Minnesota Trans Aging Project Dylan Flunker, MPP Abel Knochel, PhD, MSW Rainbow Health Initiative UMD Social Work Department he/him/his they/them/theirs dylan.flunker@rainbowhealth.org aknochel@d.umn.edu Research reported in this publication was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health Award Number UL1TR000114. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Welcome! 1. Introductions 2. Study Overview and Results 3. How do you use this?
Study Overview
tudy Overview S How do t ransgender older adult s experience t he qualit y and welcome of healt h services and aging services?
tudy Overview: Interviews S S emi-structured individual interviews (24 complete) Average 60-90 minutes Audiotaped, transcribed, NVIVO coding Results confirmed by participant s at community gatherings
Interview Participant Demographics Demographics: • Primarily white • Age range: 56-73 • Mean age of 63 • 3/ 4 Twin Cities Metro, 1/ 4 Arrowhead area • 18 transfeminine, 5 transmasculine, 2 nonbinary • All but 2 transitioning or transitioned 2/ 3 started 2000 - 2016. 1/ 3 started 1976 - 1999
Big Picture (Take Home) Messages Mix of positive and negative experiences in accessing care or services, often in the same systems and sometimes in the same visit. Cumulative effects of bias. Provider willingness to listen, learn, and act is crucial. All parts of the provider system matter. Many fears about long term care.
Positive Experiences Basic service and decency I had a hip placement ...I was crashing a bit and needed t o get a cat het er insert ed. And I had t o let t hem know t hat I was t rans in case t hey f ound some anat omy t hat didn’t mat ch what t hey were used t o...Nobody was spooked...I mean, t hey were j ust f ine wit h everyt hing...given t hat , boom, I j ust dropped t he bomb on t hem t hat I was t ransgender. [trans woman, hospital, Twin Cities metro, 58] “ No small t hing!”
Positive Experiences Supportive and respectful It 's a dent ist t hat we have been using f or probably 25 years...They list ened wit h great int ent and really seemed t o care...t hey went out of t heir way t o make sure t hat I knew t hat t hey were okay wit h t his...I f eel very comf ort able going t here and being able t o bring up somet hing in my lif e t hat 's relat ed t o being t ransgender and I don't f eel like I can't . [transwoman, dentist, Twin Cities metro, 62]
Positive Experiences Trans competent in communication S omebody on t he phone gent ly t alked me t hrough coming in t o see t hem. They were really, really pat ient on t he phone and get t ing me t here. [nonbinary person, Arrowhead region, contacting therapist in Twin Cities Metro that specializes in trans care, 60]
Positive Experiences Trans competent in care and service provision Knowing t hat he came recommended by...ot her t rans f olks and...had credibilit y wit h t hem, and t he sense t hat I wouldn't have t o educat e him as I was t rying t o educat e myself , was import ant t o me as I went in...He was good at communicat ing wit h my t herapist at t he t ime, and he knew what needed t o be done and how t o get it done. (61, transguy, Twin Cities metro)
Positive Experiences Basic service and decency S upportive, respectful communication and care Trans competent communication and care
Negative Experiences Misgendering in communication [W]hen I was very early in my t ransit ion, I was misgendered during a mammogram. Y ou sort of want t o say you hardly blame t hem at t hat point , but it was on t he piece of paper. [64, transgender man, Twin Cities metro] S ocial services… are okay unt il we t alk on t he phone. If I'm t alking t o somebody and… I don't answer t he phone like t his [Using a f alset t o voice] t hen t hey're like, “ Excuse me, sir, is [name of int erviewee] available? ” [trans woman, social services, Twin Cities metro, 60]
Negative Experiences Misgendering in care or services I had a hemat oma...af t er one of t he surgeries… [S ]he obviously didn’t read t he chart , and it was very awkward because...she’ d had cancer and had had a mast ect omy, so she knew I had had a mast ect omy and she t hought it was f or t hat … [S ]he t ouched my arm t o say it ’ ll be all right ...I’ m f inally like, “ Y ou know...my surgery’s not quit e what you t hink it is.” ...And t hen t he surgeons were kind of dumb, because t hey came in, again, not having read. And so you kind of had t o explain...t oo much t o t hem (63, transguy, Twin Cities metro)
Negative Experiences S ubstandard care I j ust see her f or my meds. And she didn't know what st rengt h of est rogen t o put on me. In f act , she t ells me… ,"Y ou probably won't be on est rogen very long because you're older and… you'll probably have no use f or it ." [trans woman, PCA, Arrowhead, 67] I had huge problems when I had t o go in and have a colonoscopy. They had no idea. It 's like you're a but t pilot , you can't t ell t he dif f erence bet ween a but t and a vagina? I mean come on. [trans woman, Twin Cities metro, 60]
Negative Experiences Provider discomfort, ridicule, put downs “ a dagger t o t he heart .” I could t ell t hat one of my physicians was very uncomf ort able wit h me when I went t o have a prost at e exam… This was j ust last week. [trans woman, primary care, Twin Cities metro, 56] I could hear t he ER nurses laughing. And I didn’t call t hem on it … I mean I’ m t here seeking t heir t reat ment . If I annoy t hem, t here’s a risk. I t hink t hey j ust t hought t his is silly: We’ re gonna laugh at it . [trans woman, emergency services, Twin Cities metro, 62]
Negative Experiences Denial of care or services The endocrinologist ...basically let me know, “ We're done. I don't do t his.” ...“ I can't help you” was his phrase. That was such a kick in t he st omach because he was looking across t he desk in a manner t hat was very likely j udgment al and very likely conf ident ly so… He'd got t en his prof essional act down well enough t o j ust put up t he f ence and say, “ Y ou can't get past ; I'm not gonna help you.” [nonbinary person, endocrinologist, Arrowhead, 60]
Negative Experiences Misgendering in communication and care S ubstandard care or services Provider discomfort, ridicule, put downs Denial of care or services
ervices Aging S Few have used: “too young/too healthy” Will use (some services) to avoid long-term care Considerations of passing Will I be welcome at t he senior cent er in a dress? No. I t hink nobody will play chess or checkers wit h me. I don’t t hink anybody will invit e me t o go f ishing wit h t hem, you know. I'll j ust be t hat oddball t hat nobody really want s t o be seen as f riends wit h. [Non binary, senior center expectations, Arrowhead area, 60]
Long-Term Care No experience as residents and hope to keep it that way. I’ ve cont emplat ed simply st epping in f ront of a bus or somet hing rat her t han going int o a nursing home. (63, female, Twin Cities metro) I t old my daught er...when I have t o go int o a nursing home, if I have any money, let 's put it in your account and I'll come st ay wit h you. I'll t ry t o be quiet , but I'm not going t o a nursing home. (60, transwoman, rural WI using services in Twin Cities Metro)
LTC Concern: Abuse/ Mistreatment [P]eople are at ot her people’s mercy, not j ust t he st af f , but ot her t hings t oo...I’ m a lit t le bit anxious, you know, about somet hing like t hat . S o I’ m hoping I’ ll [snaps] j ust go. Not going t o land in one. (63, transguy, Twin Cities metro) I t hink in sit uat ions where ot her people have care and cont rol over you, what ever biases t hey are carrying t hey can bring t o you in t hat set t ing and you're not able t o do much t o prot ect yourself . (69, transwoman, Twin Cities metro)
LTC Concern: Gender Identity Not Honored They're going t o call me sir and t hey're gonna t reat me like one of t he guys and I’ m gonna have t o complain. And I don’t know how effect ive I'll be, but I expect t o fight a lot . I already t old my daught er, “ Expect me t o get kicked out of every nursing home from Maine t o Baj a and t hen st art in Washingt on and go t o Florida because I'm not gonna put up wit h it .” (60, trans woman, rural WI using services in Twin Cities Metro) They bet t er not put me in some lit t le female night gown- t ype crap, ya’ know, ‘ cause t hat would be demoralizing t o end my life t hat way ( 60, FTM, Arrowhead)
S o What? A t ransgender older adult seeks your care or services t omorrow. What positive experiences are they likely to have? In climate/ communication In care/ services What negative experiences are they likely to have? In climate/ communication In care/ services
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