Collaborating to embed truly affirming care for 2SLGBTQ+ elders
I retired after thirty years in education in June of 2024. I had made the decision to train as an End-of-Life Doula and was just finishing up when I was introduced to Sara Rodenhizer. Sara, was a Doula who had a project in mind that would create grassroots change for 2SLGBTQ+ elders at the end of life.
Her research had identified concerns for 2SLGBTQ+ seniors in long term care who often face institutionalized homophobia and transphobia that results in verbal harassment, physical abuse, and discriminatory practices. This often forces residents to conceal their identities, leading to social isolation and inadequate care.
A hands on approach
After establishing our team and terms of reference we set about finding partners within Long Term Care residences (LTC) to help us launch what we called, the “Open Door Project”. We were energized and optimistic and, when we got a meeting with Barbara Michalik at Rekai Wellesley Central Place and formed a partnership for this work, the project came to life.
Rainbow Wing
Our first year was a huge learning curve. Rekai Wellesley Central Place was just launching the first Rainbow Wing in Canada. The Rainbow Wing was designed to provide 2SLGBTQ+ seniors a space where their history can be present in the environment. Its goal is to help many of our elders feel safe and celebrated as they transition to long-term care.
Artifacts donated by the Gay and Lesbian Archives, range from posters to photographs alongside a whistle once used to alert the area of police presence to escape a raid.
It was inspiring to see the work Rekai put in to create not only the physical environment, but also the cultural environment that is needed for truly affirming care.
Person centred approach
As a doula, much of my experience is with individuals in their homes or in my community facilitating death cafes and information sessions. Here, the operational and cultural intricacies of a long-term care home needed to be understood as well as the relationships with staff and residents that needed to be nurtured.
It also required time to understand the unique competencies each resident has, how they wish to communicate, how they process information and prefer to interact. In addition, trust needed to be built so that staff, (clinical, life enrichment, food services or environmental services) would see me as a beneficial collaborator and support person. Because of the incredible inclusion of Rekai administration and the warmth and openness of staff, this was a success.
Early progress
The past six months, with the financial support of the Pride and Remembrance Run, we have been able to create some structures that are supporting residents as we engage meaningfully with them, their loved ones and staff as follows:
1) Advance Care Planning (ACP)
Most, if not all LTCs have a document they use that addresses advance care for their residents. The documents address the wishes of the resident at the end of life. What do they see as a peaceful, comfortable end? What are their views on sensory items (scent, music, lighting, touch)?
The challenge here is that many staff who are responsible for this document are nervous about engaging in end-of-life conversations. We don’t want it to be transactional—that can do actual harm—especially for our 2SLGBTQ+ elders who have experienced trauma and rejection so often in their lives.
Our Open Door Project work includes collaborating with staff to engage in hearing the stories of our elders; guiding the conversation into the subject matter of the ACP document but ultimately spending the extra few minutes to just listen to the stories of the people whose home we work within.
2) The art of pacing
Staff are becoming more comfortable with the art of slowing down. There is no doubt that everyone comes to work with a view to care for and respect all that live in the residence but truly affirming their lives, stories, perspectives and histories takes small, but necessary actions. It takes patience and the willingness to pause when a resident begins to answer a question or tell a story. Sometimes staff forget the processing time needed by even the most alert elderly person. Wait time is needed. Staff are now better at listening to understand and honour what is being shared with them. This strengthens relationships and makes it safer for residents to ask for assistance, to disclose concerns and to participate openly in their residential community.
3) Working with our judgements
Many of us have visceral responses to some scenarios that exist in LTC spaces and that can be elevated when we are witness to 2SLGBTQ+ contexts.
Open Door Project has designed and are implementing a five-session staff experience designed to use the 2SLGBTQ+ lens to understand how each of us holds our unique set of judgements and how it might currently be interfering with our desire to provide affirming care. Then, we looked at what we can do to place our judgements away from our work without putting pressure on ourselves.
If staff did not experience urban 2SLGBTQ+ culture or have a close personal relationship with members of the 2SLGBTQ+ communities in the 1960s,1970s,1980s and 1990s it is going to be very difficult to understand even on an intellectual level, the experiences our elders had. There is a rising number of staff, both clinical and supportive, in long term care residences who are New Canadians. For many of these staff, the 2SLGBTQ+ experience will be even farther away from their lived experience. If staff are coming from a place that actively persecuted 2SLGBTQ+ people the complexity of receiving these stories is heightened. Our sessions are designed to acknowledge and validate that holding judgement is natural and universal. Judgements can also get in the way of providing affirming care. We utilize the incredible physical environment of Rekai’s Rainbow Wing which is full of primary documentation of the experiences of our elders through time. Being there allows us to understand stories better and make connections to our own experiences in a way that will enhance how we interact with residents. Finally, sessions provide practical tools to leave our judgements outside the residence and learn to pair our good intentions with concrete skills that affirm the unique identities and histories of each resident.
4) Acknowledging loss and grief
Open Door Project is led primarily by End-of-Life Doulas. We know that holding space for caregivers to speak about their anticipatory or complex grief allows them to continue learning and engaging in the sensitive, but necessary, conversations with residents.
Drop-in sessions and formal circles provide sincere supports to those who provide care. When staff are invited to share how they are feeling and are validated, attending sessions or collaborating in conversations about serious illness and judgements becomes safer and purposeful. It also secures the best opportunity for professional practice to evolve.
Looking ahead
Our team anticipates moving into phase two of Open Door Project in the fall of 2026. Then, we will examine and implement the actions that help embed the work of phase one into the culture of the LTC and the daily practice of staff.
Importantly, phase two includes additional structures for residents. These include group times which create space for sharing hopes, nostalgia, and stories of loss and laughter. We’ll explore ways we can provide these experiences to residents who struggle with language or memory as well as those who have higher expressive capacity. Key to creating a momentum for dynamic cultural affirmation this work will support our ability to address the needs of all residents and to replicate this work in other Long Term Care residences.
People do well when they can
When we can provide and embed responsive structures, we build the skills needed to secure the best possible experiences for some of our most vulnerable elders. Their stories need to matter to us and be used to ensure that all care provided is affirming care.
Rhonda Garnier is a trained End-of-Life Doula and founder of lifesmomentsinlove.ca. Reach out via Open Door Project Instagram: theopendoor_project
Financial support for this project was provided by The Pride and Remembrance Run – Open Door Project also holds incredible gratitude to the Canadian Abilities Foundation for their enthusiastic support of this work.
Photos: Getty Images. Age Cymru.
