[Les personnes âgées immigrantes et leurs proches à Montréal : des vies oubliées durant la pandémie].

Malgré l'attention renouvelée de plusieurs médias sur la question des risques liés à la COVID-19 au sein de diverses communautés marginalisées au Québec, nous entendons encore très peu parler des personnes âgées immigrantes et de leurs proches. Dans cette note sur les politiques et pratiques, nous aborderons l'expérience du contexte pandémique chez les personnes âgées immigrantes montréalaises et leurs réseaux. Nous présenterons d'abord quelques données sociodémographiques sur les immigrants âgés montréalais. Nous exposerons ensuite nos constats sur les impacts de la COVID-19 sur les personnes âgées immigrantes, en particulier en ce qui concerne l'accès aux soins de la santé et aux services sociaux, la proche-aidance, l'emploi et le logement, à partir de nos travaux et de la littérature en gérontologie sociale. Nous terminerons en proposant quelques recommandations qui permettraient d'améliorer l'inclusion sociale des personnes âgées immigrantes et de leurs proches, autant en matière de politiques publiques que de pratiques sur le terrain.

Unravelling the Interconnections of Immigration, Precarious Labour and Racism Across the Life Course.

This paper contributes to the growing body of work on precarious labor, immigration, and social gerontology by examining the racialization of precarious employment across the life course. In particular, the authors examine the impact of precarious employment and discrimination among racialized older immigrants in Canada. Racialized older immigrants are more likely to be disadvantaged by the effects of lifelong intersections of economic and social discrimination rooted in racialization, gender, ageism, and socio-economic status. Drawing from a narrative-photovoice project that focused on the life stories of older immigrants living in Quebec and British Columbia, this paper presents the in-depth stories and photographs of four participants to highlight how intersections of race, gender, age, immigration status, and ability shape and structure experiences of aging, labor market participation and caregiving relationships.

Advance Care Planning among Older Gay Men Living with HIV in Montreal, Canada: Challenges to Thinking and Talking about Future Care.

This qualitative study employed a cross sectional focus group design to explore how older gay men living with HIV, experience, perceive, and engage with advance care planning (ACP). Seven gay men 50+, residing in Montreal, Canada, participated in a focus group that was audio-recorded, transcribed, and thematically analyzed. Findings suggested that social isolation, preoccupations with day-to-day living, and managing disclosures related to sexual orientation and HIV status created barriers to these men's capacities to think about let alone talk about future care. These findings challenge current conceptualizations of ACP, which position reflection as an individual process that precedes allocating a decision-maker and communicating care preferences. Analyses further revealed that relational connections helped create a space where ACP could occur for participants. Hence, improving the uptake of ACP amongst older gay men with HIV may require interventions that embed such discussions into broader programs aimed at building support and community.

The Crisis Facing Older People Living with Neurodiversity and Their Aging Family Carers: A Social Work Perspective.

This commentary addresses barriers to care among older adults living with neurodiversity (ND), and their aging family carers in the context of the COVID-19 pandemic in Canada. Factors contributing to inequities are described and the significant negative consequences of current policy decisions on the social and mental health of older adults with ND and their aging family carers are highlighted. The commentary calls for a collective social work response that highlights the critical role of support and advocacy necessary to redress social exclusion.

A Framework for Enhancing Access to Equitable Home Care for 2SLGBTQ+ Communities.

Canadian, US, and UK public health and clinical research has identified barriers to health service access for Two-Spirit, lesbian, gay, bisexual, transgender, queer, non-binary, and intersex (2SLGBTQ+) communities. While offering important insight into the health service experiences of 2SLGBTQ+ communities, this body of research only recently, and still only minimally, reports on home care access experiences. Drawing on key findings from the 2SLGBTQ+ Home Care Access Project, a mixed-methods, Ontario-wide study, this paper animates an Access and Equity Framework, using participant stories and perspectives to underscore the relevance and effectiveness of the Framework as a tool to support systematic organizational assessment, evaluation, and implementation of access and equity strategies. Home care organizations can use this tool to assess their programs and services along a continuum of intentionally inviting, unintentionally inviting, unintentionally disinviting, and intentionally disinviting care for 2SLGBTQ+ people. To support this process, the framework includes six indicators of access to care: community engagement, leadership, environment, policies and processes, education and training, and programs and services.

Supporting Lesbian, Gay, Bisexual, & Transgender Inclusivity in Long-Term Care Homes: A Canadian Perspective.

ABSTRACTIt is critical to ensure that long-term care (LTC) homes are sensitive to the needs of lesbian, gay, bisexual, and transgender (LGBT) older adults. However, the extent to which the LTC home sector has adopted recommended strategies is unknown. This qualitative study reports findings from two initiatives: Semi-structured telephone interviews with Canadian LTC home administrators on strategies adopted to support LGBT inclusivity (n = 32), and discussions with participants attending a 2-day meeting on supporting LGBT inclusivity in LTC (n = 25). We found that LGBT inclusivity training was the most commonly adopted strategy among the LTC homes surveyed. Study findings further suggested that practices more visible to residents and families, such as LGBT-themed programming, inclusive language and symbols, or joint initiatives with LGBT communities, were less commonly adopted because of anticipated negative resident/family reactions. The importance and benefits of comprehensive strategies that include staff, residents, and family are discussed.

Understanding the experiences of racialized older people through an intersectional life course perspective.

This article proposes the development of an intersectional life course perspective that is capable of exploring the links between structural inequalities and the lived experience of aging among racialized older people. Merging key concepts from intersectionality and life course perspectives, the authors suggest an analytic approach to better account for the connections between individual narratives and systems of domination that impinge upon the everyday lives of racialized older people. Our proposed intersectional life course perspective includes four dimensions: 1) identifying key events and their timing, 2) examining locally and globally linked lives, 3) exploring categories of difference and how they shape identities, 4) and assessing how processes of differentiation, and systems of domination shape the lives, agency and resistance among older people. Although applicable to various forms of marginalization, we examine the interplay of racialization, immigration, labour and care in later life to highlight relationships between systems, events, trajectories, and linked lives. The illustrative case example used in this paper emerged from a larger critical ethnographic study of aging in the Filipino community in Montreal, Canada. We suggest that an intersectional life course perspective has the potential to facilitate a deeper understanding of the nexus of structural, personal and relational processes that are experienced by diverse groups of older people across the life course and into late life.

The Experiences of Reciprocity among Filipino Older Adults in Canada: Intergenerational, Transnational, and Community Considerations.

This article illustrates the concept of reciprocity in the context of immigrant families. It recommends that definition of reciprocity account for exchanges beyond the immediate family, and render visible the simultaneous location of older people as care recipients and providers, and care arrangements across generations, borders, community, and time. Adopting a critical ethnographic study on the aging and care experiences of older Filipinos in Canada, this article analyzes data from extended observations and in-depth semi-structured interviews with 18 older people, 6 adult children, and 13 community stakeholders. Findings highlight the unique configurations of care among the Filipino community whereby older people engage in care exchange as active participants across intergenerational, transnational, and fictive kin networks.

Talking about Sexuality and Intimacy with Women Spousal Caregivers: Perspectives of Service Providers.

This article reports the findings of an exploratory study examining service provider perceptions and experiences of addressing sexuality and intimacy with women spousal caregivers. The caregiver-provider encounter is examined, and challenges faced by service providers in addressing sexuality are considered. Themes identified include ambivalence and discomfort, personal and institutional barriers, meanings attributed to sexuality and intimacy, and lack of opportunities to discuss experiences. Strategies to overcome silence and invisibility on the part of service providers in the health and social services system are considered.

Diversity Within Family Caregiving: Extending Definitions of "Who Counts" to Include Marginalized Communities.

As researchers in the field of diversity and aging, we share Williams et al.'s call for policymakers to pay attention to the experiences of family caregivers across a wider spectrum than that which currently operates in health and social care. This paper addresses the particular issues at play in interactions between caregivers from marginalized 1communities and mainstream service providers. Using case studies from our work with ethnocultural minority (2) and LGBT (3) older adults, this commentary describes the unique realities faced by marginalized communities in their efforts to both provide care and gain access to a broad range of health and social care services. The assumptions addressed provide a basis for reconsidering how caregivers are perceived, experience services and demonstrate resilience in developing alternative forms of support.

Identity, refugeeness, belonging: experiences of sexual minority refugees in Canada.

This article explores the results of a qualitative community-based research project on the intersectional experiences of sexual minority refugees living in Canada. Undertaken between 2008 and 2010, this study examines sexual minority refugees' multifaceted experiences of migration, the refugee determination process, and settlement. Through an analysis of the interrelated themes of identity, refugeeness, and belonging, we hope to further investigate the ways in which Canadian refugee policies, social institutions, and dominant discourses contribute to the sociopolitical construction of sexual minority refugees. We conclude with an exploration of strategies for increasing protection of sexual minority refugees in Canada.

Exploring the promises of intersectionality for advancing women's health research.

Women's health research strives to make change. It seeks to produce knowledge that promotes action on the variety of factors that affect women's lives and their health. As part of this general movement, important strides have been made to raise awareness of the health effects of sex and gender. The resultant base of knowledge has been used to inform health research, policy, and practice. Increasingly, however, the need to pay better attention to the inequities among women that are caused by racism, colonialism, ethnocentrism, heterosexism, and able-bodism, is confronting feminist health researchers and activists. Researchers are seeking new conceptual frameworks that can transform the design of research to produce knowledge that captures how systems of discrimination or subordination overlap and "articulate" with one another. An emerging paradigm for women's health research is intersectionality. Intersectionality places an explicit focus on differences among groups and seeks to illuminate various interacting social factors that affect human lives, including social locations, health status, and quality of life. This paper will draw on recently emerging intersectionality research in the Canadian women's health context in order to explore the promises and practical challenges of the processes involved in applying an intersectionality paradigm. We begin with a brief overview of why the need for an intersectionality approach has emerged within the context of women's health research and introduce current thinking about how intersectionality can inform and transform health research more broadly. We then highlight novel Canadian research that is grappling with the challenges in addressing issues of difference and diversity. In the analysis of these examples, we focus on a largely uninvestigated aspect of intersectionality research - the challenges involved in the process of initiating and developing such projects and, in particular, the meaning and significance of social locations for researchers and participants who utilize an intersectionality approach. The examples highlighted in the paper represent important shifts in the health field, demonstrating the potential of intersectionality for examining the social context of women's lives, as well as developing methods which elucidate power, create new knowledge, and have the potential to inform appropriate action to bring about positive social change.

Coming out to care: caregivers of gay and lesbian seniors in Canada.

PURPOSE: This article reports on the findings of a study whose purpose was to explore the experiences of caregivers of gay and lesbian seniors living in the community and to identify issues that emerged from an exploration of access to and equity in health care services for these populations. DESIGN AND METHODS: The study used a qualitative methodology based upon principles of grounded theory in which open-ended interviews were undertaken with 17 caregivers living in three different cities across Canada. RESULTS: Findings indicated several critical themes, including the impact of felt and anticipated discrimination, complex processes of coming out, the role of caregivers, self-identification as a caregiver, and support. IMPLICATIONS: We consider several recommendations for change in light of emerging themes, including expanding the definition of caregivers to be more inclusive of gay and lesbian realities, developing specialized services, and advocating to eliminate discrimination faced by these populations.

The health and social service needs of gay and lesbian elders and their families in Canada.

PURPOSE: This article reports the findings of a study, undertaken in 2000, whose purpose was to gather information about the experiences and realities of gay and lesbian seniors and their families from across Canada in accessing a broad range of health and social services in the community, and to examine the role of health care and social service organizations in shaping access and service delivery. DESIGN AND METHODS: This study used a qualitative exploratory design based on focus group interviews. Perspectives of older gay men and lesbians and their families involved in organizations addressing these issues, as well as professionals from both gay and lesbian health organizations and mainstream elder care organizations were sought. RESULTS: Specific reference was made to the impact of discrimination on the health and access to health services of these populations. Issues relating to invisibility, historic and current barriers to care, and the nature of service options are identified. IMPLICATIONS: Recommendations for change are highlighted, including those related to best practice programs and policies in the long-term care sector.

Transforming schools of social work into spaces of social action: a critical exploration of Project Interaction, The Gay, Lesbian, Bisexual and Two-Spirit Initiative of McGill University's School of Social Work.

This article examines the question of how universities can be encouraged to address the mental health concerns of GLBT-SQ people and communities from a perspective of solidarity. In so doing, the authors take a case study approach, using Project Interaction: The Gay, Lesbian, Bisexual and Two-Spirit Initiative of McGill University's School of Social Work, to critically reflect upon the challenges arising from the development of an alternative organization within academia. The purpose of this reflection is to highlight how normal operations at work on university campuses, and within health and allied health curriculum, can be disrupted with the goal of providing momentum for the creation of affirmative space, the advancement of educational initiatives, and the building of opportunities for social change.

The impact of coming out on health and health care access: the experiences of gay, lesbian, bisexual and two-spirit people.

This paper documents the experiences of health care access among gay, lesbian, bisexual and Two-Spirit (glbt-s) people in Canada. In particular, it addresses the importance of coming out as glbt-s to the development of good health and appropriate care. The paper reflects upon the impact of hiding one's sexual orientation on glbt-s people's experience of and use of health care resources and the responsibility of health care institutions to address homophobia and create supportive environments in order to facilitate the coming out process in health care settings. The central role of health care policy makers with regard to the articulation of gay-positive policy and practice in health care institutions is highlighted.