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The problem with both policies, however, is that they're unfunded mandates. Most facilities don't have the financial means, the time, or the disposition to implement such measures. This represents one of the main challenges advocacy groups face.
"We're having difficulty trying to go in and say, 'You have to do this training,' because nobody is going to hold the long-term care facilities accountable," said Dan Ashbrook.
There is also the issue of staff turnover. Advocates have found that, left on their own, facilities do not continue cultural competency training when new staff members come on board.
Meanwhile, there's only so much that cash-strapped advocacy group can do. Ashbrook, who's the only paid employee at Lavender Seniors, says his organization may carry out six to fifteen trainings a year, but it depends on the funding, which is difficult to come by these days, especially for elder care programs. It also depends on his time, split between trainings, coordinating senior lunches, networking with administrators in long-term care facilities, and running a friendly visitor's program.
In Alameda County, attitudes toward gay seniors are slowly beginning to change across the health care spectrum, from county administrators to skilled nurses and on down to residents.
A year ago, when the California State Department flagged LGBT people as one of the five groups with the largest health disparities, Gigi Crowder knew it was time to act. In her roles as ethnic services manager for the Alameda County Behavioral Health Care Services, an agency that contracts with organizations throughout the county to provide direct health care services, she launched a campaign to reach out to LGBT advocacy groups. The plan was to offer a grant to an organization that could help them begin to assess the needs of LGBT seniors locally.
"We're trying to cater to communities that we have not done a good job in addressing," said Crowder. "And it's kind of embarrassing that we, having the largest population of lesbians over any other community, haven't done much."
The grant — the first of its kind — went to Lavender Seniors for its proposal to carry out an LGBT elder needs-assessment project, one that would track the needs of local LGBT seniors as well as give a sense of staff awareness. The result was a landmark study of Alameda County.
Ashbrook partnered with Center for Elder Independence, an adult day care center, and Salem Lutheran Home, a retirement community in Oakland. Ashbrook had standing relationships with these facilities and knew they were receptive to gay seniors.
The results showed that work still needed to be done to raise staff awareness on the needs of LGBT seniors, as well as the policies that exist to protect them. But it also found that respondents, both staff and residents, showed a positive attitude toward LGBT seniors.
The majority of staff respondents said they felt comfortable working with LGBT patients, with only a small percentage — 1 to 8 percent — reporting they would feel uncomfortable. In the process, some staff came out as gay.
At Salem Luther Home, 97 percent of the residents who answered the survey said they think the facility should be inclusive and welcoming of LGBT seniors.
"People are opening up and learning to be more welcoming and understanding that others might be different," said Gilbert Carrasco, the executive director of Salem Lutheran Home, who noted that without the grant, the agency would not have been able to carry out these efforts themselves.
"Personally, I had my reservations in doing the survey at first, because I am gay," said Carrasco. "I would never try to force a community to do something they are not ready to do."
With such positive outcomes, Carrasco said Salem Lutheran Home would take the next step in continuing LGBT education. Trainings and workshops are in the works for both staff and residents.
Ashbrook and other advocates have found that having gay staff is key to beginning this dialogue, and they become important advocates within the facilities. These personal connections can make a world of difference to gay seniors and are what have allowed for such strides to take place.
For the last two years, P.A. Cooley, the admissions manager at Chaparral House, has kept a close eye on the list of elders waiting to be admitted into the five-star skilled nursing facility in Berkeley. The home has room for up to 47 seniors, but has only 12 beds available for seniors with Medi-Cal. On any given month, the list can be nearly one hundred names long.
A few weeks ago, Bob McDonald's name had inched its way to the top of the list. Cooley had worked on his behalf to make sure of that.
"I get dozens of calls a month from Medi-Cal applicants looking for rooms. I put Robert on this waiting list. He stood out in my head," said Cooley.
When Cooley first saw McDonald "toddle" — as he puts it — through their doors two years ago, he took an instant liking to him. Cooley, who is openly gay, recalls they had a good time getting to know each other. But what struck him more about McDonald in that initial encounter was his steadfastness. With a cane in one hand and his mind made up, McDonald had somehow managed to walk on his own from his nursing home on Ashby Avenue to Chaparral House, located several blocks away on Allston.
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