New realities, expectations drive changes and choice
Nationally, senior residences are home to more than twice as many women than men, according to a 2017 Argentum report. A Pew research study shows more older couples living together. A British study reveals nearly half of older men suffer from loneliness that could compromise their health. A lawsuit in a bullying incident against an LGBT woman makes national headlines.
These realities send the signal to senior living leaders that gender identity matters. To provide optimum quality of life in communities, now and in the future, gender is an element that can’t be overlooked. And more states, most recently Massachusetts and California, are requiring LGBT cultural competency training for caregivers.
How important is gender in senior living?
Individual preferences aside, gender or conventions around it affect everything in senior residences: activities, design, workforce, resident satisfaction levels. How senior living leaders handle gender can make a difference in branding and marketplace positioning, as well—from visual identity to media and community image.
In a residence itself, complaints and perceptions can be of the minor variety that end up having a major effect on quality of life—too many floral prints, too many floral scents, too many salads and teas. But gender issues can also create social isolation or, at worst, an unsafe environment.
Choice: It’s not just for menus
For many leaders, the key to handling this disparity is to offer more choices. In 2016, Commonwealth Memory Care in Virginia began offering separate floors for men and women.
“It’s definitely about choice,” for residents and for families, said Bernie Cavis, vice president of resident programs at Commonwealth. “If someone can benefit from it, then we can offer it.”
The provider also now has a male-specific community in Hampton, Va., where there’s a large former military population. “The gentlemen can tap into that and have camaraderie,” Cavis said.
Demand is high for the “elite unit” of about 20 rooms, Cavis said, and she’s also noticing that while women are still the majority, that’s changing, with more men choosing senior living.
Truisms in the industry include that men are easier to deal with and harder to program for, because they may not have connections to religious or hobby communities that women might have cultivated over the years.
Get ready for change there, too, Cavis said. For instance, in memory care, a woman might want to care for a baby doll, but so might a man. “Someone might find that unusual. But be open to it, and don’t generalize,” she said. Whatever helps a person tap into their individual life experiences and reduces stress is the right thing to do.
“With our baby boomers coming in, we’re going to really have to open our minds and think about this,” Cavis said.
Awareness: Key to a thriving resident community
From The Golden Girls to Frankie and Johnny, images in popular culture reflect the importance of gender identity and affinity in seniors’ lives. But the reality can be less pleasant. Older women speak of cliques and “mean girls” even at the senior level, and LGBT older adults have experienced bullying, abuse, and isolation.
The solution: articulate and communicate a culture of respect for differences, said Jason Flatt, PhD, MPH, and assistant professor at the Institute for Health & Aging at University of California, San Francisco, who is involved in several research projects in the areas of LGBT seniors and memory care.
Focusing on culture and values is a gentle and effective approach that works for residents, staff, and visitors alike. If problems arise, “the idea isn’t to cause stress or strife, but to refocus on values,” Flatt said. “Communicate that ‘we have respect for all people here, this is a safe and supportive place. Here, we appreciate differences, and differences matter.’”
Identity is critical to mental and physical health in aging, and gender is a big part of identity—and LGBT older adults face realities of having to deny their identities. Flatt even cited depression rates of 35 percent among LGBT older adults.
Other older adults prefer not to be out, and that should be respected as well, leaders in that area note. There’s a paradox in that creating special programming can inadvertently out people, so residents should stay aware of this. Creating an individualized friendly-visitor program, or activities that focus on advocacy or programs for “allies” can allow both pride and privacy to coexist.
The “good” stereotypes around gender can be just as problematic as the destructive ones: images, for instance, of women as “merry widows” with inheritances and gay male couples as affluent “double income, no kids” partners. But gender and identity affect salaries, home ownership, inherited wealth, and health in different ways. A lifetime of systematic bias could put burdens on women and LGBT people in particular, leaving them at a deficit in resources, support, and health.
Workforce: Training and leading in gender issues
Cultural competency training is becoming more often required, but even where it’s not regulated, such training can have benefits for the enterprise.
Training can start at the top, with examination of policies and programs as well as marketing and communications, said Lisa Krinsky, director of the LGBT Aging Project at Fenway Health in Boston, which has been conducting training and education since 2001. But the dining room staff needs training, too—they may see residents more often than anyone else.
The guiding factor is to make no assumptions. For instance, at one residence, Krinsky said, caregivers and fellow residents wondered why a resident’s granddaughter had not been to visit her in a while. It turned out the adult grandchild was transitioning to be male, and neither he nor his grandmother felt safe enough for him to visit.
Recruiting a diverse workforce is another benefit—it allows tapping into a larger labor pool. Cavis, of Commonwealth, for instance, said recruiting more male caregivers “would be wonderful.”
“The male caregivers in our gender-specific residence are brilliant, and I think our gentlemen like it,” Cavis said. “In any good memory care program, caregivers need to be really comfortable with the whole person.”
“You can do this now, or you can do it later, but you’ll have to at some point,” Krinsky said. “We want to create a space where people feel welcome, and at home, and part of things.”
Three best practices
Leaders, educators, and researchers pointed to three top areas where senior living leaders can provide a better experience for all genders:
1. Hold strong community values and communicate them often.
Make “valuing difference,” respect, and kindness part of the community culture; talk about these, and gently remind people of the importance of this when needed, trainers recommend. “Diversity doesn’t mean you have to agree with me,” is one of the messages Krinsky uses, along with reassuring people that they’re entitled to their personal beliefs, but that the community needs to create a space where all beliefs are respected.
2. Cultivate both unique and inclusive activities.
Evaluate your offerings for range and choice for all genders, on their own and together. Are men getting short shrift? The idea that activities such as golf or chess are “traditionally male” is now discounted, but has your programming caught up? A Veterans’ Day celebration, for instance, shouldn’t be planned around men alone, but needs to include women and LGBT individuals who served, too.
3. Check your communications.
What kind of photos do you use in your marketing materials? Can you expand your advertising and information to use inclusive language such as “spouse or partner” rather than only “husband” or “wife”? This communicates your tone and values from the first contact. Assuming that all residents will have adult children as a primary point of contact can cause problems; non-traditional couples and aging heterosexual adults alike may have a friend in that advocate role instead. Being aware—and showing you’re aware—of such differences can save time and trouble from a business standpoint as well as affirm inclusive values. 
