman out of bed and dressed.  The woman is scared, and actively trying to stop the care worker helping.

The scene is punctuated with increasingly vocal protestations from the woman “Get off me !!”, “They’re not mine !!”, “Leave me alone !!”  Frustrated, the care worker eventually gives up, at a loss to know what to do and instead turns her attention to trying to calm the situation down.  Eventually, some 10 minutes later, the woman is back in bed rigid and tense beneath the covers and the care worker has retreated to the relative safety of her other residents and her colleagues.

You’re probably thinking the elderly woman is suffering with something like dementia or maybe altzheimers. And in truth, you’re partly right.  But the reality is a little more complicated.  The elderly woman is transgender, she transitioned some time ago, but now, because of failing mental health, no longer remembers a thing about it.  “It happens quite a bit with Mrs Cairson” (Not her real name) when I ask the nurse.  “It’s very unsettling for the staff and the other residents here.  So we try to give her some time and talk to her when it happens and let her calm down.  But it’s not always easy.  We’re struggling to balance her needs with others who have similar issues” .  “Although we want to try and integrate her into the home, she regularly gets upset or confused and it affects our other residents.  We’re finding that to keep her separate makes it easier for us to manage the peace in the facility.  We know it’s not the best answer for her, but, it’s the most practical solution we have at the moment”

Here in the UK many residential care facilities are ill-equipped and poorly trained to manage the needs of elderly transgender people, who fear that a move to assisted living may leave them vulnerable to discrimination and harassment.  Worse still, because of issues with her family and friends when Mrs Cairson transitioned, she is isolated and alone.  When I ask, the staff nurse tells me “You’re the first person who has visited her this year”.  Think about that for a moment.  She has family. It’s now June. That’s a long time to be alone and for anyone to hold onto hate.

“Ruby’s” (Mrs Cairson to you and me) situation is only one aspect of the problems facing Trans people in care.  She at least transitioned and is congruent with her gender identity.  A considerable number of trans people actually don’t complete their transition with surgery, either because of the cost, or other difficulties (such as decreased sexual function).  This is particularly true for Female to Male (FTM) transgender people.  When these people disrobe in a care home setting, they’re automatically “outed” which creates problems supporting trans people in residential care. As Kyle told me

I think women would have a problem with me sharing with them and I’d have a problem with a men unless I transitioned.  In truth, I don’t think I would want anyone to know about me, but with what I expect to be the level of gossip in such a confined space, I wouldn’t expect my “secret” would last a minute.

Bi-gendered people also struggle to thrive in care homes too.  They often fear that the homes policy will force them to be totally one gender or the other and exiled from the gender identity bringing them more distress.  As an attempt to appease the situation, one care home I went to told me “we allow trans residents to dress in appropriate clothes in their own rooms.  That is, when their room-mate is agreeable”.  Does this really sound like a solution ?

Many people I have spoken to have said “they would prefer to be left to die at home rather than be in a residential care home facility”.  When I asked why, the most common concern is the type of care they think they would receive, as well as if their gender identities be respected, allowing them to live their last moments with grace and dignity.

Past research has found that many transgender people avoid seeing a doctor for fear of being ostracized. Of those who do seek health care, a survey of transgender people found that 22 percent had suffered harassment in medical settings, including ridicule or rough treatment. 15 percent said that they had been denied care altogether by doctors and other providers, and 50 percent reported having to educate their medical providers on transgender care.

Isn’t it time for a better solution ?

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