Advancing Person-Centered Services: Incorporating Sexual Orientation and Gender Identity Questions in APS Practice
 

Kat Preston-Wager, Workforce Development Supervisor, Academy for Professional Excellence, APS Workforce Innovations

Whitney Barnes, MSW, Social Work Supervisor, Santa Cruz County Adult Protective Services

April 2024

The LGBTQ+ population is aging, and as such there is growing representation of this community among APS caseloads. APS professionals who develop skills and comfort with asking older adults and adults with disabilities about their sexual orientation and gender identity (SOGI) will find benefits in their risk assessment, service planning, and overall client outcomes. Making this effort will increase rapport-building skills and understanding of complex family and household dynamics, demonstrate a commitment to combat ageism/ableism, and further one’s commitment to social justice for minoritized communities.
 

How does this show up in APS programs?

Depending on jurisdiction and agency policies, APS professionals may be required by statute to ask for self-identified demographic information of persons they serve. However, whether or not this is a requirement, there are benefits in knowing this information when working with individuals.
 

Educating yourself and maintaining an accurate understanding of your program’s engagement with historically minoritized communities is an important reflection of the resources needed to meet the community’s needs. Funding and resources are often data driven. Whether it’s adequate staffing for your program, funding health care services or case management programs, or justifying specialized training for your team, access to funds and resources depends on consistent and reliable information about the scope and needs of the population served. Making sure this is known or documented in a case file or even a data system, if applicable, can be useful to demonstrate growth and need for additional resources. 

How does understanding someone’s sexual orientation or gender identity affect the APS assessment process? 

The risk assessment, or biopsychosocial assessment, that APS professionals conduct is extremely thorough. APS professionals seek and document details on people’s marital status, employment history, family structure, income and expenses, sometimes intimate needs for caregiving, and so on. 
 

As APS professionals, we gather information and compile evidence to determine findings on allegations and to capture a comprehensive understanding of the person we are serving. Intentional gaps in our risk assessment may leave our service planning vulnerable to missed intervention points and have a direct effect on client outcomes.
 

Imagine conducting an APS assessment and choosing not to ask the client about their Medicaid eligibility, how many children they have and their relationships with them, or their veteran status. Imagine making erroneous assumptions about a client’s preferred language or communication method, ethnic background, or religious affiliation without taking the time to confirm or clarify. Consider the message this sends to the person you are interviewing about your commitment to them, and the level of respect being given to the process of developing an APS assessment.   

What difference does knowing someone’s sexual orientation or gender identity have on APS service plan development? 

The bulk of our efforts working APS cases involve developing and implementing service plans or interventions. Effective service plans rely on our ability to leverage the most appropriate resource or intervention strategy that meets the identified need. If we are working off inaccurate assumptions about major components of the client’s identity and community fellowship, how could we ever identify or leverage the right resources?
 

Let’s say you are serving an LGBTQ+ APS client experiencing symptoms of medical self-neglect. Are you aware that LGBTQ+ older adults have lower rates of health insurance coverage, are more likely to delay necessary care and prescriptions, are more likely to utilize emergency rooms for care, and are less likely to receive preventive care such as mammograms than their heterosexual peers (Choi & Meyer, 2016)? In creating your service plan for this client, you should seek to understand their SOGI to know the importance of taking the time to identify and liaise with an LGBTQ+ inclusive health care provider. This might make all the difference in increasing the client’s comfort with attending and following through with their medical care plan, improving their safety and well-being.
 

Suppose you are working with a client who is exploring assisted living options. It would be critical to know if the APS client identifies as LGBTQ+. Nationwide, there continues to be widespread discrimination against LGBTQ+ residents of congregate care facilities, affecting physical safety, emotional well-being, and receipt of care. As a professional committed to serving in a protective capacity, you would need to rule out facilities with anti-LGBTQ+ policies and practices. Having a facility that is LGBTQ+ inclusive as an available option for the client would likely increase their willingness to accept care in a safe and supportive environment. 
 

There are real and proven risks to the client's welfare and safety when APS service planning fails to consider the client’s fully lived experience inclusive of their sexual orientation or gender identity.  

How do I become more comfortable incorporating SOGI into my APS practices? 

Be patient and give grace — to yourself, with your teammates, and the people you serve. Like any change in practice, this may take some time to get used to and feel comfortable with. Accept that there are times when your efforts at collecting SOGI will result in “Unknown” or “Client declined to answer.” 
 

Phrases, acronyms, and symbols for the LGBTQ+ community have evolved over time and continue to do so. It can be confusing and overwhelming, even for those who identify as members of the community. Empower yourself and your teammates to get comfortable with the language. Consider what each of the letters in LGBTQ+ means and say them out loud to yourself – alphabet soup is more meaningful when we understand and acknowledge each of the ingredients.
 

Practice asking client demographic questions in different ways to have different styles for various situations. As with most interviewing, there is no “one size fits all.” Two APS training videos, “Asking Inclusive Demographic Questions” and “Assessing for Risk: Initial Home Visit” demonstrate various ways to ask about an APS client’s SOGI. You can also incorporate role playing into team meetings or individual supervision.

 

Know and respect your audience. Remember that data collection, including SOGI, is client-centered; it’s asking about them. Use language, verbal and nonverbal, that conveys the intention behind your questions to the individual served. Let them know you are asking about their identification because you care, because it can enhance the services you can offer, and because it matters to you to know them and their genuine lived experiences.

Resources

The following resources are available to support your continued efforts to include sexual orientation and gender identity questions in your APS practice.  

• LGBTQ+ Inclusive Intake and Engagement for Elder Justice Professionals Tip Sheet 
• Asking Inclusive Demographic Questions: How to Do It and Why It Matters  
• Including Sexual Orientation and Gender Identification Questions in APS Practice eLearning and Transfer of Learning Packet 
• Asking Inclusive Demographic Questions Training Video and Discussion Guide 
• National Resource Center on LGBTQ+ Aging 
• Improving the Lives of Transgender Older Adults 
• LGBT Older Adults and Health Disparities  
• How Many Adults and Youth Identify as Transgender in the United States? 

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