Retirement can often be a source of great apprehension, discomfort, and—in some cases—torment for older trans people. From care homes and carers, to mental health wards and the staff that populate them, transgender senior citizens are being failed by the services they rely on more and more as they get older. Whether plagued with ignorance about the specific needs of the trans community, or directly harbouring hostile attitudes towards them, one of society's most vulnerable groups is being let down by the very institutions established to protect and look after them.
"We have actually seen cases where trans people have then been less cared for by their care givers," says Jenny-Anne Bishop, a trans activist who helps to run The Rainbow Lives Project, a charity that offers diversity training to care workers, amongst other services. "They start to deteriorate until they are transferred to a place where they are better accepted."
"There are definitely some areas of really bad practice," she adds. Bishop is currently working on a project with the ageing center at Swansea University, interviewing and gathering evidence on the situation for aging trans people in Wales, UK. Her work has seen her speak to seniors from all walks of life about their experiences with various age related social and health services. Like with so much of the trans experience, Bishop feels the way residents are treated in care homes is down to "potluck."
One person said the day they had to go into care is the day they would exercise their suicide plan.
"One person said the day they had to go into care is the day they would exercise their suicide plan, because they were so afraid they would be mistreated, laughed at," she says, reflecting on the many fears people have expressed to her about late-in-life care. It's a very real issue among LGBTQ people in care homes. "In one case in Liverpool, quite recently, an elderly man hung himself because of all the taunts he was getting for being gay. So there are some real problems there too."
Last October, Tonic Housing announced plans to launch the UK's first LGBT-friendly care home in response to the discrimination faced by the group. But such plans are a long way off; even if they do come to fruition, the home would only be available to around 150 residents. In the meantime, LGBTQ seniors often find relocating to a retirement home means returning to the closet, living in stealth as a way of avoiding exposure to the bigotry of other residents. Not everyone has that option.
"There was another trans woman whom none of the residents would talk to anymore," says Bishop. "They wouldn't sit with her for meals, they wouldn't let her join in the games, they deliberately made sure she couldn't watch her programs on the television. The caregiver then started giving her less care, and nobody checked to see if she had eaten her food. She's fine now because our group in Liverpool found out about it and got her moved to her a care home where they are very accepting."
Julia Barber began transitioning at 60 years old, shortly after retiring. She currently lives in Bury St Edmunds in Suffolk, UK. The market town (population: 69,690) is not known for its trans community. When she informed her GP of her intention to transition, his incredulous response was : "You do know this is Bury St Edmunds?"
As someone who now alternates her time between caring for her wife and fighting for trans inclusive services in the National Health Service, she knows too well the lack of understanding that trans people will be met with in late-in-life services.
"I am very, very bothered about what's going to happen to a trans person, who's in a care home with a lot of elderly people and the word gets round," she says. "A person can seem perfectly 'normal,' but the word gets round [that they are trans], people's attitudes change. The other residents of the care home could make life very, very uncomfortable for that person."
As well as a lack of acceptance within care homes, Barber is also concerned about the abilities of her GP to understand the needs of an older trans person. "My endocrinologist is very out of date," she says. "I'll be on hormone replacement therapy (HRT) for the rest of my life and so I have to have a yearly blood test. Now, GPs in this area aren't aware of that, and I have to keep reminding them, 'Isn't it about time I have a blood test?' because the consequences of blood clots on HRT are enormous. It's up to us to chase them for these things and as I get older perhaps I'll forget to chase them."
Ignorance and intolerance towards trans people—young and old—is also present on mental health wards, where patients are even more vulnerable.
"I've heard people being referred to by both their names, their preferred name and their birth name—it's totally inappropriate," says Claire*, who works in secondary mental health on a ward and has asked to remain anonymous. She has also heard staff refer to patients as "he-she" and "it," adding, "It's totally wrong."
Claire has also caught staff reacting negatively towards trans patients who choose to dress in accordance with their gender identity.
"There are a lot of people who just 'crossdress,' fine, if that's what suits them crack on," she says. "They all deserve respect. There shouldn't be any of this, 'Oh, you can't wear male clothes.' And that has happened on wards. You go with the name that they prefer, you let them dress appropriately, you don't say on their medical notes 'it.' A lot of people's mental health suffers because of the way they're treated because they're trans."
Claire's experiences are indicative of the way many of those working in care homes and wards fail to see past the gender binary—an oversight that's causing confusion and derision.
If somebody needs help with dressing, undressing, and washing, there's always the danger a carer is going to be surprised or just laugh at them.
"There's a whole range of identities that people present as," says Jenny-Anne Bishop. "Their body may not match their gender presentation. If somebody needs help with dressing, undressing, and washing, there's always the danger a carer is going to be surprised or just laugh at them or be derogatory."
When asked what was being done to ensure care homes were not overlooking their trans residents, the National Care Association said: "Every individual who becomes eligible for a care service will have a personalized plan of care developed for them. This will include all information to support them to continue to live in the manner in which they choose. I would anticipate when this is being drafted, in conjunction with the individual and their loved ones, all their needs would be recorded and met."
While the discrimination trans seniors experience may arise on account of direct transphobia, it is also a product of the ignorance surrounding the nuances and needs of the trans community. So long as equalities training is seen as peripheral, medical professional and carers alike will remain uninformed about trans people's needs. Whether it's help to learn the right pronouns, understand the different identities people may have, or simply how to avoid bad practices that have come to plague these social services, equalities training is a necessary first step towards acceptance.
"It's a cultural difficulty; something that can feel transphobic... doesn't necessarily come from a place of massive bigotry," says Chryssy Hunter, who is currently helping research the additional complications trans people experience when they have dementia, alongside Bishop.
"We've got used to the idea that people have different sexualities, but the idea that people have different, flexible, or changing genders is something that is much newer," she continues. "People find it much more difficult to overcome. It is only through training and through familiarity that people will overcome it. I don't think just having some training sessions in care homes is the full answer, it's part of the answer. We need to be thinking about things much more broadly."