Aging as LGBTQ
LGBTQ elders face many challenges as they age. A lifetime of discrimination, lost wages, lack of family recognition, and more add up to create substantial difficulties for most LGBTQ seniors.
America’s population is aging: by 2050, the number of people over the age of 65 will double to 83.7 million (from 43.1 million in 2012). While the public perception of LGBTQ people is largely one of a young, affluent community, there are more than 2.7 million LGBTQ adults ages 50 or older living in communities across the country, one in five of whom are older adults of color. A new report released in May 2017 by the Movement Advancement Project (MAP) and SAGE, Understanding Issues Facing LGBTQ Older Adults, provides a snapshot of the demographics of LGBTQ elders, an aging community that is diverse in terms of race and ethnicity, gender, and age.
The report details the many challenges facing LGBTQ older people as they age. Health and wellbeing, economic security, and social connections are among the cornerstones for successful aging, yet these are areas in which many LGBTQ elders face substantial barriers stemming from current discrimination as well as the accumulation of a lifetime of legal and structural discrimination, social stigma, and isolation.
The report offers high-level recommendations for addressing key disparities facing LGBTQ older adults including:
--Passing comprehensive employment and housing nondiscrimination protections prohibiting discrimination based on sexual orientation and gender identity.
--Ensuring that all senior housing, assisted living, and nursing homes have explicit nondiscrimination policies and train staff on competently serving LGBTQ elders.
--Revising federal and state programs to recognize the relationships of same-sex couples in which one partner died before the freedom to marry became available.
--Designating LGBTQ elders as an underserved population within the Older Americans Act and within the Department of Health and Human Services, allowing government agencies to more easily target services
--Passing the Restoration of Honor Act to make veterans discharged because of their sexual orientation or gender identity eligible for a number of programs, services, and benefits available at the state level.
Aging Back Into the Closet
Lesbian, gay, bisexual, transgender, and queer older adults are pioneers who bravely pushed open the doors to coming out. It is unconscionable that many of these leaders of social justice are forced to retreat into the closet as they age. The troubling reality is that the US lacks a complete understanding of the LGBTQ senior community and is particularly unprepared for the needs of LGBTQ older adults at the intersection of multiple disadvantaged populations, such as LGBTQ seniors who are people of color, disabled, living with HIV/AIDS, undocumented immigrants or socioeconomically marginalized. Many LGBTQ seniors fear that the health-care system is judgmental and have experienced discriminatory care or lack access to culturally competent aging services. To address this crisis, the US must adopt a new perspective that emphasizes health, rather than just health care. All sectors of society must come together with a renewed sense of social responsibility that focuses on social determinants of health. They need to adopt a holistic view of everyday factors that impact the health, economic and social well-being of LGBTQ seniors.
Eliminating LGBTQ health disparities and providing more personal and equitable care to LGBTQ populations depends on overcoming a primary obstacle: Many LGBTQ patients are uncomfortable discussing sexual orientation or gender identity with health-care providers, and many providers need training on these discussions. Consequently, LGBTQ patients often forgo prevention screenings or seek care late in their illnesses or diseases, and clinicians lack information that helps in making a diagnosis and recommending treatment. Research has found that more than one fifth of LGBTQ older adults have not disclosed their sexual orientation or gender identity status to their primary physician. Almost 20 percent of lesbian, gay, and bisexual seniors and more than 50 percent of transgender seniors fear that they will be treated differently, and almost 35 percent of lesbian, gay, and bisexual seniors and more than 60 percent of transgender seniors have encountered a health-care provider who was unaware of their health needs. These factors contribute to LGBTQ adults (24 percent) being more likely than heterosexuals (18 percent) to receive services in emergency rooms.
Medical care influences only about 10 percent of health status. The truly powerful determinants are genetics, behaviors and social circumstances. For many LGBTQ seniors, numerous factors complicate the path to health security, such as low likelihood of biological family assistance during health crises, lack of health insurance or same-sex partner retiree benefits, low incomes and high rates of poverty, geographic locations without LGBTQ-welcoming support systems, and social isolation for those who are single, live alone or do not have children. Addressing these determinants is critical to finding sustainable solutions for responding to LGBTQ older adults' health needs. There are inspiring examples of upstream approaches to addressing the health needs of the LGBTQ senior community. They represent advancement of social justice for the LGBTQ community, yet we have more to do. We have what it takes: skills, knowledge, caring, determination and, most importantly, a passion for doing the right thing. Now is the time for all members of society to come together to help prevent LGBTQ older adults from aging back into the closet.
[Source: Claire Pomeroy, Lasker Foundation, January 2014]
LGBTQ Conference on Aging
Gay seniors, like seniors in general, worry about safe housing, good health care and having enough money in retirement. But according to those who attended the first White House conference devoted to gay, lesbian, bisexual, transgender, and queer aging, held at the University of Miami on May 7, 2012, they also face unique obstacles because of discrimination, health-care inequities and fear of retaliation. The White House LGBTQ Conference on Aging was the first-ever conference dedicated to lesbian, gay, bisexual, transgender, and queer (LGBTQ) aging issues. Sponsored by SAGE (Services and Advocacy for GLBT Elders), it was hosted by The White House Office of Public Engagement, in partnership with the University of Miami Center on Aging. It met at the University of Miami Miller School of Medicine, where it provided advocates, community leaders, and members of the public an opportunity to engage with the Obama Administration on the health, housing, and security needs of aging members of the LGBTQ community.
Elderly LGBTQ People
Despite advances in LGBTQ civil rights, many older adult care providers never stop to consider that their older clients may be lesbian, gay, bisexual, transgender, and queer (LGBTQ). And sometimes those who do know may not know how to provide services in culturally-sensitive ways. As a result, LGBTQ older adults often avoid seeking needed services out of fear of discrimination. The tendency for LGBTQ older adults to go "back in the closet" is particularly pronounced in situations where they are most vulnerable, such as when accessing home health care or residing in assisted living or residential care facilities. One study indicated that LGBTQ older adults may be as much as five times less likely to access needed health and social services because of their fear of discrimination from the very people who should be helping them.
This type of social isolation has an enormous impact in the health and well-being of LGBTQ older adults. With LGBTQ older adults twice as likely to live alone than heterosexual older adults, more than four times as likely to have no children, the informal caregiving support we assume is in place for older adults may not be there for LGBTQ elders. LGBTQ people face a number of particular challenges as they age. They often do not have access to adequate health care, affordable housing and other social services that they need due to institutionalized heterosexism and transphobia. Mainstream senior providers have limited information or training in how to appropriately work with and serve our diverse communities. Existing regulations and proposed policy changes in programs like Social Security or Medicare, which impact millions of LGBTQ elders, are discussed without LGBTQ views and interests as part of the debate.
Wellness Challenges of LGBTQ Seniors
There are many challenges faced by the Lesbian, Gay, Bisexual, Transgender, and Queer elderly community. Family and support networks can be critical to the wellbeing of the elderly. Due to homophobia and other factors, LGBTQ elderly may not have strong ties to traditional social support networks such as adult children to provide care, extended family or faith-based support, and frequently end up relying on friends and service agencies.
A recent Met Life survey noted that 27% of LGBTQ baby boomers reported great concern about discrimination as they age and less than half expressed strong confidence that they will be treated “with dignity and respect” by healthcare professionals. Financial challenges include inability to transfer assets such as social security, Medicare, Medicaid and pensions to the surviving partner. The same Met Life survey indicated that 51% of LGBTQ Baby Boomers indicated they have yet to complete wills that spell out their long term and end of life wishes. This is of concern since LGBTQ partnerships frequently are not recognized legally in matters of health care decisions and finances.
Care and Aging With Pride
SAGE: Services & Advocacy for LGBTQ Elders
LGBTQ Aging Project
National Resource Center on LGBTQ Aging
Center for American Progress: Protecting our LGBTQ Elders
Message for LGBTQ Seniors
If any of you are at least 50 or older, you, along with me, can remember how important it was to keep your gay secret. Of course, before the 70's there weren't any polite words like gay. All the standard insults were there. Being homosexual was the epitome of perversion and degradation. It was something never spoken of in any type of polite or common conversation. For example, before the early 70's, New York had a law that prohibited any bar or club from serving alcohol to a homosexual. Of course, most gay men passed easily. Imagine not being able to legally get a drink in a public bar like the other straight patrons. This was the law that the police used to back up their bar raids. When things were slow out on the streets, they would just get prepared with the paddy wagons and go raid a couple of known gay hangouts, arrest and fine the patrons, close and fine the bar owner, and call it a night. Imagine kids, being hustled out of a bar and arrested for being gay and having a drink! In Atlantic City there were gay clubs but you couldn't dance or touch in any fashion. Even when dancing became permissible, you were not allowed to touch because that would get a club closed down and fined. Try to imagine it.
One night in 1969 (yes only 30 years ago) in New York's Greenwich Village at the Stonewall Inn, the police pulled one of their many gay bar raids and all hell broke loose. The fight started and continued for several nights. Gay Liberation as a national struggle was born. I remember in 1972 (I was 22 at the time) tuning in to The David Susskind Show because he was having a panel of lesbians on to discuss being gay and gay liberation. You young people won't remember but, at that time, talk shows were not like they are today. The David Susskind show was a serious show with serious and informative discussions. The audiences at the talk shows were adult and quiet and sometimes allowed to ask questions at specific times. There was nothing like the ridiculous carrying-on that you see all the time on the Jerry Springer Show and the like. Anyway it was the first time I had ever seen such an open discussion on TV. Where I grew up, I was absolutely certain I was the only gay man within many miles. I watched that show on every channel it appeared for a whole week. Being that there was no such thing as a video recorder, I taped it on cassette tape. I still have it and listen to it at least once a year. I had to make a copy of it about 3 years ago as the tape was getting too old and fragile. It still stirs me like it did 30 years ago.
Things have changed and we are not so much the filthiest things on the planet. However, as we all hear and see all the time now, the hatred is still very much alive and as vicious. It's just all out in the open. The old myths about "queers" are still going strong. Kids, let me reassure you that these self-righteous bastards will do anything to send us back into nonexistence. We see that in the news all the time. This year Oregon will be voting on an antigay measure for the 32nd time. They are relentless and we have to be also. Don't take it for granted that someone else will do the fighting for you. We all need to do this together in any legal fashion that we are able. We deserve everything that the law grants to them. Don't wait expecting them to someday get nice to us. Your society still would rather you didn't exist. And for us older people, we must not allow ourselves to just sit back figuring that we don't have to bother because it's up to the younger folks. They need our voices as much as we need theirs. Do something to help us all become equal citizens.
[Source: Gianni, Tampa Bay Coalition, 1999]
Aging in Equity
“We’re coming out of an experience of being badly treated in society, and there’s no sense that treatment is going to get any better when you get older and more vulnerable within the system.”
A VISION OF “HEALTHY AGING”
The growth of the nation’s older population is among the most significant demographic shifts taking place in the United States today. The “graying of America” has profound implications for health care and other senior services. As this issue takes center stage, a greater emphasis is being placed on the notion of “healthy aging” or “successful aging.”
Access to appropriate housing, quality health care, and supportive services are the main ingredients of aging well, and the exponential rise in the number of older Americans will challenge and transform the systems charged with providing these services. At the same time, the growing number of lesbian, gay, bisexual, transgender, and queer (LGBTQ) seniors (and their increasing degree of openness and demands for fair and equal treatment) are further challenging the elder care system to meet the needs of all seniors, sparking transformations that are long overdue.
Society must adopt a positive vision of “successful aging” for LGBTQ elders, which encompasses a variety of quality-of-life issues that affect all senior citizens, regardless of their sexual orientation or gender identity. These quality-of-life issues include the ability to:
--Maximize one’s physical and emotional well-being throughout the aging process.
--Maintain the highest possible degree of autonomy and independence for as long as possible.
--“Age in place” in one’s own neighborhood or community within a context of respect, safety, and support.
--Remain actively engaged with social networks, including chosen and biological families.
--Pursue the social, recreational, intellectual, spiritual, and creative activities that provide a sense of stability, fulfillment, and vibrancy throughout the life cycle.
This information is designed to help funders recognize and resource this vision for healthy aging within the LGBTQ community, which faces numerous barriers to accessing the services and support systems that promote “successful aging” in our society.
Before describing these barriers and concerns, it is important to first understand the broader context of aging in America.
CHANGING DEMOGRAPHICS BEHIND “THE GRAYING OF AMERICA”
In 2000, there were an estimated 35 million people age 65 or older in the United States, representing 12 percent of the U.S. population, up from 8 percent in 1950. In 2010, the post–World War II baby boom generation will begin to turn 65, so that by 2030, there will be about 70 million older persons, more than twice as many as in 2000. By 2030, people age 65 and older are expected to represent 20 percent of the U.S. population. Individuals age 85 and older are the fastest growing segment of the older population. The increasing size of this age group has major implications for the future of this country’s health care system, because these individuals tend to be in poorer health and require more services than elders in their 60s and 70s (a group sometimes referred to as the “younger old”).
In 2000, an estimated 2 percent of the U.S. population was 85 or older. By 2050, the percentage of persons in this age group is projected to more than double to nearly 5 percent of the population. The US Census Bureau projects that the population of persons age 85 and older could grow from about four million in 2000 to 19 million by 2050. Increasing life expectancy rates contribute to the growth of the older population. In 1900, life expectancy at birth was about 49 years. By 1960, life expectancy had increased to 70 years.
In 2001, life expectancy at birth reached a record high of 77.27 years. Life expectancies at 65 and 85 have also increased. Under current mortality conditions, people who survive to age 65 can expect to live an average of nearly 18 more years, while those who survive to age 85 can expect to live an average of seven years (for women) and six years (for men). In broad terms, these life expectancy rates not only amount to an “elder boom,” but to large numbers of much older individuals with commensurate health care and other aging-related needs. On an individual level, these rates will translate into much longer periods of retirement for individual seniors, and more extended periods of reliance on housing, health care, and social services geared to their needs.
Older Americans are also growing more racially and ethnically diverse. In 2000, an estimated 84 percent of persons age 65 and older were non-Hispanic white, 8 percent were non-Hispanic black, 6 percent were Hispanic, 2 percent were Asian/Pacific Islander, and less than 1 percent were Native American/Alaska Native. By 2050, it is projected that approximately 64 percent of persons age 65 or older will be non-Hispanic white, 16 percent will be Hispanic, 12 percent will be non-Hispanic black, and 7 percent will be Asian/Pacific Islander. Services for America’s seniors will need to take this growing diversity into account as they strive to provide services that truly meet seniors’ needs.
CORE ISSUES FOR LGBTQ ELDERS
A contemporary understanding of culturally competent service delivery for seniors must include LGBTQ issues. While LGBTQ elders and their heterosexual counterparts contend with many of the same aging-related issues (including challenges to their health, independence, and mobility; social isolation; the loss of peers and loved ones; and financial concerns, among others), LGBTQ seniors face special difficulties as well. These seniors are “twice-hidden” due to social discrimination on two levels: ageism and homophobia or heterosexism. LGBTQ seniors often face antigay or gender discrimination by mainstream elder care providers that renders them “invisible” and impedes their access to vitally important services. At the same time, LGBTQ elders frequently confront ageism within the LGBTQ community and the organizations created to serve the community’s needs. Many older LGBTQ people respond to the pressures of discrimination by concealing their sexuality in settings where being “out of the closet” might hinder their access to quality care or even endanger their well-being. For many LGBTQ elders in their 70s and 80s, “passing” as heterosexual has been a lifelong survival strategy, one they are likely to carry with them when seeking long-term care, entering a nursing home, or speaking with a health care provider. This dynamic prevents many LGBTQ seniors from openly accessing the very programs that could be most beneficial to them, if only these programs were perceived as safe places to turn for help and if they were culturally responsive to LGBTQ elders’ needs.
The gravity of this problem was even acknowledged on the federal level when, in 2001, the US Office on Aging recognized that LGBTQ elders are underserved by the federally funded programs that receive support through the Older Americans Act to help elders remain independent and in their home environment and to prevent unnecessary or premature institutionalization.
LGBTQ elders are vulnerable in another important area as well. Being closely linked with income, health status, and the availability of caregivers, living arrangements are an important indicator of well-being among older persons. The US Census Bureau reports that older persons who live alone are more likely to be in poverty than older persons who live with their spouse. Needs assessments of LGBTQ elders in Los Angeles, Milwaukee, New York City, San Francisco, and elsewhere have found that LGBTQ elders are far more likely to live alone than heterosexual elders. LGBTQ elders are also less likely to have children than their heterosexual counterparts. Since life partners and children play an important role in caregiving, many LGBTQ elders become reliant on formal caregiving services sooner than elders who can turn to family members and partners for informal support. LGBTQ elders who are partnered must contend with an array of discriminatory practices that arise from the lack of formal recognition of their personal relationships. LGBTQ couples face unequal treatment in hospital visitation, health decision making, nursing care policies, Medicaid regulations, Medicare and Social Security coverage, pension and tax regulations, housing rights, and a host of other issues that fundamentally affect their financial security, health status, and quality of life.
[Source: Funders for Lesbian and Gay Issues, Report on LGBTQ Elders in America, 2004]