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‘Improving services for older trans people is a social justice issue for social workers’

Paul Willis outlines findings of a two-year study that highlights gaps in health and care provision, fear of ‘transphobic responses’ from service users and a need for better training for professionals

Trans ageing and care project
The Trans Ageing and Care project gives guidance to professionals

Professional Social Work magazine – 2 October 2019

Despite LGBT+ pride events taking place across the country in recent months, many trans people still say they will avoid expressing their gender identity, particularly in public, for fear of the negative reactions of others.

Trans lives have recently been the subject of much negative press, partly in response to recent government proposals to amend and update the Gender Recognition Act 2004. One of the proposed reforms currently being considered is to give people the right to self-declare their gender identity rather than having to prove their gender through bureaucratic and medical processes.

Within social research, people identifying as trans are often the forgotten ‘T’ in ‘LGBT’. The inclusion and recognition of trans people in communities as well as academia is a fundamental social justice issue and therefore an important issue for social work.

A 2018 government-commissioned survey of more than 100,000 LGBT people found they had a 13 per cent lower life-satisfaction score than the general population. This is based on a survey item that asks respondents to rate on a scale of 1 to ten their satisfaction with current life.

However, only six per cent of respondents were aged 55 or over, indicating a significant gap in knowledge about LGB and trans citizens in later life. Similarly, little is known about the health and social care needs of trans people within this age group and there is a lack of research on how social care is experienced by older adults identifying as trans.

A recent UK government inquiry noted “trans people face significant difficulties when accessing general NHS services”. Is it a similar situation with social care services?

Later life can bring worries about receiving dignified and inclusive care from social care services. For trans service users, this includes a dual concern about encountering ageist and cisnormative attitudes from workers (‘cisnormative’ refers to assumptions made about a person’s gender identity based on the sex assigned to them at birth).

The objective of our two-year study at Swansea University was to better understand the health and social care needs of trans adults aged 50 and over. We intentionally adopted a broad definition of ‘trans’ so we could hear life-stories from individuals who were transitioning through gender affirming treatments and surgeries and those not invested in this. Our research included people who were transitioning male-to-female and female-to-male, people who cross-dressed, and people who described their gender outside of the gender binary model, for example as gender-queer or gender-fluid. The research found the following:

1) Based on interviews with trans people, concerns were expressed about discriminatory treatment from social care staff if they had to receive personal care. This included whether they would experience transphobic responses from other service users and residents, and what the impact would be if their mental capacity declined and they became heavily reliant on others for assistance with intimate practices such as dressing and bathing.

2) Based on an online questionnaire with 165 health and social care professionals across Wales (20 per cent employed in social work and social care roles), respondents appeared familiar with trans issues and generally supportive of trans civil rights. However, there were notable gaps in knowledge about trans issues in later life, mainly around medical and legal matters. It was felt there was a need for more education and training in health and social care.

3) Based on workshops with older trans people and health and social care professionals, a need for compulsory education and training was recommended. This should be in primary and secondary healthcare services as well as in pre-qualifying professional programmes, including social work. Involvement of trans people with lived experience was essential. Workshop participants also highlighted the importance of increasing social support for trans individuals in the local community – trans groups and networks can be a vital source of peer advocacy in later life but receive little, if any, funding.

As part of our research, we created digital stories to inform practitioners about trans older adult’s lives. Storytelling through online media is a powerful way of highlighting the hopes, expectations and concerns that different groups of older adults hold about ageing and getting older. Four short films co-produced with trans film-makers Fox and Owl highlighting older trans people’s stories in Wales can be viewed here (go to the 'digital stories' tab at the top of the page).

Our research also culminated in the launch of new practice guidelines for professionals, including for social workers which can be viewed here (click on the resources tab).

The guidelines highlight how important it is to adopt a lifecourse perspective when working with trans service users to recognise key turning points in their transitioning journey. An individual’s understanding of their gender identity and how they express this may change across their lifetime and continue to change in later life. Social workers need a social understanding of gender and the ways in which the dominant model of gender being a fixed binary (i.e. male and female) can result in trans individuals enduring a lifetime of being misgendered - incorrectly addressed in name and gender pronoun - or encountering transphobic attitudes, abuse and discrimination in work, at home or in their local community.

We encourage practitioners to download, read and share our guidelines with colleagues and their managers and together discuss how social workers can better support older trans individuals and how older people’s services can be more trans-inclusive.

Dr Paul Willis is a senior lecturer in social work with adults in the School for Policy Studies at the University of Bristol and a Senior Fellow in the NIHR School for Social Care Research. He currently teaches on the MSc Social Work programme and his research areas include masculinities and loneliness, social work practice with older adults, and the health and social care needs of older LGBT+ people

October’s edition of Professional Social Work magazine features an account from a social worker who is the parent of a trans child

This article is published by Professional Social work magazine which provides a platform for a range of perspectives across the social work sector. It does not necessarily reflect the views of the British Association of Social Workers.