Older lesbian, gay, bisexual, transgender, queer and intersex peoples’ experiences and perceptions of receiving home care services in the community: A systematic review

Background
Numbers of older lesbian, gay, bisexual, transgender, queer and intersex (LGBTQI+) people are increasing worldwide in line with the ageing populations of many countries. Most LGBTQI+ people want to remain in their own homes as they age, making it important to understand their experiences and perceptions of receiving home care. This systematic review aimed to examine older (over 60 years) LGBTQI+ people's perceptions and experiences of using formal home care services in the community.

Methods
The following six electronic databases were searched from the date of their first records until the first week of March 2020: MEDLINE; PsycINFO; Social Policy and Practice; CINAHL; SSCI; and ASSIA. Hand searches of the reference lists of the included studies and relevant reviews were also conducted. Only peer reviewed research published in English was included. There were no restrictions on study design. Findings were analysed using narrative synthesis. The PROSPERO protocol registration identification number is: CRD42020168443.

Results
Seven studies involving 169 participants were included in the synthesis. All were qualitative. Most participants were either lesbian women or gay men, with no studies investigating home care for transgender, queer, intersex or other sexual minorities. Fear of accessing home care services due to the perceived threat of homophobia and past negative experiences of discrimination were common. Some concealed any LGBTQI+ materials in their homes to try and hide their sexuality from home care workers. Despite fear of discrimination, lesbian women and gay men reported wanting and expecting the same level of care, dignity and respect as their heterosexual counterparts. Mandatory LGBTQI+ sensitivity training for home care workers was identified for reducing homophobia and increasing the inclusivity of service providers.

Conclusion
Older lesbian women and gay men fear or experience discrimination from home care workers, with some choosing to hide their sexuality causing stress and anxiety. Sensitivity training in the needs of older LGBTQI+ people should be considered by home care service providers as a way of reducing homophobic attitudes which may exist among some home care workers. Due to the paucity of studies and their focus on older lesbian women and gay men, more research is needed to explore the experiences of other sexual minorities receiving home care services who are represented by the LGBTQI+ umbrella term.