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    Beyond Cultural Competence: Cultural Humility Is Key in Caring for LGBT Elders

    By Michelle Alcedo and Ariel Mellinger

    LGBT seniors often face sub-standard care within health and social services, whether it is due to overt discrimination from providers, or it results from the unintentional barriers that prevent LGBT elders from feeling safe and welcome within senior centers, health, and social service settings.

    In response to an increasingly complex, multicultural, and diverse society, some housing, health and social service providers have recognized the value of creating environments that welcome people of all backgrounds in a culturally responsive way. For many years, training and education efforts emphasized attaining cultural competence or “mastery” in any number of cultural backgrounds as the model for realizing such an approach.

    While these goals were worthy, on a practical level, the expectation of achieving cultural competence is, at best, impractical. At worst, it reduces the idea of culture to an interchangeable set of characteristics that allegedly defines whole groups of people without recognizing their unique individuality. This approach further isolates LGBT seniors, whose experiences of exclusion are amplified by being the targets of both ageism in agencies serving LGBT communities, and homophobia/biphobia and transphobia in agencies whose mission is to serve seniors.

    Cultural humility, however, sees individuals and communities that have historically been oppressed as experts in their own experience and therefore an indispensable source of information about how to best serve them. It emphasizes active listening and seeking out the inherent wisdom in their lived experience to determine the best course of action. It recognizes there is no endpoint to this learning process.

    Being culturally humble means we must be willing to develop self-awareness about our own biases, including ways we may communicate using assumptions we have internalized about age, gender identity, and sexuality. For example, LGBT people are often reduced to stereotypes that portray us exclusively in terms of our sexual behaviors. At the same time, our culture desexualizes all older people, thereby forcing LGBT seniors into the shadows.

    More recently, in the context of the Women’s Marches organized globally in January, the term “intersectionality” has come into the spotlight as a way of talking and thinking about the impact of multiple forms of discrimination. Kimberlé Crenshaw, a law professor at both UCLA and Columbia, is credited with coining the term intersectionality which is defined as “cultural patterns of oppression are not only interrelated, but are bound together and influenced by the intersectional systems of society; examples of this include race, gender, class, ability, and ethnicity.”

    While the concept of intersectionality emerged from feminist discourse, it’s not just women who are affected by the forces of institutionalized oppressions. Sexual orientation and gender identity represent only one part of a person’s identity. Each LGBT senior also brings their racial/ethnic and/or cultural heritage, their socio-economic status, their gender identity, and unique individual history with them when seeking services. As providers who seek to offer person-centered care, it is our responsibility to interrogate the ways in which our actions, behaviors and assumptions keep us from seeing our clients as whole persons.

    Cultural humility helps us to work in partnership with LGBT older clients, to understand how they see themselves and how they want to be seen. It can help us to support and create safety for LGBT seniors who have experienced lifetimes of being invisible or not accepted for who they are. An intersectional lens creates space to make visible all of one’s identities, without having to choose which are most salient depending on any given moment.

    No matter where you are today, you can always become more culturally respectful. Cultural humility emphasizes having a commitment to create spaces that honor the wisdom of folks living at the intersections of multiple identities. This can be done in areas such as hiring practices, composition of staff, and building partnerships with other members of the community. First and foremost, however, being culturally humble requires a commitment from every service provider to continue learning from those you serve.

    Michelle Alcedo is the Director of Programs at Openhouse and provided training to hundreds of organizations to help them better meet the needs of LGBT seniors.

    Ariel Mellinger has her Master’s in Social Work and is a Program Coordinator at Openhouse. She leads community outreach events and provides support to LGBT seniors throughout the Bay Area.