Gwenda Darling, a vibrant and outspoken member of the Aged Care Council of Elders, has been a familiar face at aged care conferences over the past decade. And while vibrant pink is no longer a shock to most in the sector, some of the topics that she enjoys talking about are.
Gwenda’s candid discussions about sex and sexuality in aged care and disability care, topics often considered taboo, have been both refreshing and challenging in a sector that increasingly emphasises sensitivity in language.
Gwenda, diagnosed with behaviour-variant frontotemporal dementia 12 years ago, recently highlighted a growing concern in aged care: the needs of post-op transgender individuals, particularly the necessity of dilating cosmetically created sex organs to prevent closure.
“We have a generation of post-op transgender people coming in. They need to be dilated, particularly females. If you don’t dilate, the urethra closes,” Gwenda explained. “Finding workers who are prepared to do it is another issue. I have two very close friends who are male to female. One of them transitioned at 63; she is now 76. If she doesn’t dilate daily, she will close.”
“If she’s unable to do it for various reasons—then what happens? We have to train workers to dilate?”
Gwenda’s concerns touch on a critical and sensitive aspect of aged care. As the population of post-op transgender individuals entering aged care facilities grows, the question arises: Should aged care staff be tasked with dilating transgender residents?
This procedure, essential for many trans individuals, particularly those who have undergone male-to-female surgery, involves using a dilator to keep the surgically created vaginal cavity open.
The necessity of dilation is not just a medical issue but a deeply personal one. It can be a source of discomfort, both physical and emotional, for the individuals involved. The prospect of aged care workers performing this task, especially in a sector where discussions about sex are still somewhat taboo, is undoubtedly challenging.
“It’s essential, but I think (it shouldn’t be a task for every staff member) because you’ve also got to consider the potential past traumas of aged care staff,” Gwenda pointed out.
According to Gwenda, this issue is further compounded by the lack of family support and advocacy that many transgender individuals might face. “Who are you going to get to do it? Your children? If you’ve got children. Many same-sex couples have no one to care for them; they have no one to even be there as an enduring power of attorney,” Gwenda noted.
So, how should aged care facilities address this need? Gwenda believes that the most sensible approach is to incorporate training on this procedure into aged care education. “Maybe it needs to be included in aged care training,” Gwenda suggested. “Every residential aged care home should have somebody who is trained to do it.”
This suggestion raises another important question: How do aged care facilities ensure that staff are willing and comfortable performing this task? Gwenda believes it starts with the governance of these facilities.
“We have to change the minds of boards of governance. They also need to look at hiring based on emotional intelligence. They need to look at the staff they’re hiring for the type of home, instead of just grabbing anybody.”
A potential solution could be the establishment of specialised facilities that cater to the needs of the LGBTQI+ community.
“If assisting with dilation were to become part of the everyday process in aged care for staff, it would be more suitable in a specific type of facility, maybe somewhere that is specialised in LGBTQI+ care,” Gwenda proposed. “I don’t think it’s segregation. We should have an opportunity by choice. We could call them Rainbow Homes because they are for the rainbow community.”
Specialised care facilities are not entirely new, with most catering to residents with specific cultural backgrounds or religious beliefs. However, the implementation of such an idea would require significant changes in the way aged care services are currently structured and delivered. There would need to be careful consideration of the emotional and psychological support provided to both residents and staff.
Despite the challenges, Gwenda’s insights highlight a crucial need for a more inclusive approach in aged care. As the demographic of aged care residents becomes increasingly diverse, so too must the services and support provided. This includes recognising and addressing the unique needs of transgender individuals, particularly regarding medical procedures like dilation.
Gwenda’s call to action is clear: “We also need to ensure that transgender individuals receive the care they need. This means training and supporting staff to perform these tasks and considering the establishment of specialised facilities to cater to the LGBTQI+ community.”
OMG, just another reason not to live to an old age. I don’t want to.
I come d Glenda for her advocacy. As an aged care/Disability/Leisure & health/Edu support & Integration Ade trainer of long standing as well as past OH& S Union Rep I have called for the registration of aged care workers (such as within Nursing) so they can have opportunities to be specialist trained in targeted areas of medical support/needs. I called for this in 2015, 2016 at ANF State conference and was rebuffed. I submitted to Senate inquiry into future of Aged care and though it was accepted in submission nothing came from it. I have written & emailed every political rep for multiple years snd yep same deafness. With the shortages of people wanting to train as nurses why an earth don’t we train our great carers to specialise, giving them professionalised skills and registered status. Call me a ‘Progressive’ unfortunately we don’t have any government reps from any persuasion who are.
No, no, no! That is over the top to expect aged care workers to do that. That is a medical procedure almost not a personal care routine. At that age, it doesn’t matter if it closes over. They are in the final stages of their life anyway. There would be many aged care workers who are opposed to the transgender ideology anyway and they should not be forced to perform something like that. Quite distasteful. Their jobs are already too many for the time they work in any one shift. Have mercy on those poor aged care workers. They are overworked and underpaid. Don’t give them more medical type duties in their already overburdened day.
I work in an Aged Care Facility that is a Rainbow Facility. As yet We do not have any Transgender Residents. When that time does come I feel dilating would have to be done by Nursing Professionals.
When talking about those not willing to do the procedure, We must respect the Cultures of the Employees who frown upon Transgender. I Personally would Welcome A Transgender with open arms.
I am a bit confused by the article as Gwenda states that ‘if you dont dilate the urethra closes’ . doesn’t she mean the vagina? dilating the urethra would need to be an aseptic technique as with catheterisation surely?
The article’s premiss is incorrect. Dilation has zero to do with urethra closure. It is 100% to do with vaginal closure. If a transfemale patient was to dilate (and this is subject to many conditions) it has to do with maintaining the patency of the neovagina. And don’t think that the urethra is somehow connected to the neovagina. As in CIS women the two are kept separate.
In addition a large proportion of elderly transwomen elect for a zero depth vaginoplasty which doesn’t require dilation at all.