Experiences and actions of inclusivity & cultural competence in community based social care for older LGBTQ+ adults: A Qualitative Study

Background:
Social care is often required by older people, and those with marginalised identities may be at risk of inequitable or discriminatory experiences. Older LGBTQ+ people have commonly faced historic discrimination over their lifetimes, which may include experiences that influence decision making and engagement with social care. Inclusivity, particularly in more informal community-based social care, is a complex area. Understanding what may need to change and how to achieve inclusive services has been little explored in community-based provision.

Method:
A scoping review of current literature was undertaken. Subsequently, interviews and focus groups with 23 older LGBTQ+ people and staff/volunteers were used to understand their perspectives of using and delivering inclusive community based social care. Thematic and narrative analysis of findings was undertaken.

Findings:
There were differences in the importance and relevance given to sexual identity by older LGBTQ+ people and staff. A range of methods for demonstrating inclusivity were identified across both groups. Providers were motivated to consider actions but identified complexities and a lack of external drivers and guidance for taking action.

Collection of sexual identity data was felt to be important, but complex to implement. Older LGBTQ+ people did not want to be treated differently but wanted validation and recognition of their LGBTQ+ identity. Staff training was felt to be key, although ways of delivering impactful training often relied on retelling lived experiences without frameworks of support. Clear signals of LGBTQ+ inclusion and tangible links with wider LGBTQ+ networks and services were felt to be key to inclusive support.

Conclusions:
A range of actions by providers may improve experiences of inclusivity, but support is required to ensure adjustments are effective and meaningful. Mechanisms and support for inclusive conversations, although complex to navigate, are likely to have the most impact on uptake and engagement with informal social care.