Queer Cafe

Enduring hardship makes this population masters of perseverance. LGBTQ elders know a lot about resilience. They've simply had to in order to survive — and certainly to live long enough to become elders. Their wisdom offers lessons for anyone who wants to grow older with the strength of resilience or bolster this skill while the pandemic continues to challenge our lives.

Researchers studying LGBTQ elders find that the unfortunate experience of resisting homophobia and/or transphobia provides the emotional and psychological tools needed to resist ageism. Karen I. Fredriksen Goldsen uses the word "resist" to describe the way LGBTQ older adults push back against stigma. She's a professor of social work at the University of Washington and the principal investigator of the largest ongoing study of LGBTQ elders. "Not everyone, but many, resisted the kind of stigma and the obstacles that they faced and tried to create new pathways," she said.

Mark Brennan-Ing, a senior research scientist at the Brookdale Center for Healthy Aging at Hunter College in New York City, said this "crisis competence" can make LGBTQ older adults "better positioned to cope with the challenges of aging." Another tool for coping is what Brian de Vries, professor emeritus of gerontology at San Francisco State University, calls "perspective-taking." He said LGBTQ people are used to being vigilant about others' responses to them, which leads to empathy and the need, and freedom, for LGBTQ elders to "age on a path of our own creation."

That path begins with coming out. New York City psychologist Harold Kooden, 84, explores in his book "Golden Men: The Power of Gay Midlife" the connection between the dynamics of coming out and the development of skills that can be used to age successfully. Kooden writes that aging with resilience — like the coming out experience — is about moving beyond what others want to living the life you want, from isolation to belonging to a community, and developing a sense of hope for a positive future with a feeling of pride.

An attitude of defiance has served Robert Mary Clement well throughout his 95 years. An ordained priest since 1948 in the American Catholic Church, Clement founded The Church of the Beloved Disciple in 1970 — New York City's first church specifically for LGBTQ people.

Clement celebrated the first same-sex holy union at the church that July, shortly after the first march commemorating the 1969 Stonewall uprising that launched the modern LGBTQ rights movement. "I certainly was defiant and caused a number of eyebrows to go up," said Clement, now a resident of the Los Angeles LGBT Center's Triangle Square — a 104-unit apartment complex in Hollywood for low-income elders. His persistent attitude has served him well in his older years, especially when dealing with health issues such as having brain surgery at 89. "But I am not going to dwell on them," he said. "I'm not feeble. I am still as positive about being gay as I was back then."

Defiance also shaped the life of David Epstein, 70, Clement's husband of one year and friend of 12. A student radical in the 1960s, Epstein defied anyone who tried to put him in the box of expected heterosexuality. Epstein, too, pushes back against the negative stereotypes about people his age: "It's a choice about how we present ourselves," said Epstein, clear about his own choice. "I am not going to be that kind of old person, the one who sits down and lists his aches and pains," he said.

Community comes up often in conversations with LGBTQ elders and those who serve them. Karen Skultety, executive director of San Francisco's Openhouse, said, "resilience makes communities." Everything Openhouse does in managing 104 low-income apartments for LGBTQ residents and offering wellness, transportation and community engagement programs grows out of its commitment to supporting LGBTQ and other elders' resilience. "We believe that the power of resilience makes communities stronger, better, more powerful and richer," Skultety said.

Resisting internalized ageism is a "hard row to hoe," said Imani Woody, founder of Mary's House in Washington, D.C. and one of Next Avenue's 2019 Influencers in Aging. Mary's House (a renovated and expanded version of the house Woody grew up in) is the first of what she envisions will become a nationwide network of affordable independent living communities for LGBTQ elders of color.

Woody explains that Black people know a thing or two about resilience. "People of African descent have endured enslavement, inferior legal standing in the Constitution, lynching, Jim Crow and systemic racism," Woody said. "Each generation has been told, 'Your ancestors are from Africa, where they were kings and queens, healers, and craftspeople. You are enough.'"

What we tell ourselves about our own aging matters, too. "There is a vocabulary of happy aging," said English professor emeritus Frank Galassi, 82. Galassi still teaches, currently a Zoom class for the Los Angeles LGBT Center on LGBTQ history. He said it helps to frame one's aging experience as a journey of seeking "more" (such as more wisdom, kindness, fellowship or service to others) rather than simply becoming older."I use those words mentally on a day-to-day basis," he said.

Galassi laughs recalling an incident that underscored how even words that should signify honor and respect can be used to demean an older person when coming from a place of ageism — and the humor that helps to bat them away. "It ain't easy being surrounded by millennials in West Hollywood," said Galassi. "I had the experience a few months ago — going up the street by a group of gay white men in their thirties. I heard one of them say, 'Let grandpa go by.' So as I passed, I said, 'Stay well, my grandchildren.'" He added, "You've got to laugh."

[Source: John-Manuel Andriote, January 2021]

LGBTQ Seniors Overcoming Social Isolation

What can LGBTQ older adults do to stayed connected and overcome social isolation during a time when a major pandemic has made quarantine necessary and social isolation even more commonplace? Whether hunkered down with the nuclear family, a spouse, or roommates, practically everyone is feeling the pinch of curtailed interactions and relationships that are confined to the phone and video conferencing. Social isolation is a health risk for all seniors, especially older LGTBQ people. It is important to find resources to empower you to fight it.

But for older adults, the pandemic only made an existing problem worse. The CDC has called social isolation in older adults a serious public health risk. “It actually increases your risk of early death from all causes,” Dr. Erwin Tan, director of health and thought leadership at AARP, noted on a recent AARP Town Hall for the LGBTQ community. “Some people say it’s as bad as smoking 15 cigarettes a day.”

And social isolation is an even bigger issue for LGBTQ elders. According to “Maintaining Dignity: Understanding and Responding to the Challenges Facing Older LGBTQ Americans,” a survey conducted by AARP, increasing social support is a major challenge. That’s particularly true of gay men and transgender/gender-expansive individuals. Gay men in the survey were far more likely to be single and living alone compared to lesbians and reported being less connected than lesbians on every relationship type tested, including friends, partners, and neighbors. Transgender people were the least likely of all to be connected to sources of social support.

However, there are resources available to help older adults recognize and overcome social isolation. These resources work particularly well for a community that has relied upon self-empowerment in its quest for liberation, by allowing individuals to take better control over their lives and ensure themselves the social support they need.

Assess how connected you are. Knowing where you are are in terms of a support network at the moment helps you understand where you need to be. Just how strong is your social support system? It may not be as strong as you think. The AARP Foundation offers a short assessment as part of its Connect2Affect program to help you identify problem areas.

Talk to someone. A conversation can go a long way to alleviating a sense of loneliness. Don’t discount the power of an online community as well. Even if you are staying at home most of the time, you don’t have to be cut off from other people. AARP offers their Friendly Voice program, that allows you to request a phone conversation from a trained volunteer.

Be aware of how your health affects your social connections. Isolation is a major issue for people with physical limitations that affect mobility. Hearing loss and visual impairment may also be contributors. AARP offers their The Mighty program, which is a safe, supportive online community for people facing health challenges and their caregivers.

AARP: Volunteer Opportunity Board

Be a volunteer. Maybe you’re feeling isolated but you don’t have the physical limitations that keep you at home most of the time. If you’re physically able, you can consider volunteering. During the pandemic, there are volunteer opportunities that require only a telephone or laptop that will still keep you connected. It’s a great way to meet people, stay active, get involved in the community, and to put your experience to good use. AARP has a Volunteer Opportunity Board that tells you about organizations in your area that lets you share your experience and interests with groups that could use your help. LGBTQ organizations also rely heavily on volunteers to keep them going. Consider reaching out to see what you can do to help your community and you will be enriched beyond measure in return.

An OWL is an older wiser lesbian. This acronym, used informally to describe elderly gay women, is a slang expression referring to experienced lesbians who have personal insight of the history of the LGBTQ movement. Typically, it is a term meant as an expression of respect. Around the country, there are local social groups and support groups for elderly gay women called OWL clubs or organizations. And there is a 2010 movie entitled "The Owls," about a group of senior lesbians.

National Honor Our LGBT Elders Day is celebrated annually on May 16. It was established to draw awareness to and appreciation of the lifetime of contributions made by LGBTQ older adults. National Honor Our LGBTQ Elders Day works to unite the LGBTQ community and its allies to celebrate and thank those individuals who fought on behalf of us all. The idea for this special day was conceived in 2016, by the LGBTQ Health Resource Center of Chase Brexton Health Care, in Baltimore, Maryland. It first opened its doors in 1978 as a clinic focused exclusively on the health care of gay men, a revolutionary and much-needed concept for its time.

Axel Axgil (1915-2011) and Eigil Axgil (1922-1995) were Danish gay activists and a longtime couple. They were the first gay couple to enter into a registered partnership anywhere in the world following Denmark's legalization of same-sex partnership registration in 1989, a landmark legislation which they were instrumental in bringing about. They adopted the shared surname, Axgil, a combination of their given names, as an expression of their commitment. In 1948 they established the Danish National Association of Gays and Lesbians, Denmark's first gay rights organization. In 1989, Denmark became the first nation in the world to recognize registered partnerships for same-sex couples, nearly equal to (opposite-sex) marriage.

Nick Cardello, 54, and Kurt English, 52, met in 1992 at the Washington DC Gay Pride event. They took a photograph on the National Mall to commemorate the day. In June 2017, 25 years later, they went again to the Washington DC Gay Pride event and re-created the photo they took. The photo, which went viral, was an important moment for them and their long-term relationship. "This is so necessary. For young gays to see old gays happy, in love, and proud." They're now married and living in Tampa, Florida.

Ageing 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 ageing 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 ageing back into the closet.

[Source: Claire Pomeroy, Lasker Foundation, January 2014]

LGBTQ Seniors: The Joy of Being Out

Frightening and Encouraging: Being an Older LGBTQ Person

What it's Like to be Older, Gay, Unmarried

Elderly Gay WWII Veteran Attacked and Robbed

Never Have I Ever: Elder Gay Men Having Fun

Double Lives: LGBTQ Elders Tell Their Stories

Ageism Takes Heavy Toll on LGBTQ Seniors

Video Talk: Together for 54 Wonderful Years

90 Year Old Man Reveals Long Struggle With Coming Out

Improving the Lives of LGBTQ Older Adults

Photos: Trans Elders Who Have Survived

Same Sex Couples Tell Us What it's Like to be Legally Married

Things Older Adults Can Do to Stay Connected and Overcome Isolation

Lessons on Resilience From LGBTQ Elders

PBS: Finding Care For LGBTQ Seniors

HRC: Honoring LGBTQ Elders Day

LGBTQ Seniors Tell Their Stories

Center for Positive Ageing: Resources for Older LGBTQ Persons

Never Have I Ever: Elder Lesbians Having Fun

Advocate: No One Will Care for LGBTQ Seniors But Themselves

Elder Lesbians Share Coming Out Stories

Resources for Transgender Seniors

APA Info: LGBTQ Ageing Facts

Life After Fifty for a Gay Man

Mosaic: Older Gay Couples Documentary

Gray Gays: Ageing as an LGBTQ Adult

Richard and John: Elderly Couple

Video: Silent Pioneers

LGBTQ Conference on Ageing

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 ageing, held at the University of Miami in May 2012, they also face unique obstacles because of discrimination, health-care inequities and fear of retaliation. The White House LGBTQ Conference on Ageing was the first-ever conference dedicated to lesbian, gay, bisexual, transgender, and queer (LGBTQ) ageing 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 Ageing. 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 ageing 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.

LGBTQ Elders Show Resiliency Despite Barriers

Video Talk: Old Gays Share Their Coming Out Stories

Older Queer Voices: The Intimacy of Survival

Sage Advice to Young Queers From a Gay Elder

Williams Institute Report: LGBTQ Ageing

Center for Positive Ageing: Resources for Older LGBTQ Persons

Elder Lesbians Try New Lesbian Slang

AARP Pride: LGBTQ Advocates See Hurdles Ahead

Gen Silent: LGBTQ Ageing Documentary

LGBTQ Seniors Tell Their Stories

LGBTQ Seniors: The Joy of Being Out

Frightening and Encouraging: Being an Older LGBTQ Person

Bill and John: More Than Ever

Lessons on Resilience From LGBTQ Elders

Old Lesbians Organizing for Change

Ageing in Equity: LGBTQ Elders in America

LGBTQ Ageing: A Question of Identity

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.

Gay and Lesbian Association of Retiring Persons

Care and Ageing With Pride
SAGE: Services & Advocacy for LGBTQ Elders
Never Have I Ever: Elder Gay Men Having Fun

LGBTQ Ageing Project
National Resource Center on LGBTQ Ageing
Center for American Progress: Protecting our LGBTQ Elders
University of North Dakota: Resources for the Ageing LGBTQ Community

Resources for Transgender Seniors

Richard and John: Elderly Couple
Gray Gays: Ageing as an LGBTQ Adult
Elder Lesbians Watch Hayley Kiyoko

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]

Elder Lesbians Give Advice to Young Lesbians

Same Sex Couples Tell Us What it's Like to be Legally Married

LGBTQ Seniors: The Joy of Being Out

Gay and Lesbian Association of Retiring Persons

Edith & Thea: A Love Story for the Ages

Center for Positive Ageing: Resources for Older LGBTQ Persons

Plight of Elder LGBTQ People

Challenges of Coming Out Late in Life

Frightening and Encouraging: Being an Older LGBTQ Person

Advocate: No One Will Care for LGBTQ Seniors But Themselves

Housing for LGBTQ Elders Should Be a Priority
Older Lesbian Couple: Happy for 30 Years

Video Talk: Old Gays Share Their Coming Out Stories

Ageism Takes Heavy Toll on LGBTQ Seniors

Video: This is What 54 Years of Unwavering Love Looks Like
Lessons on Resilience From LGBTQ Elders

Video: Silent Pioneers

Williams Institute Report: LGBTQ Ageing

Richard and John: Elderly Couple
Things Older Adults Can Do to Stay Connected and Overcome Isolation

Ageing 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 Ageing

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 ageing” or “successful ageing.”

Access to appropriate housing, quality health care, and supportive services are the main ingredients of ageing 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 ageing” 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 ageing 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 ageing within the LGBTQ community, which faces numerous barriers to accessing the services and support systems that promote “successful ageing” in our society.

Before describing these barriers and concerns, it is important to first understand the broader context of ageing in America.

LGBTQ Seniors: Depression and Loneliness

Gray Gays: Ageing as an LGBTQ Adult

LGBTQ MAP: Improving the Lives of LGBTQ Older Adults

Bill and John: More Than Ever

LGBTQ Seniors: The Joy of Being Out

Frightening and Encouraging: Being an Older LGBTQ Person

Video: Silent Pioneers

LGBTQ Seniors Tell Their Stories

Gay and Lesbian Association of Retiring Persons

Need to Build More LGBTQ Senior Housing

Elderly Gay Man Recalls His Visit to a Psychologist in 1948

AARP Launches Website for Older LGBTQ Americans

Gay Seniors: Mental Health and Stress

Resources for Transgender Seniors

SAGE Publication: Practical Guide for LGBTQ Elders

Double Lives: LGBTQ Elders Tell Their Stories

Advocate: Politics of Caring for Our Queer Elders

Richard and John: Elderly Couple

Changing Demographics: 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 ageing-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 ageing-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 Ageing 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]