What is internalized homophobia? Heterosexism? How have each impacted the lives of Ruth and Janice?

Case Study 8-1 The Case of Ruth and Janice


This case involves an older lesbian couple who encounter the challenge of a lifethreatening accident and its aftermath. Issues pertaining to chronic and acute medical needs are addressed, including the financial crisis of managing long-term nursing care through Medicare and Medicaid. In addition, issues of internalized homophobia and institutional heterosexism are factors in this case.


1. What is internalized homophobia? Heterosexism? How have each impacted the lives of Ruth and Janice?

2. How do you think Ruth’s background as an elementary school teacher and long-time member of her childhood church impacted her openness about her sexual orientation?

The social worker had an initial impression about Ruth’s internalized homophobia, but he did not immediately address his thoughts with Ruth and Janice. What are your thoughts about the worker’s decision to defer on addressing these concerns until later in his work with Ruth and Janice?

3. The social worker used both a micro and macro systems perspective in responding to this case. Describe his actions that support intervention across different systems.

4. Go to the Medicare website at www.medicare.gov to determine available Medicare coverage for skilled nursing home care. Based on your findings, how useful is Medicare in funding skilled nursing home care? What are its benefits? Its limitations?


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