1.1 million Americans age 65 and older identify as LGBTQ+ (lesbian, gay, bisexual, transgender, queer, plus others), and 40 percent are over the age of 80. Although there has been a notable shift in thinking and attitudes, laws, and focus on the needs and rights of individuals who are LGBTQ+, it is important to remember that seniors, particularly those over 80, have endured a lifetime of discrimination, violence, and marginalization. Regardless of the recent progress that has been made for LGBTQ+ rights, these seniors remain at higher risk of isolation, health problems, and economic insecurity. In fact, one in three live in poverty. What can we, as allies and health care providers, do to address these risks and help to level the playing field?
Understanding LGBTQ+ issues and challenges for our elders
While the narrowly approved 2015 Supreme Court decision Obergefell v Hodges recognized same-sex marriage as legal in all 50 states, individuals who lost same-sex partners prior to 2015 were unable to reap its benefits. As a result, the over-80 generation—who were the activists demonstrating at Stonewall, advocating for gay rights, fighting AIDS and employment discrimination—are the ones who continue to suffer from oppression that impacts their current mental and physical well-being. In very tangible ways, most LGBTQ+ seniors over the age of 80 are denied marriage benefits such as:
- Spousal survivor benefits
- Spousal retirement benefits
- Death benefits
- Tax benefits
- Veteran benefits
- Immigration benefits
These disparities, coupled with other forms of discrimination and isolation, make it more likely for seniors in the LGBTQ+ population to live in poverty. Often, they lack adequate community support systems and access to non-judgmental health care, creating a justified fear of moving into traditional long-term care settings.
Isolation is one of the biggest fears and realities for the elderly LBGTQ+ individual. Those who were shunned by family and friends many years ago if/when they “came out,” they tended to form their own support network or “chosen family.” The problem with this is that they all are aging in place at the same time and facing the same physical and mental health challenges, making it difficult to offer each other caregiving support. 76 percent of LGBTQ+ adults report they are anxious about having “adequate family and/or social supports” as they age, particularly because of the estrangement mentioned above. Their social networks consist of friends, but they are less likely to have adult children to offer support or care.
Health disparities: fair treatment in care or nursing homes
According to population statistics, LGBTQ+ elders are nervous about how they will be treated in long-term care settings. More than 60 percent surveyed said they fear they might be refused care or receive
limited care. They also fear living in danger of neglect, abuse, or verbal and physical harassment due to lack of acceptance of their lifestyle.
Even more sobering, studies have shown that about 80 percent of older adults who are LGBTQ+ hide their sexual orientation/identity when they move into long-term care settings such as assisted living or skilled nursing facilities, where they feel particularly vulnerable to personal, religious, and geographic biases, especially away from larger urban areas. They are wary and robbed of the opportunity to share their life stories and memories with others, which leads to loneliness and depression. It also, in some cases, puts them “back in the closet,” unable to be their authentic selves.
How to support equitable health care for seniors who identify as LGBTQ+
With over a million LGBTQ+ seniors living in the United States, a number that will double in ten years, this is an opportunity for health care and residential care providers to step up and meet the needs of this growing demographic. Where to start?
- While laws and a more accepting view of this community have progressed in the past ten years, there is little doubt that there continues to be bias, prejudice, hostility, and a lack of tolerance or understanding of the LGBTQ+ population. Education at every level, from an early age and ongoing, will help to lessen stereotypes, objections, and intolerance.
- Training of personnel in home care and residential settings is essential. Sensitivity to and understanding of the historic impact of discrimination on clients’ mental and physical health must be a minimal expectation. A lack of understanding of some of the unique needs of this population and health care workers’ personal biases have no place in the delivery of health care services.
- Access to LGBTQ+-friendly social services and health care means welcoming their unique needs outside of urban areas, so any choice of community or congregate living setting offers the care and dignity seniors seek and deserve.
- Get involved in local and state politics to serve as an LGBTQ+ advocate in underserved areas, understanding that fairness and equity for everyone makes for a better community at large.
There is cause for hope and change, however slow the process may be. I am proud that in my own state of New Jersey, there is a retirement community that holds a free, annual open house every year known as The LGBT Senior Housing and Care Expo, open to LGBTQ+ individuals and groups, allies, health care, senior care, and senior living professionals.
I am equally proud of the nationally recognized provider of home health care, BAYADA, for embracing the challenging issues of Diversity, Equity and Inclusion in companywide roundtable and town hall discussions. Their ongoing process creates a regular safe space for employees to identify, explore, discuss, and share feelings around biases, to learn how to better serve its diverse staff and client populations.
For further information on this topic, some resources include:
- The Movement Advancement Project (MAP) think tank for equality research and insights, at lgbtmap.org
- The SAGE Hotline (Services and Advocacy for LGBTQIA Elders), at SeniorGuidance.org
And always feel free to discuss your needs, and any issues you may be experiencing with access to health care and social services, with your local BAYADA office.