The needs of an aging LGBTQ population is a topic that is so often not discussed yet the unique risks endured by these diverse Americans – depression, poverty, isolation, fear of authenticity, less willingness to approach institutional resources – make it an important one. One of the unique challenges is that the LGBTQ population is very much aging single; more likely to be single, without children, dependent on friends for care giving needs who, themselves, are aging at the same rate.
When older adults need care, they typically turn to a child, spouse, or other relative for assistance. LGBTQ older adults are 4 times less likely to have children and twice as likely to be single as their non-LGBTQ peers. They may also be estranged from their biological or legal family members if those people do not accept their sexual orientation and/or gender identity.
And, all the while, this diverse population has endured institutionalized discrimination and ignorance, smaller communities than the hetero-normalized adults, and fearing persecution. In 1973 the American Psychiatric Association removed homosexuality as a mental disorder and it was only very recently, in 2019, that the World Health Organization no longer classified transgender identity as a mental health issue.
So, we have LGBTQ individuals who’ve lived the vast majority of their lives in isolation, fear, legalized persecution; stigmas that have transferred to today and have created a great deal of difficulty as they age.
Some fear their connections to their family of origin; their careers, finances, and opportunity to save for retirement are likely to be less secure. And because of all the stigma of the past, thinking or being treated as ill, members of this population fear government agencies, healthcare providers and the likelihood of less than relevant treatment they’ll experience when they do reach out to available services. This can lead to a delay in care, premature institutionalization, and even premature death
The result is vastly higher risks for illness and many older LGBTQ are concerned about their healthcare and access to resources as they age; here are some alarming statistics:
- Forty percent of LGBTQ adults in their 60s and 70s, as well as 43% of single, older LGBTQ individualsaged 45 to 75 years, state that their healthcare providers are not aware of their sexual orientations.
- 65% of transgender adults aged 45 to 75 years believe that there will be limited access to healthcare as they grow older.
- In a different survey of LGBTQ adults aged 50 to 95 years, 21% reported not disclosing their sexual or gender identity to their physicians
As providers and as members of a society that’s aging overall, we need to understand these obstacles, the history of a lifetime. As a result, LGBTQ individuals, who largely go into their senior years as single adults, are at higher risk for physical and mental health challenges – depression, anxiety, poverty, poor coping skills, while, at the same time, they fear accessing the resources and established systems that could mitigate these severe problems.
And it’s obvious why: History of prejudice has led to high levels of LGBTQ distrust for mental and physical health providers, social services, meal services. And, if they have to access these services, they fear expressing their needs, culture and personal history, thus living inauthentic lives with declining abilities and resources when they’re needed most.
We should all have the confidence to know we can access available resources with dignity yet to age as an LGBTQ individual is typically to deny this sense of entitlement after a lifetime of contributing to society. The result is a unique burden on this population and, in fact, a larger burden on an overall aging American society to find ways to address it.
Younger LGBTQ people are less cautious and benefit from changing laws and acceptability in growing swaths of the population. Yet, those who lived through the 1950’s- 70’s with violence and tremendous trauma found their careers were stunted, they were shunned. In fact, as I pointed out above, a large percentage have never shared their gay identity with their doctors and this alone diminishes some relevant aspect of their health care.
It’s hard for younger people who’ve seen an opening in acceptance and equality to understand the life experience of older LGBTQ Americans. And, for an aging population we need to change the focus in care communities and facilities to incorporate gender and preference inclusivity. We need to acknowledge the status of partners and caregivers of choice who may not have the traditional legal status to make choices on behalf of their companions and friends.
As a professional member of the health or caring communities, if you have not yet worked with older LGBT communities, it is recommended that you implement some best practices to make your agency generally welcoming to LGBT older adults before you move on to specific programs.
- Improve your organization’s knowledge of LGBTQ issues
- Consider going through formalized LGBTQ cultural competency training in order to best understand the history, language, and social and political context of the community.
- If your organization could use a refresher, if you have never had a formal LGBTQ cultural competency training, or if you would like to learn more specifically about LGBTQ aging, request a visit the National Resource Center on LGBTQ Aging to find resources.
- Promote inclusivity in your hiring and training policies.
On the other side of the aging population, LGBTQ caregivers make up 9% of the 34.2 million Americans caring for adults over age 50. Interestingly, LGBTQ people also become caregivers at a slightly higher rate than their non-LGBTQ peers: 1 in 5 LGBTQ people is providing care for another adult, compared to 1 in 6 non-LGBTQ people.
LGBTQ caregivers come from a variety of different backgrounds and provide care in a variety of different relationship structures, but there are some common themes in the unique needs and experiences of most LGBTQ caregivers, as well as those who are caring for LGBTQ older adults but may not be LGBTQ-identified themselves.
LGBTQ older adults, caregivers themselves, are more likely to be caring for one another in isolation, without other people involved to share the burden. Only about half of all caregivers have another unpaid caregiver to help them, and about 2/3 of family of choice caregivers, many of whom identify as LGBTQ, provide sole care (43%) or are the primary caregiver (25%). Having just one caregiver means that the person receiving care lacks a safety net, and that the caregiver is likely to experience an increased burden, both of which could ultimately jeopardize the care recipient’s ability to age in place.
For many LGBTQ people, families of choice are the cornerstones of caregiving. These chosen families provide social, emotional and physical support, and often serve as advocates when medical needs arise. However, most families of choice are not afforded any legal recognition or protection, and service providers may not think to inquire about or include these people in their work. It is important to recognize these relationships, and to provide support in completing paperwork that ensures the wishes of the care recipient are recognized.
As you can see, special circumstances and historical discrimination have placed enormous burdens on the LGBTQ population that will continue through old age. Here are a sampling of legal aids to utilize; Decades Group can assist you with all.
The CARE Act:
In 40 states plus the District of Columbia Puerto Rico and the U.S. Virgin Islands, some version of the Caregiver Advice, Record and Enable Act is in effect. While varying from state to state, its basic premise is that hospitals are required to ask patients at admission whether they’d like to designate a caregiver.
Once named, regardless of that person’s relationship to the patient, the hospital is general required to record the name of that caregiver in medical records, inform the chosen caregiver when the patient is being discharged and give the caregiver adequate training on how to perform any medical tasks needed at home.
For our topic, it’s important to note that the Act makes no stipulations about who may be named as the caregiver – relative, friend, chosen family, etc – and the hospital must formally recognize that person as the caregiver. This link to AARP will take you to a wallet card you may wish to have with details of the Act in those states/territories where it’s been enacted.
Advance directives allow an individual to ensure their wishes will be honored should they become unable to communicate or make decisions for themselves. While relevant for all adults, these are particularly important for people whose caregivers or closest loved ones are not legal relatives, often the case for LGBTQ people.
The following documents are recommended for anyone for whom their primary caregiver is not their legal next of kin (see more at Lambda Legal’s ‘Take the Power’ toolkit). Of course, Decades Group will assist and guide you with any and all these important documents:
- Medical Power of Attorney (or Health Care Proxy)
- Living Will
- Hospital Visitation Directive
- HIPAA Waiver
- Financial Power of Attorney
- Written documentation of an individual’s wishes upon their death, i.e. funeral arrangements, disposition of remains, organ/tissue donation, obituary, etc.
Is it possible the current aging LGBTQ population will begin to shift attitudes and awareness when their chosen families can no longer act as care givers? Will their presence in typically hetero-normalized care facilities open awareness and attitudes? Awareness, acceptance and appropriate responsiveness to diverse populations with varied histories, cultures and needs can only serve to improve care for us all.
For more information about any of the varied forms of legal protections mentioned here, we welcome your call, no obligation is implied:
Celebrating Decades: The 70’s
June became Gay Pride Month after the Stonewall Riots, a series of violent confrontations between police and gay patrons of the Stonewall Inn on June 28, 1969. This began to build cohesive communities of LGBT New Yorkers, leading to similar organizations around the U.S.A. and the world. In June the following year, a first march for gay rights covered 51 blocks of New York City and, within 2 years, gay rights groups existed in every major American city as well as Canada, Australia and Western Europe. Throughout the ‘70’s gay activism had significant successes including the American Psychiatric Ass’n. invitation to activists to speak at the 1972 conference and the deletion of homosexuality as an illness by that group in 1973.
Celebrating 2 Decades of Service in the New Mexico Community
Karen McPhail, BSN, MSN, CDP, Aging Life Network Podcast w/Nancy Oriola
Daniel B. Stewart, MSG and Alex Kent, MPA, “A Guide to Engaging and Supporting LGBT Caregivers through Programming”
Aliza R. Grossberg and George T. Grossberg, MD, “Aging LGBTQ Patients and Barriers to Care”
Jesus Ramirez-Valles, “Queer Aging”