Journal of Lesbian Studies, 19:62–72, 2015 Copyright © Taylor & Francis Group, LLC ISSN: 1089-4160 print / 1540-3548 online DOI: 10.1080/10894160.2015.959875
Older Lesbians and Work in the Australian Health and Aged Care Sector MARK HUGHES School of Arts and Social Sciences, Southern Cross University, Queensland, Australia
SUJAY KENTLYN National LGBTI Health Alliance, Newtown, New South Wales, Australia
While research has identified challenges lesbians face in the workplace, there is limited understanding of the particular experiences of older lesbians, especially those working in the health and aged care sector. This article draws on the stories of four women who participated in a narrative research project on lesbian and gay people’s experiences of health and aged care. It highlights the need for future research to examine the complexity of identity expression and community affiliation, how people negotiate “coming out” in the workplace, the impact of discrimination, and the resources (such as friends) available to lesbians in the workplace. KEYWORDS
lesbians, older people, aging, work
INTRODUCTION Despite the high proportion of women in the Australian health and aged care workforce and its increasingly older profile (Australian Bureau of Statistics, 2011), female workers in this sector continue to negotiate gendered and ageist practices in their everyday work. For example, dignity violations in health care—such as objectification, condescension, and disregard—remain a significant concern (Jacobson, 2009). For lesbian employees, additional factors need to be negotiated, which vary in significance according to different situations and contexts. The concerns most commonly reported by lesbians in the workplace are that they are invisible and silenced (Bell et al., 2011). With regard to nursing, Eliason et al. (2011a, p. 237) argue that lesbians are “often invisible Address correspondence to Mark Hughes, School of Arts and Social Sciences, Southern Cross University, Locked Mail Bag 4, Coolangatta, Queensland, 4225, Australia. E-mail: [email protected] 62
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in the nursing workforce, absent from discourses of professional nursing organizations, ignored or pathologized in the nursing curriculum, and only rarely found on the pages of nursing journals.” In some workplaces there is an unwritten “don’t ask, don’t tell” policy, while others are so heteronormative that it is inconceivable that anyone could be non-heterosexual (Losert, 2008). In others, such as for teachers in high schools (Ferfolja, 2010), active and persistent harassment can be the most powerful silencer. In the health and aged care sector, lesbian workers, like gay, bisexual, and transgender workers, are confronted not only with the discrimination and mistreatment directed toward themselves, but also the discrimination directed at lesbian, gay, bisexual, and transgender (LGBT) people in general, whether clients or patients, their families, or other workers. In a survey of 427 LGBT physicians, 65% reported having heard disparaging remarks about LGBT patients at work, 36% witnessed the disrespecting of a patient’s same-sex partner, 34% witnessed discriminatory care, 27% witnessed discrimination of another LGBT employee, 22% had themselves been socially ostracised at work, 15% had been harassed by colleagues, and 10% had been refused patient referrals (Eliason et al., 2011b). In this study, most physicians reported that their knowledge of LGBT patient care came from their own experiences rather than from any formal training. Lesbians are also confronted with negotiating whether or not to “come out” in the workplace. “Negotiating refers to the continuous process of decision making about if , when, and how to discuss non-normative sexual identities with other organizational participants, including coworkers and clients” (Willis, 2011, p. 958, emphasis in original). Factors influencing such decisions include the anticipated consequences (costs and benefits) of disclosure, the nature of the stigma in a particular workplace, individuals’ internal psychological processes such as needing to present themselves in an honest way, and the work environment, such as whether there are any other non-heterosexual workers and whether there are LGBT-affirmative policies (Ragins, 2004). In Eliason et al.’s (2011a) study of 261 LGBT nurses, 73% said that their workplace was LGBT friendly, although only 57% said they were out to all their co-workers. When they are recognized within the workplace, lesbians can feel the pressure of being treated as an agency resource, supposedly expert on all things LGBT (MacDonnell, 2010). Nonetheless some organizations are actively promoting strategies, such as “new voice mechanisms,” which enable people from minority groups to network with others and access needed resources (Bell et al., 2011). Bell et al. highlight four dimensions of voice that human resource managers should promote for LGBT employees. These include enabling individuals to articulate dissatisfaction, for example by having effective complaints and advocacy mechanisms, as well as providing opportunities for collective organization of LGBT employees, such as via union representation. They also argue that management needs to enable
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LGBT employees to contribute to decision making and ensure that funds are allocated to support equality strategies within the organization. Finally, they stress the need for mutuality in that the organization should build positive collaborative relationships with LGBT organizations and, for example, join equality campaigns. While these studies highlight issues of potential significance to older lesbians at work, there is a need to develop further research that explores their particular experiences, especially with respect to the intersection of aging, gender, and sexuality, as well as what helps them in their experience of the workplace. The purpose of this article is to provide an initial exploration of the work experiences of a small group of older lesbians to assist in developing questions for further research.
ABOUT THE STUDY The four women we describe here participated in a larger narrative research project on older lesbians and gays accessing health and aged care services (Hughes, 2007, 2008). That project was conducted in the Blue Mountains region of New South Wales, Australia, which is a recognized center of attraction for LGBT retirement migration. The narrative approach was acknowledged as valuable in enabling participants to talk about their public and private identities as they relate to the delivery of health and aged care services. Nonetheless it was recognized that narratives do not necessarily convey a static interpretation of identity; rather they can be multiple and contradictory (Abma, 2002), reflecting the view that identity(ies) can shift over time and be contingent on different circumstances and contexts (Heaphy, Weeks, & Donovan, 1998). Semi-structured interviews were conducted with 14 participants, aged 59 to 72, including five women. These interviews contained open-ended questions, designed to facilitate stories about life experiences. Participants were recruited through advertising in local media, including gay and lesbian community media, as well as local health and aged care organizations. They were also recruited through a snowballing sampling method, which reached out into LGBT friendship networks. While the original research was focused on people’s experience and expectations about being a consumer of health and aged care services, it was apparent that a number of research participants had also worked in health and aged care settings themselves. For these people, there appeared to be a reflexive movement between reflecting on and imagining what it is like to be a receiver of services and what it is like to be a provider of services: a worker in these settings. For the purposes of this article we have selected, of the five women participants, the four who had worked in health or aged care. The analysis of the data in the original project was based on a sociolinguistic approach to narrative analysis (Labov, 1972), which involved
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identifying narrative segments, extracting evaluation statements and then analyzing these thematically. In this article, case studies were developed from the interviews with the four women. The focus of these case studies is on the participants’ reflection of their experience of work in the health and aged care sector, how this intersects with their identity(ies) and how it relates to their own experience of aging and their past or future use of health and aged care services.
JAN Jan (aged 66, retired) was a medical specialist who worked in private practice and also in hospitals. She was married for 12 years and has an adult son, but she reported that since the death of her husband, when she was 38, she has had no attraction to men. Her relationship with her husband was more “a matter of getting on with a person” rather than a matter of sexual identity. Now her lesbian identity is central to her sense of self and her social networks. At the time of the interview, Jan was scheduled for hip replacement surgery. Although she lived alone she had many friends and reported having a wonderful support system, including a “roster” of lesbians to look after her when she gets home. Jan and her friends have thought about what they would do if they got to the stage of needing full-time care, and have discussed turning her home into a little private nursing home where they could be cared for by their children or a professional. Jan readily admitted that she was not open about her sexuality during her years as a medical specialist, although now she is an active member of a lesbian medical society. Partly she thought it was not relevant or appropriate to disclose this to her patients. “The relationship with the patient is to look after them. Any of my issues just really aren’t their concern.” She was also concerned that it could have had an adverse effect on her career. She recounted a problem with a colleague but he was a “nasty customer” who would use anything to advance his career and grab power and seems to have thought her sexuality was a weapon he could use against her. Nonetheless she reported not to have been overly worried about this. In fact, Jan acknowledged that the health care field has a large number of lesbians, even though in the past they would not discuss it with each other. She reflected that not being “out” at work was more about privacy and not being a topic of discussion than it was about actively concealing her sexuality. When I was in my specialist practice, I’m sure everybody knew I was a lesbian because I was in . . . a living partnership with a general practitioner in the area. [But] they’re personal issues that you don’t want to discuss . . . with people who are my colleagues and not my friends.
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She contrasted her attitude to that of a younger colleague who was also a friend. When Jan discovered this woman was a lesbian, she suggested that they go out to dinner with their partners, but the woman was “totally affronted . . . absolutely aghast.” Jan also reflected, with regret, about an incident from her career that brought home to her how disempowered lesbians used to be in the hospital system. She was treating a patient with a terminal illness; “it was quite obvious to me that she and her friend were more than friends.” However, on her final admission Jan realized that only the biological family members were visiting, and she was concerned that the partner had been ignored. She said, “I should have taken it further. . . . The horror of it all has [only] occurred to me since.”
THELMA Thelma (aged 72, working) was a nurse and spent her working life in both general hospitals and residential aged care. She has partnered with both women and men over her life, although she has been exclusively same-sex attracted over the last several years. She has five children. Thelma did not regard her sexuality as central to her identity, and said she is not interested in talking about a community based on sexual orientation. She contended that her sexual preference has never affected her working life or been a social encumbrance. Thelma reported that she strongly resists stereotypes about lesbian identity and all attempts to impose what she sees as lesbian orthodoxy on her understanding of herself and her sexuality. She said, “This lesbian thing seems to me to be like a cult or something.” She also fiercely resisted the whole idea of “coming out.” In terms of her working life, Thelma said that her sexuality has never been a problem because she never spoke about it. Indeed, for Thelma, her sexuality was not only something that should not be disclosed, but also something that should not be conceptualized or labeled. She was very aware, though, of lesbians in her work environments: “Those kind of women . . . are rife among the nursing profession.” As with work, if Thelma were to need to access aged care services, she adamantly resisted their need to know anything about her sexuality, although did acknowledge that is important to some women.
RACHEL Rachel (aged 64, employed) worked in a range of settings, including as an administrator in a local area health service. She partnered with men in the past, but said she got married because she was afraid she might be a lesbian
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and did not want to be. However, she has since become reconciled to her lesbian identity. She reported that she feels that it’s crucial to her sense of self, makes no effort to hide it, and openly talks about her female partner. So central is it that she would prefer to be in a lesbian-only nursing home if the time comes that she needs one. She said that her desire to be with other lesbians is not so much from fear of discrimination as it is a desire for the comfort of being with her “own kind.” In the work context, Rachel saw her sexual identity as one of a number of possible stigmatized identities. She said her main concern in “coming out” to colleagues was to prevent these “really nice people” from “falling into traps of making, you know, homophobic comments, that sort of thing.” They were also “really against PhDs and doctors, and I had to say, ‘Well, look, I’m a PhD’. Yeah, so I was lesbian and PhD. Double whammy.” In recent years, she did not hide her sexual identity in the workplace, but she did only want to tell people if they became friends. Some people knew, some guessed: “the word was around.” What was of more concern to her was how she has been treated (or would be treated in the future) in receiving health and aged care services. Because she had been married and has adult children she reported being concerned that she may be assumed to be heterosexual. This had occurred during one hospital stay. On this occasion she believed staff thought she was heterosexual and so she virtually ignored her partner when she visited so as not to give staff the alternative impression.
ANGELA Angela (aged 70, retired) trained as a psychiatric nurse, spent 17 years in “hands-on nursing,” and 17 years in health administration where she ended up in senior positions in community health and aged care monitoring. A life-long lesbian, Angela said she is cautious about who she discloses her sexuality to, as much for their comfort as for her own. She reported that her experiences have been colored, to a certain degree, by having been sent to a psychologist when she was young to be treated for her sexuality. Angela reported mixed responses to her sexuality by colleagues in the workplace. Early in her career, “some of the guys . . . made some snide remarks about it once they found out,” although other colleagues such as psychologists, social workers, doctors, and psychiatrists were more accepting and supportive. However, she was acutely aware that, at that time, “homosexuality was still a disease. We came out at a time where . . . making love to a person of your own sex was certainly not an accepted thing. So that influences even today.” Angela reported that, later in her career, it was not so much her sexuality that was of significance, but her age and gender. She said that since
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becoming older, “I’m just a sort of a person that you look through.” After long discussions with a close friend she developed greater insight into the way in which younger male colleagues (both senior and junior to her) ignored her or dismissed her views. She highlighted an incident where a young male boss ignored her standing at his office door, but immediately attended to a younger, attractive female colleague when she arrived. In terms of her receiving aged care in the future, Angela believed that, based on her experiences, it will be “nothing to look forward to.”
DISCUSSION Jan, Thelma, Rachel, and Angela conveyed complex expressions of age, gender, and sexuality in their reflections on their past work in the health and aged care sector and on their actual and possible experiences as consumers within that sector. Three of them had been married to men in the past, and two had children from these relationships. Three related to the notion of being a lesbian and felt some attachment to a “lesbian community,” although one clearly rejected both of these constructs, despite being same-sex attracted and having had long-term same-sex relationships. It was notable that none of the women used the term “bisexual” to describe themselves. Future research into older lesbians’ work experiences would benefit from an appreciation that older lesbians’ identities should not necessarily be considered fixed, stable and taken-for-granted (Cronin & King, 2010), or that their affiliation with a “lesbian community” is necessarily straight-forward (Hughes, 2008). For the three women who did identify as lesbian, the process of “coming out” in different contexts was identified as important. Jan came out publicly in relation to her career after she retired and, although she believed there are many lesbians working in the health sector, in the past this was not something that was openly discussed. Rachel felt challenged by the need to “come out” constantly in work and in personal situations (such as when receiving hospital care), but she was adamant that she does not want people to assume she is heterosexual and so wishes to be “out” in all situations. In contrast, Angela was cautious about how and to whom she “comes out.” She experienced discrimination in the past and was very aware that it could easily occur in the future in relation to her own care. As in sexuality research more broadly, exploration of the process of negotiating the “closet” in relation to older lesbians’ work experience would be valuable in further research in this area. In relating her experience of discrimination, Angela highlighted that in some contexts it was her age and gender that were more determining of discriminatory practices than her sexuality. Potentially, age-based discrimination obscured her sexuality and individuality. Jan expressed a similar sentiment in relation to young medical staff who fail to see beyond the
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representations of “sick” and “old” to recognize the person and their actual or potential quality of life. Rachel also acknowledged that she had multiple identities, a number of which could be used as a basis for discrimination. These experiences suggest the need for more research into older lesbians’ experience of discrimination in the workplace. Similar to that developed in feminist gerontology (Calasanti, 2010), a fruitful line of inquiry may be the ways in which age, gender, sexuality and other characteristics (such as ethnicity) intersect, and how this relates to the privileging of an idealized and hierarchical masculinity. Having worked in the health and aged care sector, Rachel, Jan, and Angela also had views about what it might be like, as older lesbians, to receive services in that sector. Jan reported an incident in which she failed to speak up when the family of a terminally ill woman in the hospital ignored her same-sex partner. When she is a consumer of such services, she expects to be open about her sexuality and relationships if she believes it is relevant to the care provided. Rachel recounted the pressure of hiding her sexuality from hospital staff while she was a patient—to the extent that she was distant with her partner when she visited so staff would not guess the nature of their relationship. Angela was very conscious of the potential for health care staff to be discriminatory, based on her own work experiences, even though she also understands the pressures staff are under. Each of the women grew up in a time when homosexuality was, in some respects, illegal. Rachel and Angela, in particular, highlighted earlier experiences of discrimination as being very significant, with Angela reflecting on its effect on her future care. In the literature on LGBT aging and caregiving, past experiences of discrimination are highlighted as significant in influencing expectations of future discrimination and preparedness to access services (Hash & Netting, 2009; Hughes, 2009). Future research into older lesbians’ experiences of work would benefit from exploring further the implications of these experiences for later life service use. What also would be valuable in future research in this area is to ensure that samples are able to capture a diversity of views and experiences. Thelma’s situation, for example, runs counter to LGBT orthodoxy. It would be easy to problematize Thelma and her situation—to ascribe her views to internalized homophobia. And there is certainly a reflection in her comments of views held by earlier generations of gay men and lesbians who were concerned for homosexuality to be treated as private, to “pass” in society and to not draw attention to oneself in public. Rosenfeld (1999) wrote convincingly of the tensions between two cohorts of lesbian and gay people based on when they publicly identified as such—a pre-gay liberation cohort and a post-gay liberation cohort—in which the former feels that the latter are too overt, too public, and too antagonistic to society. However, perhaps Thelma’s rejection of the idea that community is easily constructed around a shared sexuality is a view that others share? How might these people relate
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to other same-sex attracted people in health and aged care settings either as workers or clients? What are the implications of workers with these views while LGBT-awareness training is delivered in aged care settings? A range of research questions could be developed to examine the implications of the diverse views on sexuality, identity, and community. An undercurrent of the stories relayed by the women reported on in this article was the support gained from others and, in particular, friendship with other women. Angela reflected on the significant role her female work colleague played in helping her understand the way she was being treated by male colleagues. Thelma, although not apparent in her interview, was actually recruited for the research via close lesbian friends. For Rachel and Jan, friendship with other lesbians is now at the center of their lives. Despite her earlier fears, Rachel now wants to mainly be “with her own kind.” And Jan, who reached out in friendship to a closeted colleague and was rebuffed, imagines that it will be her friendship networks that will support her in later life. Future research into the work experiences of older lesbians would benefit from investigating friendship patterns and what these mean for women at work and in receiving care in the future.
CONCLUSION This article reported on the experiences of four older lesbians in relation to their work in the health and aged care sector, and in relation to their past or future receipt of care themselves. While providing some initial insights that can inform future research in this area, clearly it was a very small-scale study and thus should not be considered generalizable. Even in the context of qualitative research, theoretical saturation would not have been reached. Lesbians’ experiences of working in health and aged care are important to understand not only in terms of employee rights but also to gain insight into how LGBT clients are treated. Their experiences also inevitably inform their perceptions of how they want to age and access services, and may ultimately affect how they experience these services. Future research needs to explore the challenges that these women face, including difficulties negotiating disclosure of sexuality in different settings and experiences of discrimination. It would also benefit from facilitating a diversity of views to help capture the complexity of women’s lives and identities. There is also great potential for exploring the supports and resources (such as friendship) that help lesbians survive and thrive in the workplace.
REFERENCES Abma, T. (2002). Emerging narrative forms of knowledge representation in the health sciences: Two texts in a postmodern context. Qualitative Health Research, 12(1), 5–27.
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Australian Bureau of Statistics (ABS). (2011). Australian social trends September 2011. (cat. no. 4102.0). Retrieved from www.abs.gov.au/socialtrends Bell, M. P., Ozbilgin, M. F., Beauregard, T. A., and Surgevil, O. (2011). Voice, silence, and diversity in 21st century organizations: Strategies for inclusion of gay, lesbian, bisexual and transgender employees. Human Resource Management, 50(1), 131–146. Calasanti, T. (2010). Gender relations and applied research on aging. The Gerontologist, 50(6), 720–734. Cronin, A., and King, A. (2010). Power, inequality and identification: Exploring diversity and intersectionality amongst older LGB adults. Sociology, 44(5), 876–892. Eliason, M. J., DeJoseph, J., Dibble, S., Deevey, S., and Chinn, P. (2011a). Lesbian, gay, bisexual, transgender, and queer/questioning nurses’ experiences in the workplace. Journal of Professional Nursing, 27(4), 237–244. Eliason, M. J., Dibble, S. L., and Robertson, P. A. (2011b). Lesbian, gay, bisexual, and transgender (LGBT) physicians’ experiences in the workplace. Journal of Homosexuality, 58, 1355–1371. Ferfolja, T. (2010). Lesbian teachers, harassment and the workplace. Teaching and Teacher Education, 26, 408–414. Hash, K. M., and Netting, F. E. (2009). It takes a community: Older lesbians meeting social and care needs. Journal of Gay and Lesbian Social Services, 21, 326–342. Heaphy, B., Weeks, J., and Donovan, C. (1998). “That’s like my life”: Researching stories of non-heterosexual relationships. Sexualities, 1, 453–470. Hughes, M. (2007). Older lesbians and gays accessing health and aged care services. Australian Social Work, 60(2), 197–209. Hughes, M. (2008). Imagined futures and communities: Older lesbian and gay people’s narratives on health and aged care. Journal of Gay and Lesbian Social Services, 20(1/2), 167–186. Hughes, M. (2009). Lesbian and gay people’s concerns about ageing and accessing services. Australian Social Work, 62(2), 186–201. Jacobson, N. (2009). Dignity violation in health care. Qualitative Health Research, 19(11), 1536–1547. Labov, W. (Ed.). (1972). Language in the inner city: Studies in the black English vernacular. Philadelphia, PA: University of Pennsylvania Press. Losert, A. (2008). Coping with workplace heteronormativity among lesbian employees: A German study. Journal of Lesbian Studies, 12(1), 47–58. MacDonnell, J. (2010). Policy talk: Gender and the regulation of nursing knowledge and practices. Advances in Nursing Science, 33(3), 219–233. Ragins, B. R. (2004). Sexual orientation in the workplace: The unique work and career experiences of gay, lesbian and bisexual workers. Research in Personnel and Human Resources Management, 23, 35–120. Rosenfeld, D. (1999). Identity work among lesbian and gay elderly. Journal of Aging Studies, 13(2), 121–138. Willis, P. (2011). Laboring in silence: Young lesbian, gay, bisexual, and queeridentifying workers’ negotiations of the workplace closet in Australian organizations. Youth and Society, 43(3), 957–981.
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CONTRIBUTORS Mark Hughes is a Professor of Social Work at Southern Cross University, Australia. He is currently engaged in research on LGBT aging, which includes studies on health and wellbeing, LGBT people’s use of aged care services, and their end-of-life care. Mark is currently Editor of the journal Australian Social Work. Sujay Kentlyn is the Aging and Aged Care Senior Project Officer with the National LGBTI Health Alliance. A sociologist, Sujay has taught and researched at the University of Queensland, conducting training in sexuality, sex, and gender, and provision of inclusive services for health care workers. Sujay identifies as genderqueer and prefers gender neutral pronouns, zie and hir.
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Older Lesbians and Work in the Australian Health and Aged Care Sector MARK HUGHES School of Arts and Social Sciences, Southern Cross University, Queensland, Australia
SUJAY KENTLYN National LGBTI Health Alliance, Newtown, New South Wales, Australia
While research has identified challenges lesbians face in the workplace, there is limited understanding of the particular experiences of older lesbians, especially those working in the health and aged care sector. This article draws on the stories of four women who participated in a narrative research project on lesbian and gay people’s experiences of health and aged care. It highlights the need for future research to examine the complexity of identity expression and community affiliation, how people negotiate “coming out” in the workplace, the impact of discrimination, and the resources (such as friends) available to lesbians in the workplace. KEYWORDS
lesbians, older people, aging, work
INTRODUCTION Despite the high proportion of women in the Australian health and aged care workforce and its increasingly older profile (Australian Bureau of Statistics, 2011), female workers in this sector continue to negotiate gendered and ageist practices in their everyday work. For example, dignity violations in health care—such as objectification, condescension, and disregard—remain a significant concern (Jacobson, 2009). For lesbian employees, additional factors need to be negotiated, which vary in significance according to different situations and contexts. The concerns most commonly reported by lesbians in the workplace are that they are invisible and silenced (Bell et al., 2011). With regard to nursing, Eliason et al. (2011a, p. 237) argue that lesbians are “often invisible Address correspondence to Mark Hughes, School of Arts and Social Sciences, Southern Cross University, Locked Mail Bag 4, Coolangatta, Queensland, 4225, Australia. E-mail: [email protected] 62
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in the nursing workforce, absent from discourses of professional nursing organizations, ignored or pathologized in the nursing curriculum, and only rarely found on the pages of nursing journals.” In some workplaces there is an unwritten “don’t ask, don’t tell” policy, while others are so heteronormative that it is inconceivable that anyone could be non-heterosexual (Losert, 2008). In others, such as for teachers in high schools (Ferfolja, 2010), active and persistent harassment can be the most powerful silencer. In the health and aged care sector, lesbian workers, like gay, bisexual, and transgender workers, are confronted not only with the discrimination and mistreatment directed toward themselves, but also the discrimination directed at lesbian, gay, bisexual, and transgender (LGBT) people in general, whether clients or patients, their families, or other workers. In a survey of 427 LGBT physicians, 65% reported having heard disparaging remarks about LGBT patients at work, 36% witnessed the disrespecting of a patient’s same-sex partner, 34% witnessed discriminatory care, 27% witnessed discrimination of another LGBT employee, 22% had themselves been socially ostracised at work, 15% had been harassed by colleagues, and 10% had been refused patient referrals (Eliason et al., 2011b). In this study, most physicians reported that their knowledge of LGBT patient care came from their own experiences rather than from any formal training. Lesbians are also confronted with negotiating whether or not to “come out” in the workplace. “Negotiating refers to the continuous process of decision making about if , when, and how to discuss non-normative sexual identities with other organizational participants, including coworkers and clients” (Willis, 2011, p. 958, emphasis in original). Factors influencing such decisions include the anticipated consequences (costs and benefits) of disclosure, the nature of the stigma in a particular workplace, individuals’ internal psychological processes such as needing to present themselves in an honest way, and the work environment, such as whether there are any other non-heterosexual workers and whether there are LGBT-affirmative policies (Ragins, 2004). In Eliason et al.’s (2011a) study of 261 LGBT nurses, 73% said that their workplace was LGBT friendly, although only 57% said they were out to all their co-workers. When they are recognized within the workplace, lesbians can feel the pressure of being treated as an agency resource, supposedly expert on all things LGBT (MacDonnell, 2010). Nonetheless some organizations are actively promoting strategies, such as “new voice mechanisms,” which enable people from minority groups to network with others and access needed resources (Bell et al., 2011). Bell et al. highlight four dimensions of voice that human resource managers should promote for LGBT employees. These include enabling individuals to articulate dissatisfaction, for example by having effective complaints and advocacy mechanisms, as well as providing opportunities for collective organization of LGBT employees, such as via union representation. They also argue that management needs to enable
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LGBT employees to contribute to decision making and ensure that funds are allocated to support equality strategies within the organization. Finally, they stress the need for mutuality in that the organization should build positive collaborative relationships with LGBT organizations and, for example, join equality campaigns. While these studies highlight issues of potential significance to older lesbians at work, there is a need to develop further research that explores their particular experiences, especially with respect to the intersection of aging, gender, and sexuality, as well as what helps them in their experience of the workplace. The purpose of this article is to provide an initial exploration of the work experiences of a small group of older lesbians to assist in developing questions for further research.
ABOUT THE STUDY The four women we describe here participated in a larger narrative research project on older lesbians and gays accessing health and aged care services (Hughes, 2007, 2008). That project was conducted in the Blue Mountains region of New South Wales, Australia, which is a recognized center of attraction for LGBT retirement migration. The narrative approach was acknowledged as valuable in enabling participants to talk about their public and private identities as they relate to the delivery of health and aged care services. Nonetheless it was recognized that narratives do not necessarily convey a static interpretation of identity; rather they can be multiple and contradictory (Abma, 2002), reflecting the view that identity(ies) can shift over time and be contingent on different circumstances and contexts (Heaphy, Weeks, & Donovan, 1998). Semi-structured interviews were conducted with 14 participants, aged 59 to 72, including five women. These interviews contained open-ended questions, designed to facilitate stories about life experiences. Participants were recruited through advertising in local media, including gay and lesbian community media, as well as local health and aged care organizations. They were also recruited through a snowballing sampling method, which reached out into LGBT friendship networks. While the original research was focused on people’s experience and expectations about being a consumer of health and aged care services, it was apparent that a number of research participants had also worked in health and aged care settings themselves. For these people, there appeared to be a reflexive movement between reflecting on and imagining what it is like to be a receiver of services and what it is like to be a provider of services: a worker in these settings. For the purposes of this article we have selected, of the five women participants, the four who had worked in health or aged care. The analysis of the data in the original project was based on a sociolinguistic approach to narrative analysis (Labov, 1972), which involved
Older Lesbians in the Australian Health and Aged Care Sector
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identifying narrative segments, extracting evaluation statements and then analyzing these thematically. In this article, case studies were developed from the interviews with the four women. The focus of these case studies is on the participants’ reflection of their experience of work in the health and aged care sector, how this intersects with their identity(ies) and how it relates to their own experience of aging and their past or future use of health and aged care services.
JAN Jan (aged 66, retired) was a medical specialist who worked in private practice and also in hospitals. She was married for 12 years and has an adult son, but she reported that since the death of her husband, when she was 38, she has had no attraction to men. Her relationship with her husband was more “a matter of getting on with a person” rather than a matter of sexual identity. Now her lesbian identity is central to her sense of self and her social networks. At the time of the interview, Jan was scheduled for hip replacement surgery. Although she lived alone she had many friends and reported having a wonderful support system, including a “roster” of lesbians to look after her when she gets home. Jan and her friends have thought about what they would do if they got to the stage of needing full-time care, and have discussed turning her home into a little private nursing home where they could be cared for by their children or a professional. Jan readily admitted that she was not open about her sexuality during her years as a medical specialist, although now she is an active member of a lesbian medical society. Partly she thought it was not relevant or appropriate to disclose this to her patients. “The relationship with the patient is to look after them. Any of my issues just really aren’t their concern.” She was also concerned that it could have had an adverse effect on her career. She recounted a problem with a colleague but he was a “nasty customer” who would use anything to advance his career and grab power and seems to have thought her sexuality was a weapon he could use against her. Nonetheless she reported not to have been overly worried about this. In fact, Jan acknowledged that the health care field has a large number of lesbians, even though in the past they would not discuss it with each other. She reflected that not being “out” at work was more about privacy and not being a topic of discussion than it was about actively concealing her sexuality. When I was in my specialist practice, I’m sure everybody knew I was a lesbian because I was in . . . a living partnership with a general practitioner in the area. [But] they’re personal issues that you don’t want to discuss . . . with people who are my colleagues and not my friends.
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She contrasted her attitude to that of a younger colleague who was also a friend. When Jan discovered this woman was a lesbian, she suggested that they go out to dinner with their partners, but the woman was “totally affronted . . . absolutely aghast.” Jan also reflected, with regret, about an incident from her career that brought home to her how disempowered lesbians used to be in the hospital system. She was treating a patient with a terminal illness; “it was quite obvious to me that she and her friend were more than friends.” However, on her final admission Jan realized that only the biological family members were visiting, and she was concerned that the partner had been ignored. She said, “I should have taken it further. . . . The horror of it all has [only] occurred to me since.”
THELMA Thelma (aged 72, working) was a nurse and spent her working life in both general hospitals and residential aged care. She has partnered with both women and men over her life, although she has been exclusively same-sex attracted over the last several years. She has five children. Thelma did not regard her sexuality as central to her identity, and said she is not interested in talking about a community based on sexual orientation. She contended that her sexual preference has never affected her working life or been a social encumbrance. Thelma reported that she strongly resists stereotypes about lesbian identity and all attempts to impose what she sees as lesbian orthodoxy on her understanding of herself and her sexuality. She said, “This lesbian thing seems to me to be like a cult or something.” She also fiercely resisted the whole idea of “coming out.” In terms of her working life, Thelma said that her sexuality has never been a problem because she never spoke about it. Indeed, for Thelma, her sexuality was not only something that should not be disclosed, but also something that should not be conceptualized or labeled. She was very aware, though, of lesbians in her work environments: “Those kind of women . . . are rife among the nursing profession.” As with work, if Thelma were to need to access aged care services, she adamantly resisted their need to know anything about her sexuality, although did acknowledge that is important to some women.
RACHEL Rachel (aged 64, employed) worked in a range of settings, including as an administrator in a local area health service. She partnered with men in the past, but said she got married because she was afraid she might be a lesbian
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and did not want to be. However, she has since become reconciled to her lesbian identity. She reported that she feels that it’s crucial to her sense of self, makes no effort to hide it, and openly talks about her female partner. So central is it that she would prefer to be in a lesbian-only nursing home if the time comes that she needs one. She said that her desire to be with other lesbians is not so much from fear of discrimination as it is a desire for the comfort of being with her “own kind.” In the work context, Rachel saw her sexual identity as one of a number of possible stigmatized identities. She said her main concern in “coming out” to colleagues was to prevent these “really nice people” from “falling into traps of making, you know, homophobic comments, that sort of thing.” They were also “really against PhDs and doctors, and I had to say, ‘Well, look, I’m a PhD’. Yeah, so I was lesbian and PhD. Double whammy.” In recent years, she did not hide her sexual identity in the workplace, but she did only want to tell people if they became friends. Some people knew, some guessed: “the word was around.” What was of more concern to her was how she has been treated (or would be treated in the future) in receiving health and aged care services. Because she had been married and has adult children she reported being concerned that she may be assumed to be heterosexual. This had occurred during one hospital stay. On this occasion she believed staff thought she was heterosexual and so she virtually ignored her partner when she visited so as not to give staff the alternative impression.
ANGELA Angela (aged 70, retired) trained as a psychiatric nurse, spent 17 years in “hands-on nursing,” and 17 years in health administration where she ended up in senior positions in community health and aged care monitoring. A life-long lesbian, Angela said she is cautious about who she discloses her sexuality to, as much for their comfort as for her own. She reported that her experiences have been colored, to a certain degree, by having been sent to a psychologist when she was young to be treated for her sexuality. Angela reported mixed responses to her sexuality by colleagues in the workplace. Early in her career, “some of the guys . . . made some snide remarks about it once they found out,” although other colleagues such as psychologists, social workers, doctors, and psychiatrists were more accepting and supportive. However, she was acutely aware that, at that time, “homosexuality was still a disease. We came out at a time where . . . making love to a person of your own sex was certainly not an accepted thing. So that influences even today.” Angela reported that, later in her career, it was not so much her sexuality that was of significance, but her age and gender. She said that since
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becoming older, “I’m just a sort of a person that you look through.” After long discussions with a close friend she developed greater insight into the way in which younger male colleagues (both senior and junior to her) ignored her or dismissed her views. She highlighted an incident where a young male boss ignored her standing at his office door, but immediately attended to a younger, attractive female colleague when she arrived. In terms of her receiving aged care in the future, Angela believed that, based on her experiences, it will be “nothing to look forward to.”
DISCUSSION Jan, Thelma, Rachel, and Angela conveyed complex expressions of age, gender, and sexuality in their reflections on their past work in the health and aged care sector and on their actual and possible experiences as consumers within that sector. Three of them had been married to men in the past, and two had children from these relationships. Three related to the notion of being a lesbian and felt some attachment to a “lesbian community,” although one clearly rejected both of these constructs, despite being same-sex attracted and having had long-term same-sex relationships. It was notable that none of the women used the term “bisexual” to describe themselves. Future research into older lesbians’ work experiences would benefit from an appreciation that older lesbians’ identities should not necessarily be considered fixed, stable and taken-for-granted (Cronin & King, 2010), or that their affiliation with a “lesbian community” is necessarily straight-forward (Hughes, 2008). For the three women who did identify as lesbian, the process of “coming out” in different contexts was identified as important. Jan came out publicly in relation to her career after she retired and, although she believed there are many lesbians working in the health sector, in the past this was not something that was openly discussed. Rachel felt challenged by the need to “come out” constantly in work and in personal situations (such as when receiving hospital care), but she was adamant that she does not want people to assume she is heterosexual and so wishes to be “out” in all situations. In contrast, Angela was cautious about how and to whom she “comes out.” She experienced discrimination in the past and was very aware that it could easily occur in the future in relation to her own care. As in sexuality research more broadly, exploration of the process of negotiating the “closet” in relation to older lesbians’ work experience would be valuable in further research in this area. In relating her experience of discrimination, Angela highlighted that in some contexts it was her age and gender that were more determining of discriminatory practices than her sexuality. Potentially, age-based discrimination obscured her sexuality and individuality. Jan expressed a similar sentiment in relation to young medical staff who fail to see beyond the
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representations of “sick” and “old” to recognize the person and their actual or potential quality of life. Rachel also acknowledged that she had multiple identities, a number of which could be used as a basis for discrimination. These experiences suggest the need for more research into older lesbians’ experience of discrimination in the workplace. Similar to that developed in feminist gerontology (Calasanti, 2010), a fruitful line of inquiry may be the ways in which age, gender, sexuality and other characteristics (such as ethnicity) intersect, and how this relates to the privileging of an idealized and hierarchical masculinity. Having worked in the health and aged care sector, Rachel, Jan, and Angela also had views about what it might be like, as older lesbians, to receive services in that sector. Jan reported an incident in which she failed to speak up when the family of a terminally ill woman in the hospital ignored her same-sex partner. When she is a consumer of such services, she expects to be open about her sexuality and relationships if she believes it is relevant to the care provided. Rachel recounted the pressure of hiding her sexuality from hospital staff while she was a patient—to the extent that she was distant with her partner when she visited so staff would not guess the nature of their relationship. Angela was very conscious of the potential for health care staff to be discriminatory, based on her own work experiences, even though she also understands the pressures staff are under. Each of the women grew up in a time when homosexuality was, in some respects, illegal. Rachel and Angela, in particular, highlighted earlier experiences of discrimination as being very significant, with Angela reflecting on its effect on her future care. In the literature on LGBT aging and caregiving, past experiences of discrimination are highlighted as significant in influencing expectations of future discrimination and preparedness to access services (Hash & Netting, 2009; Hughes, 2009). Future research into older lesbians’ experiences of work would benefit from exploring further the implications of these experiences for later life service use. What also would be valuable in future research in this area is to ensure that samples are able to capture a diversity of views and experiences. Thelma’s situation, for example, runs counter to LGBT orthodoxy. It would be easy to problematize Thelma and her situation—to ascribe her views to internalized homophobia. And there is certainly a reflection in her comments of views held by earlier generations of gay men and lesbians who were concerned for homosexuality to be treated as private, to “pass” in society and to not draw attention to oneself in public. Rosenfeld (1999) wrote convincingly of the tensions between two cohorts of lesbian and gay people based on when they publicly identified as such—a pre-gay liberation cohort and a post-gay liberation cohort—in which the former feels that the latter are too overt, too public, and too antagonistic to society. However, perhaps Thelma’s rejection of the idea that community is easily constructed around a shared sexuality is a view that others share? How might these people relate
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to other same-sex attracted people in health and aged care settings either as workers or clients? What are the implications of workers with these views while LGBT-awareness training is delivered in aged care settings? A range of research questions could be developed to examine the implications of the diverse views on sexuality, identity, and community. An undercurrent of the stories relayed by the women reported on in this article was the support gained from others and, in particular, friendship with other women. Angela reflected on the significant role her female work colleague played in helping her understand the way she was being treated by male colleagues. Thelma, although not apparent in her interview, was actually recruited for the research via close lesbian friends. For Rachel and Jan, friendship with other lesbians is now at the center of their lives. Despite her earlier fears, Rachel now wants to mainly be “with her own kind.” And Jan, who reached out in friendship to a closeted colleague and was rebuffed, imagines that it will be her friendship networks that will support her in later life. Future research into the work experiences of older lesbians would benefit from investigating friendship patterns and what these mean for women at work and in receiving care in the future.
CONCLUSION This article reported on the experiences of four older lesbians in relation to their work in the health and aged care sector, and in relation to their past or future receipt of care themselves. While providing some initial insights that can inform future research in this area, clearly it was a very small-scale study and thus should not be considered generalizable. Even in the context of qualitative research, theoretical saturation would not have been reached. Lesbians’ experiences of working in health and aged care are important to understand not only in terms of employee rights but also to gain insight into how LGBT clients are treated. Their experiences also inevitably inform their perceptions of how they want to age and access services, and may ultimately affect how they experience these services. Future research needs to explore the challenges that these women face, including difficulties negotiating disclosure of sexuality in different settings and experiences of discrimination. It would also benefit from facilitating a diversity of views to help capture the complexity of women’s lives and identities. There is also great potential for exploring the supports and resources (such as friendship) that help lesbians survive and thrive in the workplace.
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Australian Bureau of Statistics (ABS). (2011). Australian social trends September 2011. (cat. no. 4102.0). Retrieved from www.abs.gov.au/socialtrends Bell, M. P., Ozbilgin, M. F., Beauregard, T. A., and Surgevil, O. (2011). Voice, silence, and diversity in 21st century organizations: Strategies for inclusion of gay, lesbian, bisexual and transgender employees. Human Resource Management, 50(1), 131–146. Calasanti, T. (2010). Gender relations and applied research on aging. The Gerontologist, 50(6), 720–734. Cronin, A., and King, A. (2010). Power, inequality and identification: Exploring diversity and intersectionality amongst older LGB adults. Sociology, 44(5), 876–892. Eliason, M. J., DeJoseph, J., Dibble, S., Deevey, S., and Chinn, P. (2011a). Lesbian, gay, bisexual, transgender, and queer/questioning nurses’ experiences in the workplace. Journal of Professional Nursing, 27(4), 237–244. Eliason, M. J., Dibble, S. L., and Robertson, P. A. (2011b). Lesbian, gay, bisexual, and transgender (LGBT) physicians’ experiences in the workplace. Journal of Homosexuality, 58, 1355–1371. Ferfolja, T. (2010). Lesbian teachers, harassment and the workplace. Teaching and Teacher Education, 26, 408–414. Hash, K. M., and Netting, F. E. (2009). It takes a community: Older lesbians meeting social and care needs. Journal of Gay and Lesbian Social Services, 21, 326–342. Heaphy, B., Weeks, J., and Donovan, C. (1998). “That’s like my life”: Researching stories of non-heterosexual relationships. Sexualities, 1, 453–470. Hughes, M. (2007). Older lesbians and gays accessing health and aged care services. Australian Social Work, 60(2), 197–209. Hughes, M. (2008). Imagined futures and communities: Older lesbian and gay people’s narratives on health and aged care. Journal of Gay and Lesbian Social Services, 20(1/2), 167–186. Hughes, M. (2009). Lesbian and gay people’s concerns about ageing and accessing services. Australian Social Work, 62(2), 186–201. Jacobson, N. (2009). Dignity violation in health care. Qualitative Health Research, 19(11), 1536–1547. Labov, W. (Ed.). (1972). Language in the inner city: Studies in the black English vernacular. Philadelphia, PA: University of Pennsylvania Press. Losert, A. (2008). Coping with workplace heteronormativity among lesbian employees: A German study. Journal of Lesbian Studies, 12(1), 47–58. MacDonnell, J. (2010). Policy talk: Gender and the regulation of nursing knowledge and practices. Advances in Nursing Science, 33(3), 219–233. Ragins, B. R. (2004). Sexual orientation in the workplace: The unique work and career experiences of gay, lesbian and bisexual workers. Research in Personnel and Human Resources Management, 23, 35–120. Rosenfeld, D. (1999). Identity work among lesbian and gay elderly. Journal of Aging Studies, 13(2), 121–138. Willis, P. (2011). Laboring in silence: Young lesbian, gay, bisexual, and queeridentifying workers’ negotiations of the workplace closet in Australian organizations. Youth and Society, 43(3), 957–981.
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CONTRIBUTORS Mark Hughes is a Professor of Social Work at Southern Cross University, Australia. He is currently engaged in research on LGBT aging, which includes studies on health and wellbeing, LGBT people’s use of aged care services, and their end-of-life care. Mark is currently Editor of the journal Australian Social Work. Sujay Kentlyn is the Aging and Aged Care Senior Project Officer with the National LGBTI Health Alliance. A sociologist, Sujay has taught and researched at the University of Queensland, conducting training in sexuality, sex, and gender, and provision of inclusive services for health care workers. Sujay identifies as genderqueer and prefers gender neutral pronouns, zie and hir.
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