In Canada, health care is considered to be a universal and basic human right, with equitable access protected and guaranteed by law. The reality for many though, is that health care experiences can be impacted by geographic location, socioeconomic status, race, ability, gender identity, gender expression or sexual orientation.

The LGBTQ2S (lesbian, gay, bisexual, transgender, queer and 2-Spirit) communities face specific health challenges and barriers. For many individuals past care experiences have involved discrimination, marginalization and even violence. Research shows that these experiences commonly prevent LGBTQ2S individuals from accessing the support they need, especially when it comes to receiving care in their own homes. And further, that most home care staff and service providers do not get the opportunity to learn about LGBTQ2S health needs and sexual or gender identity through their initial training.

VHA Home HealthCare (VHA) celebrates the diversity of our staff and clients and we know that being an inclusive organization involves an ongoing process of learning and evolving. Through our partnership with The 519—a City of Toronto agency and registered charity committed to the health, happiness and full participation of LGBTQ2S communities—over 900 VHA staff and service providers have received specific and tailored inclusion training. After completing this training, care providers wear a rainbow lanyard to communicate to clients and colleagues that they support LGBTQ2S communities.

Training efforts have focused on staff in leadership roles, VHA care providers working directly in the community, and now, after a delay with COVID-19 that led The 519 to reimagine the way they deliver this education, the program has been expanded and adapted to include staff in our Customer Service Centre (CSC), our communications hub for clients, families and point-of-care staff in the community.

“While it’s absolutely vital that service providers delivering direct care understand the needs and experiences of the LGBTQ2S communities, including how to use respectful, affirming language and ways to challenge homophobic and transphobic behaviour, CSC staff may be someone’s first contact with the organization and phone conversations naturally present unique challenges to inclusion,” said Laura Gibbon, Manager of Strategic and Executive Planning at The 519.

“Challenges on the phone include potentially misgendering someone, dealing with a client that feels uncomfortable with the sexuality of their care provider or making the incorrect assumption that a support person is a friend or family member rather than a partner. From understanding these potential issues and how to respond and apologize if you make a mistake, there are countless opportunities where this type of training is beneficial for CSC staff and VHA’s clients and families,” Laura said.

For Nicolette Simon, after completing the training once as a Personal Support Worker and then as a Health Scheduling Coordinator in the CSC, many parts of the inclusion training felt quite straightforward. “I learned that in many cases it’s really as simple as introducing yourself and your pronouns. You cannot know someone’s gender identity, especially over the phone, so rather than making assumptions that we know can be upsetting, we can start every conversation in this open and inclusive way,” said Nicolette.

A takeaway for Genesis Gallardo, Integrated Child & Family Coordinator, was to view herself as an ally. “There was an occasion in the past when I knew that a client utilized a different pronoun and a preferred name. I heard nurses on my team referring to the client the way they were listed on their health card and after this training I would now feel comfortable and absolutely obligated to kindly correct them,” she said. “It was also beneficial to become more aware of the history of discrimination in health care for the LGBTQ2S communities and while I thought there were a lot of advances, there are still so many barriers that exist. It’s good to know that work is being done to continue to make changes at VHA. Everyone deserves fair, safe and equal health care,” Genesis said.

Laura confirms that this training is just one part of the efforts needed to create a safe, affirming and inclusive organization. “Where I see the most success is when initiatives are happening simultaneously across the organization, not just the over-arching changes to departmental and professional practices. Creating space for these conversations has impact and when people feel empowered and motivated to make changes at home and work, then we’re getting somewhere,” she said.

At VHA, organizational policies and clinical documents have been adapted to use gender-expansive language, LGBTQ2S working groups were developed in education, client and staff experience and the rainbow lanyard program has helped us to celebrate and support the diversity of our staff and clients.

“There isn’t a one-size-fits-all approach to inclusion work. It has to continually adapt to remain relevant and beneficial, which is what makes our partnership with The 519 so valuable. In June, 52 CSC staff completed inclusion training and two more sessions took place in July. There’s always room to grow and the work won’t stop there as we aim to meet the needs of LGBTQ2S communities and to provide the best possible gender and sexuality affirmative care,” said Kelley Myers, Vice President of Human Resources and Organizational Development at VHA.

Located in downtown Toronto, The 519 is a City of Toronto agency, a registered charity, and Canada’s most prominent LGBTQ2S community centre and service provider. The 519 strives to make a real difference in people’s lives while contributing to the advancement of LGBTQ2S rights and inclusion in Toronto and beyond. They take pride in being an organization that responds to the existing and emerging needs of the LGBTQ2S communities – by delivering essential programs and services for the most underserved, and leading advocacy, access to justice, and anti-violence initiatives. The 519 has been a valuable and vibrant community hub offering Service, Space, and Leadership for LGBTQ2S communities and the Church-Wellesley neighbourhood since 1975. Learn more at www.The519.org.