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HBHC's HEALE program: Educating nurses about LGBTQ elders

by Liz Baudler

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"When a person's getting older and they're faced with the prospect of going into long-term care, they're being taken out of their home environment. Gay or straight: no one wants to do that," said Cecilia Hardacker, geriatric trainer at the Howard Brown Health Center ( HBHC ).

Hardacker is one of the trainers of the HEALE ( Health Education about LGBT Elders ) program. The normal difficulties of aging can be compounded when sexuality comes into play. The HEALE program, in the words of a paper Hardacker coauthored about the program's work, "target[s] nurses and healthcare staff and is focused on the treatment of LGBT elders, a population that is largely misunderstood and discriminated against in health-care settings."

HBHC Vice President of Development and Communication Barbara Tieder mentioned a community meeting that HBHC hosted for older adults. "We heard a couple of folks in the group talk about the horrific experience they had being in assisted living or a nursing home."

Hardacker told the story of a man who lost his support group of friends because of a caretaker's perception of their sexualities. "We're so aware of when someone's attitude changes. It can be a look, it can be a comment, it can be something really off-handed that can just terrify a person." Within a year, she said, his friends stopped visiting and the patient died alone.

According to Hardacker, this is common. "A lot of [older adults] will say, "I'll go back in the closet" or trans people will say, "I'll wear those other clothes" to protect themselves, because there's nobody there to protect them."

"Nurses are supposed to be advocates for your health," Tieder said. "They're the people that see you every day. A doctor will interact with you for a certain period of time, but a nurse is there for however long that shift is. If they're not your advocate, how do you feel comfortable in getting that care?"

The program travels to many Chicago area long-term care facilities, hospitals, and nursing schools, including Rush's College of Nursing, Illinois Masonic, and all the Veterans' Affairs ( VA ) hospitals in the Chicago area. They've even trained nurses in Minnesota and New York. HEALE has several modules, or areas of study, including a general familiarization with the LGBTQ community and clinical information such as particular health issues a certain group might face, including a whole module about trans health.

"It really does make a dramatic impact on people," Hardacker said, "We hear stories from people saying, "Gosh, it's made such a difference, we had such and such a patient come in and we had a really excellent experience with them as opposed to back in the day when we had people who would whisper about it." At a hospital where Hardacker has run trainings for the past three years, she said nurses tell her that they feel empowered not only to help LGBT patients, but to correct others' inappropriate behavior towards those patients.

This anecdotal evidence is borne out in a research paper Hardacker and others at Howard Brown published in a 2014 issue of the Journal of Nursing Management. The program and training is funded through a three-year grant gained because of HEALE's research basis. Not only has Hardacker's team, in her words, "annihilated our numbers" when it comes to trained nurses, they demonstrate statistically significant gains in nurses' knowledge when it comes to LGBTQ issues both clinical and cultural.

For the next grant cycle, Hardacker is excited about the partnership HEALE has with the VA hospitals. "These hospitals are in fairly metropolitan areas and have access to the collar areas," she said. "It's the biggest healthcare network in the nation. If we can start to have an influence with that group of healthcare providers, that's awesome."

With the repeal of "Don't Ask, Don't Tell," the VA is starting to support LGBT veterans and their partners. According to Hardacker, for trans patients the VA will cover everything up to a gender affirming surgery and post-op care afterwards. But not having prior experience with these surgeries, staff will need more trainings, she said.

Education is valuable in places like Iron Mountain, Michigan, where there's a small population but a large VA hospital. "People would ask questions like, 'so do you think if a same-sex couple has kids, that those kids will be gay?' They're asking that in all sincerity, they just have not been exposed to it," Hardacker said. "The fundamental getting up in front of people and having them ask us any question is what makes it worth it. On the rare occasion where we get a question that makes us scratch our head a little bit, we think, 'how can I best answer this question to help open this person's mind to what they're really asking?'"

Even in Chicago, there are still knowledge gaps. "I get invited back to one of the inpatient mental health facilities here in Chicago often because they have particular issues with trans patients," Hardacker said. "It shocks me sometimes that that would be a place that would have that problem, but they continue to invite us back to help them and to train their staff."

Hardacker and her fellow trainers, Hector Salgado and Brian Jauregi, hope to get their grant renewed. For her, it's about connections beyond the training. Occasionally she's able to advise trainees about LGBT issues, or connect patients with resources at Howard Brown and elsewhere. "We're ambassadors for Howard Brown, for the healthcare that we provide," she said. It's clear, not just from nurses' comments and statistics, that HEALE has an impact. "Places keep inviting us back," Hardacker said, "which tells us, number one, that we're doing something right but, number two, that they really value the training."

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