Invisible again: The fight for inclusion in aged care for LGBTI+ Australians

Despite Australia’s progressive social reforms, many older LGBTI+ Australians face an unsettling reality when entering residential aged care, as the dark shadow of discrimination sadly remains.

A new UniSA investigation synthesising 55 global studies, alongside local lived experience, uncovered assumptions of heterosexuality, fear of discrimination, and deeply embedded heteronormative practices often make older LGBTI+ residents feel invisible, unsafe, and silenced in the very places they should feel most at home. 

Living in the shadows: Assumptions and invisibility

UniSA researchers identified four central themes: aged care assumes heterosexuality, LGBTI+ adults feel unsafe and vulnerable, many feel forced to hide their identities, and all desire inclusive, respectful care that affirms who they are.

Lead researcher and PhD candidate Sarah McMullen-Roach explained to Hello Leaders that even the smallest aspects of daily life in aged care are often rooted in heteronormative assumptions, from gendered activities and dress codes to binary language and social expectations.

“Often when I was working I couldn’t see anybody who identified openly in aged care. Then I stumbled across someone who was hiding all their photos when people were coming to see them because they were scared of being judged,” Ms McMullen-Roach said.

This experience was the spark for her PhD, The perspectives and experiences of older LGBTI+ adults about long-term care: A qualitative systematic review and meta-synthesis, and the first step in exploring a complex topic that hits home — Ms McMullen-Roach is part of the LGBTI+ community as a lesbian.

“From dress codes to daily activities, aged care settings are often assumed to reinforce heterosexual norms, making LGBTI+ residents feel invisible or unwelcome. The ladies participated in baking or knitting, and the men did ‘manly activities’. Dancing is often male to female partners,” she added. 

“There really isn’t flexibility in the choices available. There isn’t consideration if they want to express themselves differently. It’s all these underlying assumptions that aren’t even spoken about, but just assumed and participants felt invisible.”

This seemingly benign structure can render LGBTI+ residents invisible or make them feel unwelcome. 

Safety and silence: The cost of authenticity

For many, aged care brings back painful memories of discrimination after fighting for years to not only have the right to marry the person they love, but to first decriminalise homosexuality in the 1990s.

“These were people who had been incredible advocates, who’ve done amazing things, challenged the law, and now they’re in aged care and found themselves almost being silenced,” Ms McMullen-Roach said.

Even in facilities with younger or more diverse staff, fear persists. An international workforce can include individuals from cultures where homosexuality is still criminalised, adding another layer of risk for residents who might wish to come out.

Meanwhile, a significant number of aged care services in Australia are run by faith-based organisations, many of which have complex or negative histories with the LGBTI+ community. For older people who grew up during eras of criminalisation and social rejection, this can raise deep concerns about safety and dignity in care.

“Having to give up their hard-earned rights and identities is unthinkable, particularly when you remember that homosexuality was only decriminalised nationwide in 1997, and marriage equality came just a few years ago,” she added. 

Positive progress: Examples of inclusive practice

Throughout her PhD research, Dr McMullen-Roach said there were few examples of affirmative care and open conversations around sexuality and gender in aged care. However, the next phase of her research is already underway and interviews with older LGBTI+ people across Australia currently accessing aged care are having far more positive experiences.

One standout home is Arcare Parkwood in Queensland, which opened the state’s first LGBTI+ inclusive residence in 2019. While it no longer carries Rainbow Tick accreditation, it continues to prioritise inclusion in policy, training and practice.

“We continue to be an inclusive space for residents, families and staff members. We have a policy for inclusion within aged care, we have good relationships with the Queensland Council for LGBTI Health and other LGBTIQ+ groups within the community, and it’s the culture as well,” explained Maria Bernardo, Arcare Parkwood’s Residence Manager. 

Inclusion is part of the home’s daily culture. Visible signage, inclusive artwork, newsletters, drag shows, LGBTI+ choir visits, and celebration of events such as Mardi Gras and Pride Month are just some of the ways the home affirms diversity.

“It’s about raising awareness and trying to celebrate these important cultural days which are significant to the LGBTI+ community,” Ms Bernardo added.

“It’s been well received by everyone. We have team members, residents and their family members who identify, and it’s good to see a safe space for them to celebrate that.

Importantly, residents who do not wish to participate in certain events are respected.

As for staff, they participate in workplace Silver Rainbow training managed by LGBTIQ+ Health Australia and delivered collaboratively through project partners. Ms Bernardo said this helps them to understand how to provide care to residents and embrace all the differences that may be linked to their gender identity. 

A dedicated LGBTI+ champion and advisory group ensure lived experience informs ongoing improvement.

“The voice from the residents is so important. The LGBTI+ choir that recently visited was one of our resident suggestions. So it’s about including them in all of the decisions that we make. If there are any worries or any support they need, they share that safe space with us,” Ms Bernardo shared.  

A call for acceptance in aged care

What does acceptance look like in aged care? For some, Ms McMullen-Roach said it’s simply about not making a fuss and normalising ‘something that was treated differently and othered for a long time’.

For providers, though, there needs to be more than passive acceptance. Providers must actively “out” themselves as LGBTI+ friendly so vulnerable residents don’t bear the burden of disclosing their identities in unsafe environments.

“There are a few providers where it is part of their branding and their ethos, but there’s not a lot that openly say ‘we accept LGBTI+ people’ despite the fact they do. You just wouldn’t know it unless you ask,” she added. 

Education also plays a crucial role. Understanding the history of HIV stigma, transgender care needs, and the legacy of discrimination helps staff provide affirming, trauma-informed care. 

As Ms McMullen-Roach noted, many older LGBTI+ residents find themselves in the role of educator, a burden that should be shared by professionals.

Despite the ongoing challenges, one thing that stood out in the research is the strength and resilience of older LGBTI+ people.

“They have faced some truly horrific things. But the resilience and confidence is still there because they know they’ve won so many fights before. It’s wonderful to see that. Being part of the LGBTI+ community, that’s uplifted me,” Ms McMullen-Roach said.

“We often think about the vulnerability of this population, but we should always be celebrating the resilience and incredible work that this population’s done.”