 Hello and welcome to 353 participants who've joined tonight's webinar and all the viewers who are watching the podcast MHPN wishes to acknowledge the traditional custodians of the lands across Australia upon which our webinar presenters and participants are located. We wish to pay respects to the elders past, present and future, for the memories, the traditions, the culture and hopes of Indigenous Australia. Hello, I'm Catherine Bolland and I'll be facilitating tonight's session which involves working collaboratively to address the social and emotional well-being of older LGBTI people. I'm pretty excited about tonight's panel because we have a wide range of expertise and I can see from the people who've logged on so far we have diverse backgrounds from people all over Australia so welcome to you all. Before we begin tonight we'd like to conduct a little poll amongst you all just to ascertain your level of experience and background in this area and to that end we would like to ask you a little bit about whether you've undertaken any training relating to the LGBTI aged care strategy so if you could just respond to that poll that would be excellent. Alright, thanks. Interestingly I can see that there is a large need for this sort of training tonight noticing that around about 90% of you haven't received any training at all and around 10% of you have. So thanks for the poll. I think tonight we'll be in good hands and I'd like to introduce our panelist to you who can start the process of our education and training. So first of all I'd like to introduce Associate Professor Ruth McNam. Ruth is a GP in Victoria and Ruth I noticed that you're the chairperson of the Gay and Lesbian Foundation of Australia. Can you tell us a little bit about what sort of work you're currently doing with that foundation? Yeah that's a philanthropic group that's designed to meet the needs of LGBTI Australians and so we're doing some projects on homelessness amongst LGBTI young people and any age and also work in the aged care space providing grants for applications for projects. That's pretty exciting work. Yeah it sounds very interesting and diverse. Thanks Ruth. I'd now like to introduce Professor Mark Hughes who's a social worker in academic. Now Mark I understand from reading your bio that you're currently undertaking a lot of research on lesbian and gay people's experience and expectations in accessing services and the care networks of older LGBTI people. Can you tell us a little bit about the work that you're doing in that area? Well I've been involved in a few research projects. The most recent one has been looking at health and wellbeing of LGBTI seniors in New South Wales and some of the interesting findings we've identified are the higher levels of psychological distress and also the higher levels of loneliness amongst older LGBTI people and I think it's important to stress that not everybody is lonely or experiences significant mental health issues but typically a higher proportion do than the general population. That's such an interesting important research. We'll tap into your expertise a little bit later. Alright I'd now also like to introduce Associate Professor Damien Riggs who's a academic author and psychotherapist. Damien I know that amongst your other achievements you work in private practice specialising with young transgendered people and you're I think doing some research in that area. Can you tell us a little bit about that work? Yeah for a few years I've been doing research on transgendered people's mental health in Australia and more recently and yeah informed by my clinical work focusing on young people's transgendered people's needs from us as mental health professionals what they want from us in terms of service and how important that service is. Excellent and important work. Alright and last but not certainly not least I'd like to welcome Associate Professor Lynette McKenzie who is an occupational therapist from New South Wales. So Lynette I understand from reading your bio you're heavily involved in research for the NH and MRC in terms of ageing and access to services. Can you tell us a little bit about the research you're involved with? Yes certainly unfortunately unlike the other panel members my research hasn't been directly connected with LGBTI people however it's been in a lot to do with residential care and the services and ways in which we can improve the service that older people receive in residential care. Wonderful I think that you know comprehensively we have a panel who are going to help us very much understand this issue coming from the different disciplines and the different and diverse experiences of the panel. So just to let you know a little bit about the format of tonight each of the panelists are going to give a short response to explaining their approach to the case study and then there will be some questions and answers between the panel and between the panel and you guys the audience and many of you have written in with some questions already for our panel and I'll be trying diligently this evening to try and address the questions that you have. So just to go over a couple of round rules so that we can all get the most from this learning experience. In order to ensure that everybody has the opportunity to gain the most from it I'd like you to all be respectful of other participants and panelists and behave as you would in a face-to-face activity. You can post your comments and questions for the panelists in the general chat drop-down box you'll see at the below left of your screen. If you have or need help with technical issues post your query in the technical help chat box. Remember that comments posted in the chat boxes can be seen by all panelists and so try to keep your comments on topic. If you become distracted or you would like to hide the chat just click the small drop-down arrow next to the chat box. But your feedback is very important to us and we'd like you to ask us questions and we will hopefully respond to those questions. I'd like to also address the learning outcomes for this evening's webinar. What we would like to do is through an interdisciplinary panel discussion about older lesbian gay bisexual transgender or intersex people this webinar will enable you to be better equipped to describe inclusive accessible and appropriate aged care needs for LGBTI people. To implement key principles of providing an integrated approach to the social and emotional well-being for older LGBTI people and to identify challenges, tips and strategies in providing a collaborative approach a response to supporting the social emotional well-being of older LGBTI people. To that end you've all been provided with a case study and I'd like to just remind you that the case study is available on the resources section if you need to refresh yourself. But the panelists tonight are going to center their discussion on Jan who's a 77-year-old lesbian with a partner of 30 years Louise who Jan considers her next of kin. Jan had a stroke five years ago and has recently found it difficult to cope at home so she moved to aged care. She has become withdrawn and depressed because the residents are not talking to her and nurses are not treating her well and she's feeling isolated and lonely. Both Jan and Louise think that the exclusion is because they are lesbians and that people are feeling uncomfortable with it. Recently when they were in Jan's room together cuddling on the couch while watching a movie a nurse came in and said that they shouldn't be doing that as it might upset other residents. Louise noticed that after this incident Jan had become more depressed. Louise has spoken to the manager but feel she isn't seen as next of kin and her feedback has fallen on deaf ears and now she doesn't know what to do. And so I'm going to ask Associate Professor Ruth McNair to start her presentation. Hi everyone. So this is a case that's unfortunately very common. We understand from a lot of older LGBTI people that they don't feel comfortable in aged care facilities or with aged care in their homes. I think it's an opportunity to look at the principles that have been written into the aging and aged care strategy that was produced by the Commonwealth Government a couple of years ago that's linked to that is in the resources that you'll see in the box down the ride. So I just thought I'd follow through the principles within that document because it's very helpful and also we can see now that it's legislated through the federal government so it's something that we all are supposed to be doing. So the first principle is about inclusion and I've decided to think about Jan's same-sex partner as her legal next of kin so that's one of the issues that seems to be coming up for Jan and Louise that Louise feels that she's not being heard by the staff around her concerns for Jan. And you're probably aware that in every state and territory now there's legislation that says that a same-sex couple is the legal next of kin for a person who's in a hospital health care setting so it's important to recognise. The second thing I think is around respect for their need for privacy and intimacy and this comes up for anyone in aged care services that their sexuality overall can be disregarded or they find it difficult to express and even more so for a same-sex couple who are trying to maintain some intimacy in their relationship but to be told by a staff member that it would be uncomfortable for other people is pretty confronting. The second principle is empowerment and I think this is very clear that this couple both Jan and her partner need some support in how to access support for what's happening for Jan. So we need some discussion with Louise about what's happening to allow her to feel heard but also they might need some professional advocacy. I think some of the other panelists might go into that in more detail around the social work aspect but I mean from a GP perspective if I was visiting Jan at that nursing home and noticing that she was becoming increasingly withdrawn and depressed I've got to be asking what's happening for her generally you know there are the medical issues that are involved and then trying to understand whether it's related to her sexual orientation. Disclosure is one of the issues around empowerment that's mentioned specifically in the strategy and I think it isn't difficult for health providers because some clients or patients don't want or need to disclose their sexual orientation and may choose to remain quiet about it. I think in this case study the two women have it seems been quite open about their relationship but are now being asked to go back in the closet if you like. So I think when we're thinking about disclosure when a person first enters aged care or home-based care we may not expect them to come out necessarily in the first instance but to develop some trust before they come out to a provider. But secondly I've heard a lot of reports from clients of mine that when they have to access aged care services within their home they feel like they have to de-gay their environment to create a safer space for themselves so they don't feel they have to disclose until they understand that provider is going to be sensitive. I think we have to be very sensitive to the fact that people put a lot of thought into this about whether to disclose or not and once they have disclosed they want to have a supportive and inclusive approach. Another part of empowerment that I've found very useful in my practice is allowing people to connect with LGBTI communities or encouraging them to connect and this may be something that Louise needs support with here. She's now living alone with her partner in an aged care facility. She's meeting some support outside of that facility so there may be a need to refer her to some aged care, sorry, some LGBTI focus networks that would help her through this. QLife is one example. It's an online support service that's provided by councillors and psychologists. It's available I think every evening of the week for people to log in either to phone or to use online chat and get some support that's very LGBTI specific so that's something that you could do for Louise. The third principle in the strategy is around access and equity and this in terms of LGBTI issues it's largely about treating LGBTI people in aged care with respect, not ignoring their sexual orientation or gender identity but enabling them to come out if necessary and this might involve using appropriate language so using language they use for their own relationship. These women might not say they're lesbian, they might say they're in the same sex relationship without using any labels so we would need to follow the queue on that. But also having inclusive intake forms and that's one of the issues that comes up frequently from client groups that if they're attending a service there's a form that doesn't allow them to describe their same sexual relationship or their gender or sexual identity that can be a difficult starting point and therefore not an equitable arrangement. Of course access and equity also involves non-discrimination from all staff and I think this can be very difficult for an aged care service where there's a wide range of staff, some staff are overseas trained, they may come from a country or a perspective or a moral value that does not agree with sexual orientation that's not heterosexual, does not understand trans issues for example. So I think it's incumbent upon management to help those staff to understand that despite their own moral or personal viewpoints they still are required to provide an undiscriminatory service to LGBTI people. There's a really nice tool that Bell's Cafe have produced, the picture there on that slide demonstrates it's also in the resources that allows the service to think about the access and equity issues from an LGBTI perspective and what they can do to improve their service access. The fourth principle in the strategy is around quality of care and this is partly about from the management down in producing inclusive policies. So for this couple it might be something that would have flowed through if there's a policy around respect for diversity that has been embedded into staff training then it may have been less likely that a staff member would go into the room and ask them to avoid personal contact with each other. It might be more likely that a staff member would pick up the fact that Jan is becoming depressed and try to uncover that in more detail and you know professional development is a really big part of this quality of care principle that staff are trained up in this area. I guess that's why you're all here tonight. And you know part of that training is about skills in facilitating disclosure sensitively and about creating a culturally safe environment for clients. And finally the fifth principle is capacity building of LGBTI individuals and communities and this is largely about engaging with LGBTI carers, with communities surrounding the facility and trying to understand whether there's feedback that can be embedded in improved services. So that's it from me. I guess thinking about training there's also some resources there to do with the Silver Rainbow program which has run through the National LGBTI Health Alliance that provides some training in each state and territory and some of you may have done that. There's also a small online training program that takes about an hour and it's really accessible so that's a free service through the Silver Rainbow thing. So you know that's out there if this webinar tweaks your interest and you've got a bit of space to have a look at that. Thanks very much. All right thanks Rhys. I'd now like to turn over to Associate Professor Damien Riggs who's going to give us his perspective. Thanks Catherine and thanks Ruth. So I'm sort of throwing the idea out there that whilst it's not written into the case study whether or not the women are transgender what it might mean if we think about being transgender and certainly we know from previous research that a significant proportion of transgender women identify as lesbian. So this obviously draws our attention to the difference between gender and sexuality here. So what might it mean to think about being transgender living in an aged care facility. So we know from previous research and we know more generally beyond the aged care sector that cisgenderism impacts upon transgender people. So Gavi Ansara and his colleagues have cisgenderism as the ideology that delegitimizes people's own understanding of their bodies and genders. So what does that mean? That means that when someone says this is my gender this is what my body means to me regardless of what you might think it should mean what my particular genitalia or body part you think they should mean this is what they mean to me. And when someone says no that's not the case this is how it is. That is a form of cisgenderism and there's many forms of cisgenderism take whether it is refusing to use someone's preferred pronouns, refusing to use someone's correct name, making references to their gender history when they don't want that being disclosed. So there's many different forms of cisgenderism take. So we want to think about what that might mean for Jan and for Louise in the context of the aged care facility. So we know from previous research and Sally Heinz's research is a great example of this. Many of her participants were older transgender women and for example Christine one of her participants said in the 1960s and 70s the scenario is very different from how it is now. You left school and you did your duty you didn't queer anything you got your career and marriage and had children. You didn't have time to think about what you were and that was the environment that I was in. So Sally Heinz suggests and certainly I would suggest as well that many older transgender women have not transitioned until later in life because they didn't think that was possible. What that can mean for some women is that due to other health issues, aging in general, perhaps medications they might already be on, some of the aspects of their gender transition may not be possible. Hormones might be contraindicated. The surgery might be contraindicated. So all these things impact upon older transgender women's journeys. What do we know about transgender people's experiences of health care providers? As I said earlier in the introduction a lot of my research has focused on this and we've really found very consistently and I have other researchers that a majority in pretty much every sample of transgender people report negative experiences with health care providers across the board and this includes a lack of knowledge. It includes having to teach professionals through their transgender people receive adequate services. But it can also be pathologizing. There are explicit transphobic comments. It can be gatekeeping. They're keeping people out of services and a general lack of access to services and obviously that depends on where people live but we know that people really struggle to get into the Is it a very specific or mental problem? I was reading again today a case study that I put into the resources for everyone to look at by Janine Marshall and her colleagues which is a case study of a woman, a transgender woman with dementia living in an aged care facility and her sense of herself as a woman fluctuated and so they asked her daughter who was her only surviving relative what did she think and she said no no she's a man she should be wearing men's clothing she kind of took away her clothing her woman's clothing so family members can play a really important role for transgender people in aged care services either to support them or potentially to undermine them so there's something really I think to be to have our eyes open for and to be watching out for and partners is the same so it looks like from our case study the ways in Jan have a very loving relationship what might be the case if Jan's partner was not so supportive how again could that be undermining of Jan in the facility and more broadly as we know from the case study how might other people living in the facility or undermine a transgender person's sense of place so that's my general thought that's the references that I've referred to that you might like to follow up thank you very much fantastic thanks Damian very interesting and informative perspective as always all right I'm now going to turn our attention to Mark Hughes who is going to give us a perspective of the social worker thanks Mark hi everyone I think from a social work perspective a psychosocial assessment would really help to get a holistic picture of Jan's situation and the kinds of issues that are impacting on her and the resources available so psychosocial assessments are really common strategies within social work assessments particularly in health settings and so that kind of assessment would think about things like look at things like the impact of physical and mental health on her including her emotional and bodily experiences it would look at a sense of self identities relationships and communities such as the significance of identifying as a lesbian an attachment to lesbian communities and really try to unpick and explore how that sense of identity might have changed or shifted over time as Damian alluded to it will also look at social supports and the community resources that are available to her including both in the residential care facility and also externally and this might include staff obviously her partner Louise's family and don't forget the friends and the neighbors who also were important supports when she was living at home and also I think psychosocial assessment would look at her experience across the life course recognizing her history life experiences and really emphasizing that she's a person bringing all this history with her she's not simply a diagnosis and she's not simply a label lesbian and the psychosocial assessment will also look at the interconnections between all of these factors for example the impact of health on her sense of self in terms of power I mean social workers typically try to understand people within their social and political contexts and so we're going to be really concerned about the power dynamics and the potential abuse of power in this situation and I think there's clear evidence that staff are abusing their power in this circumstance and while we need to be sensitive and respectful that staff come from different kinds of perspectives we also need to acknowledge when discrimination or the abuse of power has actually has actually happened. Social workers are often also focused on enabling people to tell stories about their life and trying to gain a deeper understanding about people's situations by enabling them to talk about what's significant to them and to express their identity and sense of self in their own way. Social workers will also often focus on people's strengths so recognizing the person's strengths both as an individual and also in terms of the resources that they have available to them rather than emphasize the deficits that they might have for experience. The other thing is that social workers will also because we try to understand people's situation in a social and political context we also try to seek opportunities for change within people's environment and sometimes it may be that changing the environment, changing the aged care system or people's social networks might have the most beneficial impact rather than focusing on the individual themselves. One of the key strategies that social workers might be involved in in this situation would be case advocacy and this involves representing the interests of another person usually due to incapacity or due to discrimination. So in this situation a social worker might be concerned to represent Jan's needs to those who might be in authority or to people who might be able to influence the situation but represent her needs in a way which is respectful of her own wishes and her own circumstances and certainly will be concerned not to make things more difficult for her in that circumstance so not to make things more difficult for her in the residential facility. So a focus for a social work approach to advocacy would be enabling her own voice to be heard and supporting her to make her views known to the people who might be able to influence the situation such as a director of nursing. Advocacy should usually be done in a careful and strategic way and working collaboratively across support systems to ensure that the person's interests are best represented. And in Jan's situation it might also involve enabling her to access legal representation and potentially accessing community advocacy services such as Seniors Rights Service in New South Wales and also there might be the potential for political leverage through contacting local members of parliament and so on. The other thing I'll just say about advocacy also is that sometimes social workers take a bigger picture perspective and they look at engaging in what's referred to as cause advocacy and this is where you identify a situation that might be impacting on a range of people and so the social worker might not only be working with the individual but also trying to understand and make connections with other people experiencing similar situations. So in this situation for example we might identify discrimination faced by LGBT people in aged care and the social worker might seek to work on behalf of that group of people rather than just solely with the individual. So that might involve building coalitions between key stakeholders and influential people or groups such as LGBTI community organisations or media or politicians or aged care peak bodies and lobbying for political and legal reform in this kind of area. So and also engaging in policy practice what we refer to as policy practice which is kind of taking opportunities within everyday practice to influence policy for example writing submissions and getting involved in activist groups and so on. And so although these kinds of strategies might not resolve Jan's immediate situation they may assist in making sure that other people don't go through a similar kind of situation in the future. The last thing that I just point to is recognising the importance of training for aged care staff. I'd also highlight the need for a whole of organisation culture change. So it's one thing to provide training but it's another thing to really look carefully honestly and critically at an organisation and how responsive it is to the needs of LGBTI people. And as Ruth alluded to it might involve the organisation engaging in strategies to try to improve the circumstances of their LGBTI staff. It might involve the organisation being more out there in terms of supporting equality campaigns and it might involve the organisation partnering with LGBTI community organisations. And so thanks that's all for me. Wonderful Mark thanks so very much for your expertise in the area. I'm very much looking forward to picking your brain a little bit later when we address some of the questions that are being asked on the chat panel and keep the questions coming. Last but certainly not least I'd like to turn our attention to Associate Professor Lynette McKenzie who's going to give us the occupational therapist perspective on the case study. Over to you Lynette. Okay thank you. I thought in my presentation that I'd better just recap on what the occupational therapy role it actually is. A lot of people only think of occupational therapists as people that's all out of equipment and to deal with people with very physical issues but in fact you know our role is much larger than that so I'm just sort of giving you a bit of an overview of what that role is with that definition there. So in Jan's case the goal of occupational therapy is to enable her to participate in the activities of every day life and for many people you know significant relationship for a vital part of the sorts of participation in the activities of every day life that we all enjoy. So for Jan there's a very definite role for an occupational therapist to assist in that and generally OCs work by working with the person themselves as well as the communities they're in so that may well be something about gaining support from outside the residential care facility but obviously the residential care facility itself is the key community that's involved in this case study and enabling her to be able to engage in the occupation she wants to do, needs to do or is expected to do. So for her there's all sorts of examples in the case study of things that she's no longer doing because she doesn't feel socially engaged with other people in the residential care environment and we're not given much information about her functioning following her stroke. So I'm a bit concerned that some of the lack of care from care staff might be about very basic activities that Jan requires help with that she may be being deprived of during the day and during other activities and then of course OTs can work by modifying the environment that the person finds themselves in. So obviously there are several issues around the environment of the residential care home itself so as it's a client-centered role it's really important to consider all the factors that are impacting on Jan's capacity to engage in the things that she would like to do in the first situation. So I was thinking about how her admission to the residential care home was managed through the aged care assessment team assessment process as well because occupational therapies are often closely involved with that process in assessing what an older person's needs might be for their admission and I'm a bit concerned that Jan's sexual orientation may not have been considered as part of that process because how can you meet the needs of the older person if you don't actually know what those needs are or even explore what those needs might be by engaging in a relationship with Jan and Louise that can engender trust as Ruth said earlier. So another issue that occupational therapies are involved in is what we call occupational justice so it's about the right that people have to be supported by to pay in the activities that they want to be engaged in that involves inclusion and being a valued member of the community that they sign themselves in. So for instance if someone like Jan is prevented from engaging in a valued activity for instance coupling with Louise while she's watching a movie in her own room we would call that an example of occupational justice and one that an occupational therapist would need to make connection about. So to help you see how I would sort of look at the case we have a way of analyzing cases by looking at the person components the environment components and the occupation components. So for Jan there are some issues for her in terms of her personal identity being valued. I mean obviously sexual orientation is only part of her personal identity but it's a very significant part and it needs to be accepted by other people especially when she's actually living in what is now her home. There are some huge issues there that that isn't being respected when this is now her home. She's obviously clearly incredibly isolated and that's related to the impact that her sexual orientation is having on her ability to socialize with other people other residents as well as staff. She's not participating in a lot of activities she's socially losing. I would imagine she's also grieving a whole load of losses that she's experiencing simply by moving into the residential care environment not seeing Louise as often and being alone a lot of the time. A lot of people have also talked about her past experiences of discrimination which may also be very uppermost in her mind given that she's in an aged care environment where other people may have very rigid views and there's also her issues of her right to be free of discrimination and also her right to the consumer in that environment. So if we look at the environmental issues around the residential care facility itself hopefully at some point the advocacy that Louise is attempting is going to not fall on deaf ears that has been offensive and obviously there's a lot of support needed to enable those messages to be received by the residential care staff. Louise's Mexican's already being discussed. The attitudes of the care staff themselves they may be completely unaware of how discriminatory their behaviour is and there may well be some issues as well with the attitudes of other residents who are obviously excluding Louise or sorry Jan or Jan is conceiving that that is happening. There are also the issues of consumer directed care in residential care facilities which seem to be being overlooked at the moment in Jan's case and maybe the environment simply hasn't been made welcoming for Jan. It's interesting the part of the presentation that Ruth gave about using non-discriminatory language and is the environment comfortable for some of them in LGBTI background and we come across the idea that in many areas heteronormative so the assumption is that everyone is heterosexual and there are no variations on that and I just want to give an example of an interesting session I did with some students this week because I was amazed that I expect younger people to be a lot less rigid in some of their views but we gave them a case study of Mr so and so and Mr so and so that we're living together and they all put their hands up saying it's a taco it's a taco it should be Mr and Mrs so some of these attitudes are very entrenched and it's really important to have to work on those obviously so the last area is Jan's activities and occupations so do you obviously need some assistance with their activities or else she wouldn't be feeling the need to have moved into residential care having been five years post stroke because as I say we don't know what the extent of that is and also Jan's goals for engaging in valued activities what does she want to do what would make her feel comfortable as well need to be addressed so my thoughts about what sorts of things to potentially be done would be things like obviously some getting people together to talk about what the issue is from Jan and Louise's point of view we've seen your staff in the central care facility with the idea of coming up with an inclusive care plan for Jan I think it's really important to investigate her depression it may well just be a reaction to what's happening and her increasing isolation but I think it would be worth having a look at that more closely as Louise suggested and to identify Jan's occupations also herself and develop the programs maybe to actually address those obviously there's a need for staff training and to some extent there's a need to consider if a formal complaint needs to be made and maybe there's even the need to consider whether alternative care might be better suited to Jan whether or not she could return home with extra community care packages and services or whether there are alternative residential facilities that might be so better so that's all from me. Thanks very much Lynette I'd like to now address a couple of questions if I can to the panel based on some of the questions that you've been asking tonight and also some of the questions that we have had prior to the webinar I noticed tonight and in the questions we received a lot of people are commenting about access to training with comments that there aren't enough funds or that there should be increased requirements on the aged care facilities to conduct the sort of training that we're talking about so I guess I'd like to ask the panel whether you think our health our allied health and aged care service providers are doing enough to educate staff in relation to the specific needs of this population and also whether they're doing enough to train staff in terms of sexuality and older people. That's Ruthie, I'll start. Look I think this has been a huge advance in the last two or three years and this comes out of the aged care strategy part of that was enabling training in each state and territory. I can see from some of the questions and I know that it's been difficult in Queensland and in WA in particular to find funding for that training but I know that in Victoria it's been provided by Transgender Victoria and Gay and Lesbian Health Victoria and the uptake has been huge. They've had hundreds of aged care facilities request training and have gone out to those facilities to arrange the training so while there's a long way to go I think that's been the huge change in the last couple of years that many many aged care services have received training and one of the questions I have is first what happens when new staff come on board after the training you know is it possible to upgrade the training if you like or to provide small amounts of training within the service and secondly you know one of the other questions that has a reason is how do we train up the residents of aged care facilities to be inclusive and non-discriminatory and I think that's something that's a very difficult ask you know residents have their own personal perspectives on diversity and particularly in the aged care space you know is it possible in an aged care service to enable an environment that is safe and respectful for all residents and to do that through some advice giving if you like to other residents so my perspective is the training has exploded in the last years if we look at other sectors you know the mental health sector drug and alcohol primary care we don't see this level of training at all at this stage and it's needed in all those sectors as well. Great thanks Ruth can I just ask the panel just on that last point that you raised Ruth because some people were talking about earlier on the chat panel with respect to the other residents and this is an open question to the rest of the panel what sort of ideas do you have about the increasing awareness and affecting change in the attitudes and behaviours of other residents who might be discriminatory or have problematic behaviours towards LGBTI people in the aged care facility? It's Mark here shall I say a couple of things I think from my perspective it's important to recognise that people can change their views and society has gone through enormous changes over the last 10 or 20 years in terms of people recognising LGBTI identities in the communities and I think older people in residential aged care we should assume that those people have the capacity and willingness and interest to change and I think the basis for change is often knowing people. One of the things you hear a lot about in residential aged care is that we don't have to hear those people here we don't know anybody well that's because they're not out because they don't feel safe to be out in that environment but I think once people are supported and encouraged and people get to know their LGBTI residents and LGBTI family members who might be visiting or LGBTI staff and I think that provides a basis for individuals to to perhaps change their attitudes that they might previously have held. Great thanks Mark. Anyone else want to comment on effecting change in both the staff members and the other residents? I was thinking about the older residents. I was thinking about the older residents myself when I was going through this case study and was thinking that maybe the place that might be just with the small table of people that Jan probably sits and has her meals with. Most people are sort of usually sitting in the same place that's in the dining room with a regular set of people and that might be worth having a conversation with them and with Jan and seeing how she would feel about disclosing anything and having a discussion with them or maybe even just getting to know people a bit better as well within that environment. Great thanks Annette. All right I'd like to just sort of turn my attention to another issue that a lot of people have written in about and that is the issue of elder abuse and particularly ask the panel to turn your attention to whether the LGBTI population is more susceptible to increasing incidences of elder abuse and what does that mean and how should we respond to that? How can we address these issues while still working respectfully with cultural and social issues in families? So Damien I might ask you for your input on that particularly with the scenario you presented with us and what sort of ways does family behaviour might it constitute elder abuse with the client? A couple of years ago we did a survey of trans and gender diverse Australians and we certainly found that for our participants it was around 35 percent of our 160 participants who had children. Many of those participants were older people and older transgender women specifically and they'd had children before they had transitioned and for men all but they certainly a significant proportion they had experienced a lot of whether we want to call it abuse there's lots of different words that we could call it because there was lots of different experiences that people had had but of their adult children either alienating them or telling family members that they were dead refusing to see them refusing to use their preferred pronouns or names so and this is you know this is from their from their own children so then if those people are going into aged care services and needing support to go into those services and you know wanting to stay connected with people in their lives when they go into the service there's a significant issue there if the people are abusing them so certainly we found out in our research that the elder abuse can be a significant concern for older transgender people and coming from their own family members and their own children. Yeah thanks Damien. I wonder Mark if you've got an input on that on the ways that we could address the issue about families or those in primary caring relationships with the people who are in aged care facilities. Yeah sure I mean I guess just touching on the elder abuse point I think the thing that I've mentioned in relation to that is that elder abuse can be enormously complex and lots of diverse situations might be typified as elder abuse including sort of broken down and conflictual relationships with families domestic violence and obviously the kind of behaviors that have been evidenced by the residential care staff in this particular situation but you know I think they're quite different kinds of elder abuse and they can be experienced in different ways and so it's really important to sort of burrow down and really try to understand the complexity of how it plays out in individual situations. Sorry Catherine was there another part to your question? No no you make a good point. I guess I guess flowing on from that Mark I'm wondering and some of the questions have been what can we do as health professionals or workers within these facilities to be alert to that sort of situation and to help the the sort of you know abuse that is specific to the LGBTI person? Well I guess we've been talking about the kinds of strategies already I think in terms of providing support and resources for staff to be aware of each other and how they interact with people and to you know assume that people have the same kinds of values and concerns that we have that they might be concerned about how residents are being treated and we need to talk openly about those kinds of concerning behaviors or indeed if people are visiting and people have concerns about the late family members or friends might be engaging with the resident. So I think talking openly with people about concerns that you might share for people would be you know the first starting point. Great thanks Mark. I guess one of the other questions I will ask you a little bit about this in the first instance Lynette because you mentioned a little bit about trying to understand and facilitate Jan's participation in decision making and activities. I guess what happens when the LGBTI person is experiencing a mental health disorder or an emotional problem such as depression? How do we best support those individuals? And specifically if you can what are the most common mental health issues or difficulties experienced by LGBTI individuals in aged care facilities? Well I think Jan's case for the year is fairly typical. You know the idea of the isolation that she's experiencing and leading to her feelings of depression. Certainly the importance of a therapeutic relationship is really important to be able to assist someone like Jan to start re-engaging with activities that she enjoys. So as part of that therapeutic relationship you'd need to develop a lot of rapport and trust again. So those words come up regularly in the chat. I've been noticing as well and it's going to be really important to allow Jan to direct the thoughts of goals for the activities and interventions that you might engage in with her rather than the therapist or the staff member deciding what she can do and what she can't do. It will need to come from her. So obviously there are several activities that she enjoyed that has been excluded from participating in which concerns me. So and again I've got no idea from this what other sorts of activities she needs support with where she definitely needs the assistance of another person and the idea that some of the staff were not responding to her in a timely manner is an issue as well and I think needs to be addressed as part of her program as well. So it's not just the activities she engages in with other residents but also the things that she's dependent on staff for assistance with as well. Right it's Ruth here I've got another issue I guess around re-victimisation and you know this is one of the things that comes out repeatedly in the LGBTI community that they've had a series of events over their lifespan and you would expect that in in this age group in particular that meant that they had to not disclose or hide their sexuality or it often led to difficult mental health issues. So you know you might expect in a person of this age that she's had at least one or two even many episodes of depression or anxiety that relate to what we might call minority stress which is a in the literature one of the key underlying issues for the reason why LGBTI people have a higher level of mental health disorders and then it relates to living in a as a minority group and being discriminated against. Now while I don't want to defologise at all it's a reality that many of the LGBTI residents in an age care facility may have had this experience and I think that needs to be directly addressed so that Jan is able to express what's happened to her before that this isn't the first time she's felt like this that each time she's had to go backwards if you like in her ability to express herself and so if there's the ability for staff to at least try to unpack that with her and understand what she's been through in the past and how has she managed to come out of that you know what's been her resilience building strategies in the past and then you you have some method of enabling her to come out with the way she is feeling and to make it more specific to her her life rather than just provide a generic support mechanism. Great thanks Ruth you've really been up some really highly relevant points for this population group I guess it's sort of you know wondering if Mark, Lynette or Damien you'd like to comment specifically on the mental health needs of this population and specifically how they might be unique to other general populations in the age care group we might get Mark to Mark if you're there could you give us a bit of an idea about your perspective on on that? Yeah sure well I guess I guess well for me I'm just thinking about the idea of loneliness and that's a really key experience for Jan and it really reinforces the point that loneliness is not really about being alone or living alone it's it's about not being recognised and respected for who you are amongst the people that you live or interact and for a while obviously the residential facility is a very crowded place and there's not a lot of privacy it's really striking that Jan experiences a significant degree of loneliness in that environment and unfortunately you know as I mentioned earlier loneliness is a greater experience in the experience among LGBTI people not only in older age groups but also for young people as well and so for me I think that the issues around mental health do intersect with experience of loneliness and and what that means in terms of our failure to recognise people for who they are and to give respect for how they identify. Great yep thanks Mark that's awesome and a valued perspective I think it's probably time for us now to ask each of the panelists to just give a final couple of words of wisdom to like commenting on some of the things that the TAP panelists have asked us if they could just tell us each a little bit about their their final thoughts and wrap up and we'll start with you Ruth. Yeah thanks Katherine I feel quite hopeful in this space I think as I said there's so much more training out there but also there's more support in the community for LGBTI ageing you know this has been a very youth-orientated community from my perspective anyway over the years and I think with the both the federal legislation but also the community itself maturing we're starting to understand that we need to support our elders our LGBTI elders you know the community visiting scheme that Leanne's mentioned there is operating in various locations around Australia as a way to engage LGBTI elders back with LGBTI community and so you know these initiatives have started only in the last few years and I think we can see that there's a lot more support for older people in LGBTI community but also links across age and generations to understand each other better so you know that feels good to me and I think we can utilize that in our service provision to try to enable connections that's occurring within our LGBTI community and support these people as much as we can yeah that's absolutely true and I think in reading the comments myself from I can see that that's that's a common thing there is a theme of optimism and hope and some of the early comments about kindness training for residents and increasing compassion and so on I think reflective of that but you know the connection between community organizations I think is a fantastic resource and one of the things that I think most of the participants tonight are appreciating as am I are the enormous pooling of resources that we're seeing just happening live as we go on here many of which I didn't know about before which is absolutely fantastic I think you know ameliorating that problem of loneliness that many older people in this community experience thanks so much for that Ruth. Jamie can I turn over to you and can you give us some of your final words of wisdom and comments and summation of your observations of tonight's discussion I was just thinking that you know clinically we've known for you know a number of decades now or been aware of that older lesbians and gay men have particular trajectories often related to having lived through times that were maybe not necessarily more homophobic or transphobic than they are now there's definitely in different ways than they are now so having come out and I certainly see this with some of my older gay clients having come out in later years and 50s or 60s having to negotiate what some people describe as like a second adolescent having to learn the rules of what it means to be lesbian or gay so I think that sort of well I feel it's on our radar I saw of our radars now but I think then the next bridge to cross is understanding what that means for older bisexual transgender and intersex people really thinking about what it means to transition when you're older what it means to for something to learn that that intersects when they're older may not have been aware when they were younger that surgeries were performed on them or may not have been willing to disclose that to people until they're older and the same with bisexual people so I think there's that to come for us I think to acknowledge that for older bisexual trans and intersex people as well as lesbian and gay people and their intersections what it means to think about coming out transitioning being aware or disclosing later in life and how that's going to come up clinically for us all into the future fantastic Damian great great points I was intrigued actually being in New South Wales reading opening the City Morning Herald yesterday and reading quite a beautifully written story about a 77 year old woman who had previously been a man and who had transitioned in her late 70s with the support of her partner it's a beautiful story in the City Morning Herald website probably still on there today I and I thought well isn't that amazing timing that that's happening just before this webinar and I think illustrates the point many of the points that you've you've raised tonight all right I'd like to give you an opportunity mark to now give your all right I'd like to give you an opportunity mark to now give your summary and final words of wisdom on tonight's webinar thanks Catherine I'm not sure other words of wisdom but anyway I was reflecting on I think some points that Damian had made and I think really the the importance of acknowledging and being responsive to the complexity of people's identities and how they connect those with communities so that some people feel very confident and comfortable identifying as lesbian or gay or transgender or bi or intersex but not all everyone does and certainly for some older people that may have been a struggle that they experienced in their life and some people choose not to categorize themselves in particular ways they prefer to see their identities in sort of more fluid ways so I think I think you know needing to acknowledge LGBT identities in communities we also need to acknowledge the complexities and the diversities and be open to exploring you know what that means for people and how we deliver services to them as well fantastic yeah thanks Mark you really consolidated the point you made in your presentation which is far and indicates your you know expertise in in this population last but not least again Lynette can you give us your summation of tonight's webinar and your views thank you I've been really interested to system look at the chat that's been happening around the presentations as well and I think we have grants for hope that is possible to provide a non-judgmental environment for older people living in residential care so that they can experience the care and support that they need I think it's important for us to be very client sensitive or person-sensitive in the way that people interact with anybody in residential care and you need to be able to take the lead from the person themselves in terms of what they express that they need and it's sort of all about cultural safety and all of those issues are also very relevant here I'm encouraged certainly from the occupational therapy point of view that there is a lot more literature out there about the needs of LGBTI people and I was also interested in some of the comments about the presence of dementia in residential care facilities and of course that's an issue that complicates matters in terms of how other residents might be less inhibited about how they might relate to someone like Jan so it's not simple and certainly I think a lot of people that are managing residential care facilities would need a lot of assistance and engendering changed thanks on that it's wonderful to hear the occupational therapy perspective you know I've always admired your profession for being so practical and so person-sensitive and and such an advocate for self-directed care I can really see that in the way you conceptualize that case which is incredibly refreshing. I think I too would echo some of the comments of the panelists and some of the things that are coming up on the discussion board I think tonight's been incredibly informative kind of tip of the iceberg discussion in two ways the first is that obviously many of the issues we touched on tonight are very complex an issue like elder abuse or even the issue of the way aged care facilities deal with human sexuality in their populations are complex issues and clearly we've only touched the top of these issues but it's certainly engendered in our respondents and in some of my own thinking a real interest in this area and as our population ages and the diversity our awareness of the diversity of our age population increases I think that this there'll be enormous demand for more training and better services and the onus is on all of us as health professionals to increase our awareness and training I think some of the other useful things have come out of tonight's discussion are a focus on education and training for all of us back to that poll very few of us have had the opportunity to specific training to the needs of LGBTI people in aged care facilities and I hope that you take the opportunity as I will to look at some of those fantastic resources which are just flashing up on our on our screens and I think the other thing our panelists have done an excellent job of is explaining the sort of liaison between advocacy and policy things that are happening at an institutional and a larger political level and then bring it back down to client focused whole person care and I think the two are of course interrelated and important for the well-being of LGBTI older people in aged care facilities we touch very briefly on some of the mental health concerns of of old LGBTI people didn't get a chance to talk much about dementia and some of the other specific mental health concerns of this population I think that's probably fruit for later and more intense discussions which I I would encourage you to continue to have. I guess on a final note what I'd like to say is that MHPN supports practitioner networks where clinicians from different disciplines meet to network with other mental health practitioners they share tips and resources build local referral pathways in engaging professional development activities so there are a number that focus on supporting the mental health and well-being of LGBTI people and if you visit MHPN's website you will you can learn more about that. So I would like to thank you all for your participation in tonight's webinar and thank on behalf of you our incredibly informative interesting and diverse panelists I'd like to also ensure that you complete the exit survey before you log out it will appear on your screen after the session closes and certificates for attendance for this webinar will be issued a couple two weeks after that. I will also send you a link to online resources which are associated with this webinar in one week and I think that will be an excellent resource given the number of resources and that have been discussed in tonight's webinar and the next webinar I'd like to inform you about will be on the 25th of May at 715 Australian Eastern Standard Time and it's called Working Collaboratively to Support Students Experiencing Anxiety Whilst Completing End of High School Studies. So before I close I'd like to acknowledge the consumers and carers who've lived with mental illness in the past and those who continue to live with mental illness in the present and thank you everyone for your active participation this evening.