Challenges and Opportunities of Working with LGBT Elders

1. Challenges and Opportunities of Working with LGBT Elders Webinar Presentation prepared for the Geriatric Mental Health Alliance of New York Presented by Bobbi Williams, Ph.D. Rainbow Access Initiative, Inc.

2. WWW.RAINBOWACCESS.ORG Bobbi Williams, Ph.D Director of Academic Programs

3. PO BOX 9144, Niskayuna, NY 12309 The purpose of Rainbow Access Initiative is to increase the accessibility of health and human services to the lesbian, gay, bisexual, and transgender community and their families, with particular emphasis on underserved populations. Comprehensive and equivalent physical and mental health care and human services must be provided to the lesbian, gay, bisexual, and transgendered (LGBT) communities

4. “the ignorance of mainstream providers surrounding LGBT elder concerns and issues, creates tremendous barriers to services for LGBT seniors.” [Amber Hollibaugh , Senior Strategist National Gay and Lesbian Task Force]

5. Recognize the challenges faced by caregivers of aging LGBT clients Identify the special psychological and health needs of these clients Develop and apply resources that enable these clients to adjust to special living conditions Identify ways to eliminate prejudice and violence against LGBT clients OBJECTIVES

6. It's bad to have disabilities. CULTURAL MYTHS • It's bad to need people to help us do things. • The older you get, the more losses you have. • The older you get, the smaller your world becomes. • The older you get, the less you can contribute to other people. • Being in a nursing home is a fate worse than death.

7. The Pre-war Generation: Concealment of homosexuality Less importance attached to homosexuality as defining their whole life Three Generations [Judith Schuyf / Translated from German]

8. The Silent Generation: Second World War the defining moment in their lives; Rebuilding the nation as primary focus Emphasis on social mobility and class differences The Protest generation AIDS-HIV as a unifying force Importance of coming-out Growth of the political LGBT movement Three Generations

9. Contacts: Men: many social contacts, with family, neighbors and friends Women: fewer social contacts, mostly with ex-lovers; quieter lifestyles General Differences Between Gays and Lesbians [Judith Schuyf / Translated from German]

10. Relationships: Men: Long term (non-sexual) partners, Women: Serial monogamous relationships (Over 75% of older lesbians live alone) Work and Retirement: Men: Good paying jobs & pensions Women: Lower pay; poorer pensions General Differences Between Gays and Lesbians

11. Basic Facts • One to three million Americans over 65 years of age are GLBT* • GLBT elders will increase significantly over the next few decades* • National data on transgender people in the US. is unavailable * National Gay and Lesbian Task Force's Aging Initiative

12. 10,000 more LGBT Americans reach retire- ment age without equal access to services and economic safety nets. • There are an estimated 2.4 million gay, lesbian or bisexual Americans over the age of 55+ • By 2030, one in five will be 65 or older; some four million will be GLBT.”* + Williams Institute at the University of California, Los Angeles * National Gay and Lesbian Task Force's Aging Initiative

13. Discrimination THE ISSUES • Marriage and Family • Economics • Health • Ageism • Transgender Issues

14. Uncomfortable in organizations serving older people or LGBT community organizations DiscriminationBecause LGBT Seniors are from an era when homosexuality was taboo, they are… • Less likely to identify as LGB or T or participate in LGBT community organizations due to internalized homophobia.

15. LGBT persons may receive substandard care if they are open about their sexual orientation. Discrimination • Insensitive healthcare staff make LGBT elderly vulnerable • Federal programs and laws blatantly discriminate against same-sex couples.

16. A nurse wears rubber gloves in unnecessary circumstances Discrimination More Subtle Examples • An aide insists on reading Bible passages to a patient or resident to “prove” homosexuality is a sin.

17. The pattern is difficult to change BUT… Discrimination …decades of experience dealing with discrimination based on sexual orientation actually may help older LGBT persons cope with age discrimination.

18. Economics • There are no Medicaid regulations to protect the assets and homes of same-sex partners. • Tax laws, 401k's, and pensions discriminate against same-sex partners

19. Same-sex partners are denied medical rights or the right to live or die in the same nursing home. Economics • Gay men earn as much as 27 percent less than heterosexual men.

20. Options like continuing-care retirement communities and assisted-living facilities may include homophobic attitudes among fellow residents. Marriage & Family • Some nursing homes don’t allow LGBT residents to share a room with their partner • Some facilities exclude LGBT entirely

21. Aging parents in African American families are more likely to reside in the home of immediate family and less likely to enter a nursing home Marriage & Family • Gays and lesbians are much less likely to experience an “empty nest syndrome”

22. Many LGBT older adults have less support from families than other older people Marriage & Family • One in three gay men and lesbians provide caregiving assistance either to children or to adults with an illness or disability, yet many GLBT seniors do not know who will take care of them if they require caregiving assistance in their old age.

23. Reluctance to reveal sexual orientation to providers because of fear of discrimination or confidentiality concerns. Health • Lesbians…more likely to smoke, be overweight, or abuse alcohol; lower lifetime rates of pregnancy affects long-term health. • Insurance programs do not recognize same-sex partners for family coverage

24. The number of older people of all sexual orientations with HIV/AIDS may increase because people with the disease are living longer as a result of improved treatment. Health • 80 percent of lesbians reported excellent health, but 27 percent had no health insurance.

25. Staff refused to bathe an older resident of a nursing home whom because they didn't want to touch "the Lesbian" (Raphael, 1997). A home care assistant threatened to "out" her older Gay male client if he reported her negligent care (Roosen, personal communication, May 12, 1997). Older LGBT people who do not hide all traces of their sexual orientation are also subject to street harassment and violence (Visano, 1991). Health

26. Beauty standards value youth Ageism • Old people are excluded from community discussions and events • Senior issues are not part of the mainstream GLBT political agenda.

27. Ageism LGB survival meant figuring out if someone was “like us” using looks and codes. • Bandana in the back pocket. • The lingering “eye” • Red tie • Green on Thursday • Cocked wrist. • Haircut Harder to age, because we associate who we are with how we look, and looking old in this culture is considered a bad thing.

28. Heterosexuals toward LGBT Elderly LGBT’s are invisible because homosexuality = sex and old age does NOT = sex Sexism in old age care (men are the standard; but ratio men:women is 1:4) Ageism [Judith Schuyf / Translated from German]

29. Heterosexuals toward LGBT Because LGBT’s are ‘invisible’ in the care system there are serious consequences for care standards and psychological care Care personnel tend to think for elderly LGBT’s (“They do not want any attention” “They are not different”etc. Ageism

30. LGBT toward LGBT Perceived or real threat felt by younger gay men from older gay men Elderly gay men and lesbians are not accepted in recreational settings, such as bars (people are ignored, music policy etc.) Ageism

31. LGBT toward LGBT In some places “special interest evenings”for elderly LGBT’s start at 30 LGBT media don’t pay any attention to needs and interests of LGBT’s over 45 Ageism

32. Transgender Issues

33. Transgender Issues • Services that may accept Lesbians and Gays are not welcoming to Transgendered seniors • Senior service providers know little, if anything, about transgender issues (hormones, physical exams, etc.) • Facilities are not likely to hire openly transgendered care providers

34. Provide support to keep LGBT seniors living independently Improving the Quality of Life for Aging LGBT Folk • Provide services that are welcoming to LGBT seniors • Conduct outreach to homebound LGBT seniors • Distribute information about benefits and services for seniors • Educate senior service providers on LGBT issues From a survey conducted by SAGE/Upstate, 2004

35. Outreach to closeted and rural LGBT elders Improving the Quality of Life for Aging LGBT Folk • Continue to build relationships with providers of senior services • Build support networks specifically forLGBT seniors • Address ageism within the LGBT community • Accommodate participants still in the workforce From a survey conducted by SAGE/Upstate, 2004

36. What Would You Do? While Gloria was sitting with those she considered friends at an assisted-living center she noticed “people laughing and making certain kinds of comments about one of the other residents and I told them, ‘Please don’t do that; I’m gay too.” Everyone looked horrified. No longer included in conversation or welcome at meals, she plunged into depression. And medication did not help.

37. What Would You Do? • Create a local LGBT Aging Project to train long-term care providers. [e.g. Boston, New York, Chicago, Atlanta] • Include a unit for LGBT elderly • Design and sell homes for older LGBT people with support services similar to assisted-living centers. [Boston] • Hire openly gay and transgender geriatric case providers who can guide clients to compassionate services. • Establish separate care (if necessary)

38. Related resources located at www.rainbowaccess.org/webinar/WebinarResources.html Bobbi Williams may be contacted at: bobbiw@nycap.rr.com