Study on Long-Term Care Service Awareness, Needs, and Usage Intention of Older Adult Male Homosexuals in Taiwan and Their Ideal Long-Term Care Service Model
Abstract
:1. Introduction
2. Methods
2.1. Design
2.2. Participants
2.3. Data Collection
2.4. Data Analysis
2.5. Research Ethics
3. Results
3.1. Understanding of Long-Term Care Services among Older Gay Bisexual Men in Taiwan
“My mother was bedridden for a long time after a fall. Back then, our financial situation allowed us to hire a caregiver. After spending significantly over the years, my brother, who was opposed to this, insisted on moving her to a nursing home. I disagreed and chose early retirement to care for my mother myself. This experience made me familiar with various long-term care services and what’s available.”(PD)
“I enrolled in a healthcare aide training course to better understand the fine details needed in older adults care and learn about taking care of my health as I age. It also helped me appreciate the hard work of healthcare aides so that I would not be unreasonable and demanding when I am under care. I was delighted to receive my healthcare aide certificate. Initially, I wanted to work as a healthcare aide, but my relatives and friends opposed it, citing my age and the after-effects of a car accident. My partner works in home care; thus, we discuss current care services, and I am clear about the subsidies available for long-term care services.”(PA)
“I was hospitalized for prostate cancer surgery and applied for home care afterward. My understanding of care services improved thanks to a friend who works in home care and has been a great help... He helped set up an accessible space in my house and found a gay home care aide. I cannot go to work now and work from home, with a gay home care aide assisting me with daily tasks.”(PC)
“I have experience with it since my family members and relatives have applied for home care or hired foreign caregivers. I understand that poor health can lead to many inconveniences; even bathing and eating require help. Therefore, I try my best to stay healthy and exercise as much as possible.”(PE)
“Diagnosed with this cancer, I initially felt hopeless. During a previous hospital stay, a lady was caring for me, which was awkward and made me feel very sad. Fortunately, a friend understood my mental strain and reminded me that death is an inevitable part of life, encountered at any age. He advised me to face it positively and to undergo active treatment as long as my physical condition allowed. He then helped me find a gay home care aide. I find that care from a gay person is less embarrassing. We can talk about topics like gay senior living and emotional life.”(PC)
“If the care provider is also gay, there is a better understanding. Specifically, we do not need to hide anything. We are all gay; there are no awkward barriers.”(PB)
“Previously, my partner, a home care aide, took care of me. Thus, I believe care services from a gay are better. I have seen many home care aides who are older women, chatty and nosy. If they discovered something about me, the gossip would be endless.”(PA)
“I took a healthcare aide course. Therefore, I understood it well and encouraged my partner to enroll. He now has more stable work because of it.”(PA)
“My mother stayed in a care facility, so I understand institutional care. My father attended daycare services; thus, I am also familiar with that.”(PE)
“In the healthcare aide course I attended, many students were older adult women who do not necessarily accept gay individuals. When my partner attended a continuing education class where homosexuality was mentioned, the women showed no interest, and he also avoided coming out at work, fearing discrimination.”(PA)
“From my observation, long-term care workers are not very gay-friendly… In that environment, even older clients are not treated with much respect. Some heads of long-term care facilities are arrogant, making it evident that coming out is not an option.”(PC)
“I have always encountered unfriendly attitudes toward gays, and it is still the case. The older they are, the less they understand gays, and it is the same with long-term care workers now; they hardly know any gay individuals.”(PD)
3.2. Need for Long-Term Care Services among Older Gay Bisexual Men in Taiwan
“Even if I had no prior experience, I would still feel the need. Everyone, at some point, requires care. In our family, some relatives live in facilities, and foreign domestic workers take care of others, so the need is universal.”(PD)
“The need is inevitable, and early learning of caregiving knowledge and skills is crucial. At any age, as long as one is physically able, I encourage everyone to attend healthcare aide courses. Working as a healthcare aide is not mandatory, but at the very least, it helps increase medical knowledge and self-care skills, which can be handy when family members need care. In the event of an accident or disability, I would need long-term care services. Home or institutional care depends on government policies, regulations, and financial capability.”(PA)
“Of course, I would need long-term care services if I become bedridden or develop dementia without hope of recovery. I fear that the government’s eligibility criteria for applying for these services are so stringent that they are practically inaccessible and merely a tool for political campaigns.”(PD)
“I do need it, but I try my best to maintain my health to avoid being bedridden and dependent on others.”(PB)
“In my understanding, caregiving responsibility naturally falls to the family. Friends and partners are not obliged to care; they only provide moral support. Without family, one has to rely on friends, which depends on how close these friendships are. It is all relative—you get back what you put in, depending on the people you interact with. In seeking help, I would turn to my partner, as he has a healthcare aide certificate. Of course, he should be paid for his services. Further, some long-term care workers or facilities worry about the sexual needs of gay clients. In reality, most gays who require long-term care no longer have sexual needs; rather, the concern should be about protection from sexual harassment. In our times, gays could only seek relationships and live their lives in the shadows; thus, our thoughts tend to be more pessimistic, and hoping for a peaceful end is a blessing.”(PA)
“Friends often provide more care, especially for older gay men who lack a partner, their own housing, or savings. They need a facility that offers shelter and three meals a day. A model similar to some charitable organizations could be considered, where those still capable of manual dexterity can engage in simple manufacturing within the facility to help supplement their income.”(PD)
“I once hired a lady who made it very awkward for me. She would ask why I, at my age and with my earning capacity, lived alone and was not married. I had to brush off her questions casually. She did not know I was gay. So, there were no serious issues, but it was tiring to dodge these questions in care. I find it easier to chat with gay home care aides; there is less judgment and more common ground in conversations.”(PC)
“It would be even better if male gay healthcare aides who are careful and skillful, especially in physically demanding services, were available. They tend to be more competent and comfortable with female care recipients, avoiding awkwardness. Similarly, male recipients have better psychological comfort and less discomfort.”(PA)
“If they could empathize with the social circumstances of gays, that would be preferable. However, currently, there is a lack of education that allows long-term care providers to understand and recognize gays.”(PD)
“As I just mentioned, there is little awareness about gays in long-term care. If they could learn to interact with gays in a friendly and affirmative manner, perhaps many would not be as worried. Many gay individuals I know are concerned about being bullied or having to lie about their preferred gender if they end up in a nursing home.”(PE)
3.3. Willingness to Use Long-Term Care Services among Older Gay Bisexual Men in Taiwan
”We predominantly favor home-based care. In my case, I have already applied for home care services. Financially, I am pretty sound and can manage costs over 30,000 NT$ monthly. Nonetheless, my primary concern is that my current illness might not quickly subside.”(PC)
”I prefer getting care at home. In the future, I am considering the option of hiring foreign caregivers.”(PE)
“I had a disheartening experience when I applied for a veterans’ home. As soon as they found out about my sexual orientation, they immediately rejected me. That incident made me quite angry. I believe it is better to stay physically fit and go for home care instead of residing in an institutional setting.”(PB)
“My choice is home care, mainly because my partner can care for me, contributing to his income.”(PA)
“I tend to visit local community care centers when my health allows. Otherwise, I will have to rely on home care services.”(PD)
“Economically, I am in a position where I can afford a bit over 40,000 NT$ each month for these services.”(PC)
“Considering the care expenses it is generally about 40,000 NT$ or more. Since many gay men are unmarried and without family support, it is crucial to evaluate their capacity to shoulder such financial burdens. Generally, those requiring long-term care cannot work, leading to minimal or no income.”(PE)
“The decision to apply for long-term care depends on one’s health situation and financial means. My retirement pension is just over 30,000 NT$. I can only afford up to 1000 NT$ daily for care services. When factoring in medical costs, it appears that I have no alternative but to await death at home. The expenses for caring for my mother amounted to over 60,000 NT$ monthly, nearing a million annually. Over the seven years we employed a foreign caregiver until her passing, the total expenditure was approximately seven million NT$.”(PA)
3.4. Ideal Long-Term Care Services from the Perspective of Older Gay Bisexual Men in Taiwan
“I dream of an environment akin to a villa with a garden, accessible facilities, meals, hygiene care, and all at an affordable cost. Ideally, these should be gay-specific systems designed by and for gays, whether male or female. If heterosexual norms dictate the standards, they are simply outdated.”(PD)
“A gay-specific institution would be preferable, but its regulations must be determined privately, not widely broadcast. If everyone knows it is a gay long-term care center, residents might face pointing fingers whenever they step outside.”(PE)
“The best would be an institution for gays, but it might get stigmatized as “exclusively for gays,” inviting different treatment... Government regulations stipulate specific requirements for establishing long-term care facilities in terms of equipment and zones. Therefore, we should check whether these government regulations align with the realities of society and urge the government to make improvements. My preference for a specific type of environment is not the main issue. I once aspired to create a gay-friendly daycare service. I bought a ground-floor shop, considering its accessibility for older adults with mobility issues and easier evacuation in emergencies. When I inquired about its establishment, my application was rejected because commercial areas are not permissible locations, dousing my plans in cold water. The permissible areas are upstairs in residential zones or independent houses with bathrooms, layouts, and corridors that must all be equipped with accessible facilities and space.”(PA)
“I am aware of a gay-friendly elder care association managed by a gay. It remains to be seen whether they will evolve into a gay-specific long-term care facility. However, if they do, I would be willing to move in. Being surrounded by fellow gay individuals would undoubtedly offer a sense of reassurance. We could also learn from Japan’s gay-friendly senior housing. These places are staffed by managers who assist with shopping, medical appointments, and other basic life needs. Particularly appealing are the low rents communal dining areas that encourage interaction among residents, thus preventing isolation. Forming friendships here and mutually aiding each other can enhance independent living. Many single elders face difficulties renting homes because landlords fear what might happen if something goes wrong. Older gays are likely to encounter these issues as well.”(PB)
“Our biggest concern is the perspective of the long-term care workers towards us. If they exhibit homophobia, whether they live in a facility or use home care services, it would be a source of immense distress. Therefore, care providers must be knowledgeable about gay individuals and understand the social predicaments faced by the gay community and the specific care challenges we encounter. They must be able to see things from our perspective and comprehend our needs.”(PD)
“There is a definite need to enhance the understanding of gay issues. My partner mentioned that continuous education on gender sensitivity for long-term care workers rarely addresses gay topics. They cover other gender issues instead. How can care providers comprehend our problems without being educated about them? How can we dare to come out of the closet? Unless care providers first understand what being gay means and the concerns gays have regarding long-term care, we are too frightened to reveal our true selves. We have to remain hidden because our generation has been hurt too much in the past. In our times, gays could only seek affection while hiding in the shadows. No wonder our outlook is rather bleak and pessimistic. To die well is a fortune we hope for at the end.”(PA)
“Most of the older gays I know are retired and in relatively good health, but we still contemplate future care for one another. As friends age, who will take care of whom? That is why we discuss the importance of having long-term care providers who understand and do not discriminate against gays. If they are knowledgeable and nonjudgmental, we will consider living in care facilities and utilizing daycare and home care services.”(PB)
“Living to this age, one starts to consider life in old age. We have insurance to assist us, but human care is unpredictable. The news shows only a fraction of the mistreatment that happens. Much remains unseen. I have heard from social workers in long-term care facilities that older adults are not always treated kindly, and as gays, that scares us even more.”(PE)
“I have asked my home care aide, who said they must take courses on gender sensitivity. Nevertheless, these courses seldom cover the care of gay individuals. It is disappointing because if instructors do not address the reality of being gay, the care providers’ understanding of gays will be based solely on what they see on TV. They will not realize that there are many types of gay individuals, not just the stereotypes portrayed on television. Therefore, it is vital to elevate the gender sensitivity of care providers and equally important to educate them on the care of the gay population.”(PC)
4. Discussion
5. Conclusions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Hong, H. LGBTQ-friendly long-term care: A discussion on the dilemma of long-term care of LGBT and the LGBT cultural competence of long-term care. J. Geotech Ology Serv. Manag. 2022, 10, 229–243. [Google Scholar] [CrossRef]
- Ministry of the Interior, Taiwan. Older Adults Population Surpasses 14%: Ministry of the Interior Declares that Taiwan has Officially Become an Aging Society. Available online: https://www.moi.gov.tw/News_Content.aspx?n=2&s=11663 (accessed on 1 October 2023).
- Hong, H. LGBTQ-friendly long-term care: Letting the rainbow flag fly in long-term care. Gend. Equity Educ. Q. 2017, 80, 116–123. Available online: https://www.airitilibrary.com/Article/Detail/15629716-201709-201710200010-201710200010-116-123 (accessed on 12 October 2023).
- Brennan-Ing, M.; Seidel, L.; Larson, B.; Karpiak, S.E. Social care networks and older LGBT adults: Challenges for the future. J. Homosex. 2014, 61, 21–52. [Google Scholar] [CrossRef]
- Cahill, S.; South, K.; Spade, J. Outing Age: Public Policy Issues Affecting Gay, Lesbian, Bisexual, and Transgender Elders. The Policy Institute of the National Gay and Lesbian Task Force Foundation. Available online: http://www.thetaskforce.org/downloads/reports/reports/OutingAge.pdf (accessed on 1 October 2023).
- Gabrielson, M.L. “We have to create family”: Aging support issues and needs among older lesbians. J. Gay Lesbian Soc. Serv. 2011, 23, 322–334. [Google Scholar] [CrossRef]
- Brotman, S.; Ryan, B.; Cormier, R. The health and social service needs of gay and lesbian elders and their families in Canada. Gerontologist 2003, 43, 192–202. [Google Scholar] [CrossRef] [PubMed]
- Jackson, N.C.; Johnson, M.J.; Roberts, R. The Potential Impact of Discrimination Fears of Older Gays, Lesbians, Bisexuals and Transgender Individuals Living in Small- to Moderate-Sized Cities on Long-Term Health Care. J. Homosex. 2008, 54, 325–339. [Google Scholar] [CrossRef] [PubMed]
- Stein, G.L.; Beckerman, N.L.; Sherman, P.A. Lesbian and Gay Elders and Long-Term Care: Identifying the Unique Psychosocial Perspectives and Challenges. J. Gerontol. Soc. Work 2010, 53, 421–435. [Google Scholar] [CrossRef] [PubMed]
- Putney, J.M.; Keary, S.; Hebert, N.; Krinsky, L.; Halmo, R. Fear runs deep: The anticipated needs of LGBT older adults in long-term care. J. Gerontol. Soc. Work 2018, 61, 887–907. [Google Scholar] [CrossRef] [PubMed]
- Durso, L.E.; Meyer, I.H. Patterns and Predictors of Disclosure of Sexual Orientation to Healthcare Providers among Lesbians, Gay Men, and Bisexuals. Sex Res Soc. Policy 2013, 10, 35–42. [Google Scholar] [CrossRef] [PubMed]
- Harrison, J. Coming out ready or not! Gay, lesbian, bisexual, transgender and intersex ageing and aged care in Australia. Reflections, contemporary developments, and the road ahead. Gay Lesbian Issues Psychol. Rev. 2006, 2, 44–53. [Google Scholar]
- Mark, H. Older Lesbians and Gays Accessing Health and Aged-Care Services. Aust. Soc. Work 2007, 60, 197–209. [Google Scholar] [CrossRef]
- Hong, H. The Construction of LGBTQ Friendly Long-Term Care from LGBTQ Friendly Medicine. Formos. J. Med. 2019, 23, 362–368. [Google Scholar] [CrossRef]
- Cory, R. Cummings, Jennifer S. Dunkle, Bianca Chanel Mayes, Carolyn A. Bradley, Francesca Petruzzella & Kerstin Maguire. As we age: Listening to the voice of LGBTQ older adults. Soc. Work Public Health 2021, 36, 509–525. [Google Scholar] [CrossRef]
- Villar, F.; Serrat, R.; Celdrán, M.; Fabà, J.; Martínez, M.T. Disclosing a LGB Sexual Identity When Living in an Older adults Long-Term Care Facility: Common and Best Practices. J. Homosex. 2019, 66, 970–988. [Google Scholar] [CrossRef] [PubMed]
- Skeldon, L.; Jenkins, S. Experiences and Attitudes of the LGBTQ+ Community on Care/Nursing Homes. J. Homosex. 2023, 70, 3075–3107. [Google Scholar] [CrossRef] [PubMed]
- Fasullo, K.; McIntosh, E.; Buchholz, S.W.; Ruppar, T.; Ailey, S. LGBTQ Older adults in Long-Term Care Settings: An Integrative Review to Inform Best Practices. Clin. Gerontol. 2022, 45, 1087–1102. [Google Scholar] [CrossRef] [PubMed]
- Moone, R.P.; Croghan, C.F.; Olson, A.M. Why and how providers must build culturally competent, welcoming practices to serve LGBT elders. Gener. J. Am. Soc. Aging 2016, 40, 73–77. Available online: https://www.jstor.org/stable/26556207 (accessed on 12 October 2023).
- Goldberg, S.; Sickler, J.; Dibble, S.L. Lesbians over sixty: The consistency of findings from twenty years of survey data. J. Lesbian Stud. 2005, 9, 195–213. [Google Scholar] [CrossRef]
- Gardner, A.T.; de Vries, B.; Mockus, D.S. Aging out in the desert: Disclosure, acceptance, and service use among midlife and older lesbians and gay men. J. Homosex. 2014, 61, 129–144. [Google Scholar] [CrossRef]
- Kortes-Miller, K.; Boulé, J.; Wilson, K.; Stinchcombe, A. Dying in Long-Term Care: Perspectives from Sexual and Gender Minority Older adults about Their Fears and Hopes for End of Life. J. Soc. Work End-Life Palliat. Care 2018, 14, 209–224. [Google Scholar] [CrossRef]
- Fredriksen-Goldsen, K.I.; Cook-Daniels, L.; Kim, H.J.; Erosheva, E.A.; Emlet, C.A.; Hoy-Ellis, C.; Muraco, A. The physical and mental health of transgender older adults: An at-risk and underserved population. Gerontologist 2014, 54, 488–500. [Google Scholar] [CrossRef]
- Creswell, J.W. Qualitative Inquiry & Research Design: Choosing among Five Approaches, 2nd ed.; Sage Publications: Thousand Oaks, CA, USA, 2007. [Google Scholar]
- Hong, H. LGBTQ-Friendly Long-Term Care: The Attitude of Long-Term Care Services on the Middle-Aged Gay Male. Master’s Thesis, Kaohsiung Medical University, Kaohsiung City, Taiwan, 2018. Available online: https://hdl.handle.net/11296/e8q694 (accessed on 12 October 2023).
- Graneheim, U.H.; Lundman, B. Qualitative content analysis in nursing research: Concepts, procedures and measures to achieve trustworthiness. Nurse Educ. Today 2004, 24, 105–112. [Google Scholar] [CrossRef]
- Boggs, J.M.; Dickman Portz, J.; King, D.K.; Wright, L.A.; Helander, K.; Retrum, J.H.; Gozansky, W.S. Perspectives of LGBTQ Older adults on Aging in Place: A Qualitative Investigation. J. Homosex. 2017, 64, 1539–1560. [Google Scholar] [CrossRef]
- Hong, H. LGBTQ-friendly long-term care Rainbow Parade Journey. Forum Women’s Gend. Stud. 2018, 109, 74–81. [Google Scholar] [CrossRef]
- Shauna, W. The Silencing of LGBTQ Older adults’ Identities through Ageing in Long-Term Care. J. Integr. Res. Reflect. 2019, 2, 1–8. [Google Scholar] [CrossRef]
- Hiedemann, B.; Brodoff, L. Increased Risks of Needing Long-Term Care Among Older adults Living with Same-Sex Partners. Am. J. Public Health 2013, 103, 27–33. [Google Scholar] [CrossRef]
- Wang, T.-Y. Breaking through ageism: Understanding older adults gay men in Taiwan. J. Life Educ. 2010, 3, 169–231. [Google Scholar] [CrossRef]
- Gofyy. The stigma of older adults gay men: Aging, homosexuality and sex. J. Cult. Stud. 2011, 13, 308–312. [Google Scholar] [CrossRef]
- Hong, H. Establishing LGBTQ+ Older Adults Care Homes: A Comparative Analysis of International Systems for the Older adults of the Rainbow Community. Gend. Equity Educ. Q. 2019, 86, 98–103. Available online: https://www.airitilibrary.com/Article/Detail/15629716-201903-201904030010-201904030010-98-103 (accessed on 12 October 2023).
- Shippy, R.; Cantor, M.; Brennan, M. Social networks of aging gay men. J. Men’s Stud. 2004, 13, 107–120. [Google Scholar] [CrossRef]
- Bell, A.; Weinberg, M. The Bell and Weinberg study: Future priorities for research on homosexuality. J. Homosex. 1981, 6, 69–97. [Google Scholar] [CrossRef]
- Choi, S.K.; Meyer, I.H. LGBT Aging: A Review of Research Findings, Needs, and Policy Implications. 2016. Available online: https://williamsinstitute.law.ucla.edu/wpcontent/uploads/LGBT-Aging-A-Review.pdf (accessed on 1 October 2023).
- Caceres, B.A.; Travers, J.; Primiano, J.E.; Luscombe, R.E.; Dorsen, C. Provider and LGBT Individuals’ Perspectives on LGBT Issues in Long-Term Care: A Systematic Review. Gerontologist 2020, 60, 169–183. [Google Scholar] [CrossRef]
- Martínez-Angulo, P.; Muñoz-Mora, M.; Rich-Ruiz, M.; Ventura-Puertos, P.E.; Cantón-Habas, V.; López-Quero, S. “With your age, what do you expect?”: Ageism and healthcare of older adults in Spain. Geriatr. Nurs. 2023, 51, 4–94. [Google Scholar] [CrossRef]
- Houghton, A. Maintaining Dignity: Understanding and Responding to the Challenges Facing Older LGBT Americans; AARP Research: Washington, DC, USA, 2018; Available online: https://www.aarp.org/research/topics/life/info-2018/maintaining-dignity-lgbt.html (accessed on 1 October 2023).
Participant | Age | Education | Marital Status | Relationship Status | Coming out Status | Profession | Belief |
---|---|---|---|---|---|---|---|
A | 71 | College | Married but separated from opposite-sex partner | In a same-sex relationship | Out to friends, not to family | Retirement | Buddhism |
B | 73 | Junior high school | Never married | Single | Out to family and friends | Retirement | None |
C | 69 | College | Never married | In a same-sex relationship | Out to friends, not to family | Government employee | Taoism |
D | 67 | Master’s | Never married | Single | Out to friends, not to family | Lawyer | None |
E | 66 | Senior high school | Divorced | In a same-sex relationship | Out to family and friends | Construction worker | Taoism |
Facet | Interview Guide |
---|---|
Perception of long-term care services |
|
Demand for long-term care services |
|
Willingness to use long-term care services |
|
Ideal long-term care services |
|
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2024 by the author. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Hong, H. Study on Long-Term Care Service Awareness, Needs, and Usage Intention of Older Adult Male Homosexuals in Taiwan and Their Ideal Long-Term Care Service Model. Healthcare 2024, 12, 418. https://doi.org/10.3390/healthcare12040418
Hong H. Study on Long-Term Care Service Awareness, Needs, and Usage Intention of Older Adult Male Homosexuals in Taiwan and Their Ideal Long-Term Care Service Model. Healthcare. 2024; 12(4):418. https://doi.org/10.3390/healthcare12040418
Chicago/Turabian StyleHong, Hong. 2024. "Study on Long-Term Care Service Awareness, Needs, and Usage Intention of Older Adult Male Homosexuals in Taiwan and Their Ideal Long-Term Care Service Model" Healthcare 12, no. 4: 418. https://doi.org/10.3390/healthcare12040418