The question of how to care for a generation of LGBT+ people growing old has been bubbling away in Iceland for years.
As far back as 2016, Samtökin ’78, Iceland’s National Queer Organization, was looking at what ageing queer might mean in Iceland, including whether there could eventually be a need for specialised services for LGBTIA+ elderly people or whether the priority should be making existing care more inclusive. Reykjavík Pride returned to the subject in 2021 under the theme “Queer at Every Age”, while one fear has appeared repeatedly in the conversation: that people who fought to live openly for most of their adult lives could find themselves effectively pushed back into the closet when they become dependent on care.
It is a concern that has not gone away. Iceland’s current LGBTIA+ action plan specifically acknowledges that older queer people can face additional isolation and, in some cases, begin hiding their identity again.
And Iceland does not have to look particularly far to see what another approach might look like. In Copenhagen, Icelandic nurse and educator Björgvin Huldar has spent much of his career looking at exactly what happens when LGBTIA+ people encounter healthcare systems that were not necessarily designed with their lives in mind.
His work has taken him from volunteering with LGBT+ Denmark and working in sexual health with AIDS-Fondet’s Checkpoint to healthcare education, harm reduction and, importantly, Slottet, a Copenhagen care home with a specific LGBT+ profile.
Slottet is not exclusively for queer residents. LGBT+ and non-LGBT+ people live there. The idea is instead to create a care environment where queer residents do not have to hide, minimise or constantly explain themselves. According to Björgvin, making that work takes considerably more than putting a rainbow flag on the wall.
When he first arrived at Slottet, the home already had its LGBT+ profile. Staff had previously received some education around LGBT+ issues, but employees had come and gone and the focus had begun to disappear.
Some people working there did not even know the profile existed.
“When you have this profile, you have to keep it alive,” Björgvin says. “You can’t just say, ‘We have this profile,’ and then do nothing.”
Drawing on his experience with LGBT+ Denmark, AIDS-Fondet and healthcare education, he approached management about creating ongoing training for staff, students and nursing assistants completing placements at the home. The point was not to teach everybody once and consider the job finished. People leave. New people arrive. Students rotate through. Language changes. Knowledge changes. The education has to continue.
If you treat everybody the same, you’re going to do a bad job, because you should treat people differently. Each patient is a new person.
That approach remains part of Slottet today, where all employees undertake LGBT+ competency training. But the profile was never simply about staff training. Slottet holds Rainbow gatherings where residents, volunteers and older LGBT+ people can meet socially. There might be a film, a discussion, music or something focusing on a particular part of LGBT+ life. Residents themselves can suggest subjects they want to explore.
There are also Pride celebrations and other events that make queer life visible within the home. The important thing is remarkably simple: LGBT+ life does not suddenly disappear because somebody moves into residential care. It is allowed to remain part of everyday life.
“A lot of them just never talked about it again”
That becomes particularly important when considering the generation now entering elder care. Many older LGBT+ people spent substantial parts of their lives in societies where being open about their sexuality or gender identity came with real consequences. Some experienced discrimination directly. Others simply learned that the safest option was not to say anything. Denmark’s own Health Authority now explicitly recognises that some older LGBT+ people effectively go “back into the closet” when they begin receiving elder care. Björgvin has encountered the same phenomenon through his own work and research.
GayIceland: There is a fear that somebody can live openly for decades and then effectively find themselves pushed back into the closet once they become dependent on carers or move into residential care. How real is that problem?
Björgvin: “I think it’s very common.”
He talks about older people who did not necessarily make a conscious decision to hide their identity again. Instead, they simply stopped talking about that part of their lives. That distinction matters. Going back into the closet does not necessarily involve an announcement that you are going to start hiding who you are. Sometimes it is a photograph disappearing from the wall. A sculpture being moved before a care worker arrives. A partner becoming a “friend”.
Björgvin describes older LGBT+ people removing personal objects from their homes because they worried about how visiting care workers might react. “They minimise themselves,” he says.
He was like, ‘I’m 96. There’s not much going on at 96, but you still want to feel the person you love.
At Slottet, he also saw what could happen when the opposite message was sent. When the home adopted its LGBT+ profile, staff asked residents what they thought about it. One resident replied that he thought it was wonderful. He was gay. Until that point, nobody at the home had known. After speaking publicly about the initiative, people from earlier periods of his life saw him and made contact again.
“He got this network of friends back that he had lost contact with,” Björgvin says.
Intimacy does not stop at 96
One of the clearest examples Björgvin gives of why elder care needs to understand queer lives involves a gay man in his nineties. The man lived in another care home nearby but regularly attended Rainbow gatherings at Slottet. He had a boyfriend who still lived independently.
“He was like, ‘I’m 96. There’s not much going on at 96, but you still want to feel the person you love.’”
His boyfriend came to visit him and the two of them lay together in bed. A care worker entered the room. Instead of apologising and leaving, she reacted as though she had discovered something inappropriate. The resident reminded her that he had not invited her into the room and asked her to leave. According to Björgvin, she responded by suggesting she would report what she had seen. The resident told her that he would report her.
“If it had been a man and a woman, she probably would have just said, ‘Oops, sorry,’ and come back later.”
It is a small interaction, but it captures something much larger about queer elder care. LGBT+ people do not stop having relationships, histories, bodies, sex lives, desires or a need for intimacy because they are old enough to require assistance. Nor should receiving care automatically give other people ownership over those parts of their lives.
When nobody intends to discriminate
A recurring theme in Björgvin’s work is that discrimination in healthcare is not always dramatic or openly hostile. Sometimes it comes from habits. Assumptions. Protocols built around a narrow idea of who the patient standing in front of you is likely to be.
His academic interest in LGBT+ healthcare developed while completing his Master’s degree and interviewing queer people about their experiences with the Danish healthcare system. The more people he spoke to, the more interested he became in the gap between what healthcare professionals intend and what patients actually experience.
One lesbian described repeatedly being asked to take pregnancy tests despite explaining that, based on her sexual history, pregnancy was not possible. Eventually, she stopped arguing. She simply took the test.
She cock-blocked him.
Björgvin understands why healthcare protocols exist. Doctors and nurses do not want to skip an important step and accidentally provide treatment that could be harmful during pregnancy. But the example also shows what happens when procedure becomes more authoritative than the patient sitting in front of you.
Other LGBT+ people he interviewed described avoiding healthcare after previous experiences left them feeling humiliated, dismissed or treated like a curiosity. That is not simply uncomfortable. Denmark’s Health Authority itself acknowledges that feeling unsafe or misunderstood within healthcare can make some LGBT+ people reluctant to seek medical help or attend screening. If somebody expects another bad experience, it becomes easier to put off the next appointment. And the next one.
“I’m not here to educate people”
One woman Björgvin interviewed had been hospitalised during periods of serious depression. She was bisexual and described herself as a tomboy, usually wearing loose, more masculine clothing. During one admission, her own clothes were being washed and staff gave her temporary hospital clothing that was much more conventionally feminine.
Suddenly, people began complimenting her. She looked good. She looked feminine. Nobody was trying to insult her. If anything, staff were probably attempting to make her feel better. But that was not how she experienced it. The compliments only appeared once she looked more like the kind of woman they expected her to be. She didn’tt challenge them. She was already seriously depressed and did not have the energy to turn herself into an LGBT+ education session for the people treating her.
“I’m not here to educate people,” she told Björgvin. “I’m here to be taken care of.”
It is perhaps the simplest explanation of why this education matters. A patient should not have to teach a healthcare professional how to treat them before they can receive care. Björgvin describes something similar from a person he interviewed who identifies as agender and regularly needed treatment for digestive problems.
Healthcare professionals repeatedly referred to them as female while discussing their body. The patient did not necessarily object to respectful questions or to people wanting to understand their identity. They simply did not want to explain it every single time they were sick. Sometimes, as Björgvin puts it, “you’re just not in the mood to educate people.”
“I treat everybody the same”
Björgvin continues to teach people training to work in healthcare, and one phrase comes up repeatedly.
“I don’t care. I treat everybody the same.”
On the surface, it sounds like exactly what a healthcare worker should say. For Björgvin, it can reveal the opposite.
“If you treat everybody the same, you’re going to do a bad job, because you should treat people differently. Each patient is a new person.”
You don’t have to be your patient’s best friend. But you don’t treat a patient badly. You don’t discriminate. You do your best so the patient gets the best care possible
Equality is not the same thing as pretending everybody has identical lives, bodies and experiences. Sometimes the change required is remarkably small. Instead of asking a male patient what his wife does, ask whether he has a partner. Then listen to the answer. If he says husband, say husband.If somebody consistently says partner, use partner. There does not need to be a dramatic moment of disclosure. The patient can simply answer the question.
Björgvin talks about a married gay man whose doctor noticed his wedding ring and assumed he had a wife. He corrected her. He had a husband. The doctor then chose to record his relationship status as “partnered” rather than married. He corrected her again.He was married. She continued to use “partnered”. It is a very small distinction on a form. But being treated equally often lives in exactly those small distinctions.
When students do not want to treat trans people
Not every example Björgvin encounters is subtle. Because he deliberately brings LGBT+ people into his healthcare teaching, including trans patients where relevant, students sometimes say things they might otherwise never be forced to confront.
More than once, students have asked whether they actually have to treat transgender people. Björgvin’s answer is straightforward.
“You don’t have to be your patient’s best friend,” he says. “But you don’t treat a patient badly. You don’t discriminate. You do your best so the patient gets the best care possible.”
And if somebody knows that they are incapable of doing that?
“Then I think you should stand up, leave and not take this education. Find another career.”
Nobody has stood up and left yet.
It’s a boy,” he replied. Then he added: “Until he tells us something else.
In fact, Björgvin would rather students express those views while they are still studying. Once the prejudice has been spoken aloud, it can at least be discussed. Sometimes that discussion produces surprisingly ordinary changes.
He recalls a colleague who was expecting a child with his wife. Someone asked about the baby’s gender. “It’s a boy,” he replied. Then he added: “Until he tells us something else.”
Björgvin laughs when he talks about it.
The point is not that everybody has to speak in exactly the right way all of the time.
He readily admits that he still gets things wrong himself.
The aim is not to make healthcare workers terrified of LGBT+ patients in case they accidentally use the wrong word. It is to make difference ordinary enough that people are willing to listen, learn and correct themselves.
What should queer elder care actually look like?
For Björgvin, the existence of a place like Slottet does not mean every LGBT+ person should eventually move into a specialised queer care home. The bigger goal should be for every healthcare worker and every elder-care facility to have enough knowledge to provide safe, respectful care.
Specialist spaces can still serve an important purpose. Some people may actively want to live somewhere with a visible LGBT+ community. There are also possibilities between completely independent living and a care home, such as retirement communities where LGBT+ people have their own homes but can share social spaces, meals and community activities. What matters is choice. And there is evidence that people are choosing Slottet. The home has 111 residents, with recent Danish nursing reporting estimating that around 10 to 15 per cent identify as LGBT+.
That may sound like a relatively small proportion, but Slottet does not require anybody to disclose their sexual orientation or gender identity at all. The more important measure may be what residents say about living there: that they feel safe, that they can talk about their lives and relationships, and that their identity does not need to become either a secret or the only interesting thing about them.
Growing old queer
Björgvin’s work has also given him plenty of examples of the kind of elderly person he would like to become. He talks about one older resident who continued taking taxis into Copenhagen to visit gay bars.
Björgvin once saw him while out socially himself and deliberately did not approach.
If the resident did not acknowledge him first, Björgvin reasoned, he was entitled to enjoy a night at the bar without suddenly finding himself socialising with somebody he knew through healthcare.
On another occasion, the same resident met a younger man while out and brought him back to the care home. When they stepped out of the lift, a care worker reacted judgementally to the younger visitor. The man became uncomfortable and left.
“She cock-blocked him,” Björgvin says.
His preferred response from staff is considerably simpler. Mind your business. Maybe offer them some water. The story is funny, but the question underneath it is not. How much of yourself are you allowed to keep when other people begin helping you live?
If it had been a man and a woman, she probably would have just said, ‘Oops, sorry,’ and come back later.
Björgvin admits that ageing scares him. Growing older can mean more illness, more contact with healthcare workers and, for some people, eventually needing residential care. Even in a system that places a strong emphasis on autonomy, compromises happen. A beloved bed might need to be replaced with one that healthcare workers can safely raise and lower. Furniture may have to move. Somebody else may eventually need to help make decisions.
Loss of independence can sometimes be unavoidable. Loss of identity should not be. For LGBTIA+ people who have already spent part of their lives fighting for the right to live openly, good elder care should ensure that growing old never means having to disappear again.
