LGBT Elders in Nursing Homes, Long-Term Care Facilities, and Residential Communities

Abstract

This article examines the opportunities and challenges faced by lesbian, gay, bisexual, and transgender elders who are aging in the long-term care continuum. From independent and community living, to adult day services, assisted living and nursing facilities, LGBT elders may face discrimination from administrators, direct care professionals, neighbors, and other residents/participants. Ironically, enduring a lifetime of fear and discrimination has many positive factors for LGBT elders’ resiliency, self-esteem, and social networking. Further, LGBT individuals are now increasingly accepted into “mainstream” society. It is, however, important to understand that that the current cohort of LGBT elders may not only fear, but lack the funds to participate in, the long-term care continuum.

Appendices

Learning Exercises for Knowledge Gain

• 1. Please identify 5 barriers for LGBT inclusion in the long-term care continuum.

  (Looking for fear of discrimination by direct care professionals, fear of discrimination by other elders, lack of a formal/family caregiver infrastructure to facilitate the transition from community to the long-term care continuum, and financial barriers.)

• 2. Please offer your definition of the difference between sexual orientation and gender identity.

  (Looking for sexual orientation being an individual’s sexual attraction preference and gender identity being how an individual perceives his or her own gender, regardless of expression.)

• 3. Please identify 5 different care environments in the long-term care continuum.

  (Looking for independent living, adult day/senior centers, assisted living, skilled nursing facilities, and hospice).

• 4. What is ageism and how is it particularly prevalent among gay men?

  (Looking for ageism as discrimination or stereotyping based on age or perceived age. This is particularly prevalent among gay men in that youth and physical appearance are often revered and especially honored by gay men across the life span).

• 5. Despite the barriers to inclusion, please offer opportunities for members of the LGBT population to thrive in the long-term care continuum.

  (Looking for 80/20, socioemotional selectivity, and selective optimization with compensation. Also specific examples from the Guy Kinman case study.)

• 6. Why might direct care professionals benefit from training and education about minority or disenfranchised populations?

  (Looking for direct care professionals often having less of an educational background and being undercompensated with fewer incentives to provide person-centered, culturally competent care. They may have never been exposed to members of the LGBT population and be less aware of their unique care needs).

• 7. Please define gerontology and how the gerontological lens can be supportive of optimal aging for LGBT elders.

  (Looking for the definition of gerontology as the holistic (biological, psychological, sociological, and spiritual, study of aging. The gerontological lens allows more than just one view of the aging elder. It looks at mind, body, spirit, social connections, and more, to arrive at a more thorough diagnosis. It is also supports empowering elders rather than portraying them in a diminished capacity).

Multiple-Choice Questions

• 1. According to the National Gay and Lesbian Task Force there are currently __ LGBT elder Americans.

  • (a) 1,500,000

  • (b) 3,000,000

  • (c) 250,000

  • (d) 750,000

    (Answer: a)

• 2. The number of LGBT elder Americans is expected to increase to ____ by 2030.

  • (a) 1,500,000

  • (b) 750,000

  • (c) 3,500,000

  • (d) 6,000,000

    (Answer: c)

• 3. An holistic approach to optimal aging employs:

  • (a) Biological, psychological, sociological, and spiritual aging

  • (b) Only spiritual aging

  • (c) Only psychological aging

  • (d) Aging without dementia

    (Answer: a)

• 4. The elements of the long-term care continuum include:

  • (a) Independent living and skilled nursing facilities

  • (b) Independent living, skilled nursing facilities, and hospice

  • (c) Independent living only

  • (d) Independent living, adult day facilities, assisted living, skilled nursing facilities, and hospice

    (Answer: d)

• 5. A person-centered care philosophy is grounded in an individual’s:

  • (a) Dependence on others

  • (b) Menu items of living choices

  • (c) Choice, dignity, respect, self-determination, and purposeful living

  • (d) None of the above

    (Answer: c)

• 6. Until ____, the American Psychological Association classified homosexuality as a deviant, pathological condition.

  • (a) 1964

  • (b) 1974

  • (c) 1984

  • (d) 1994

    (Answer: b)

• 7. The Caring and Aging with Pride Study (2011) states that ___ % of LGBT elders report being victimized.

  • (a) 52 %

  • (b) 62 %

  • (c) 72 %

  • (d) 82 %

    (Answer: d)

• 8. Elements of the direct care professional demographics include:

  • (a) Limited education

  • (b) More women and racial/ethnic minorities

  • (c) Higher use of public assistance programs

  • (d) All of the above

    (Answer: d)

• 9. ___% of LGBT elders report engaging in a health and wellness activity

  • (a) 20 %

  • (b) 50 %

  • (c) 75 %

  • (d) 90 %

    (Answer: d)

• 10. According to the literature, a universal risk for all elders, regardless of sexual orientation or gender identity is:

  • (a) Social isolation

  • (b) Financial concerns

  • (c) Premature death

  • (d) Elder abuse

    (Answer: a)

Resources

AARP

American Association of Retired Persons is a nonprofit, nonpartisan organization, with a membership of more than 37 million, that helps people turn their goals and dreams into real possibilities, strengthens communities, and fights for the issues that matter most to families such as healthcare, employment security, and retirement planning. We advocate for consumers in the marketplace by selecting products and services of high quality and value to carry the AARP name as well as help our members obtain discounts on a wide range of products, travel, and services.

Web site: http://www.aarp.org/

Additional resources:

http://www.aarp.org/relationships/friends-family/aarp-pride.html?intcmp=AE-SEARCH-AARPSUGG-LGBT

http://www.aarp.org/politics-society/rights/info-06-2009/more_lgtb_resources_from_aarp.html

http://www.aarp.org/politics-society/rights/info-06-2009/lgbt_glossary.html

http://www.aarp.org/politics-society/rights/info-06-2009/wisdom_of_the_elders_aarp_and_sage.html

http://www.aarp.org/politics-society/rights/info-03-2010/marriage_and_gay_rights.html

http://www.aarp.org/relationships/love-sex/info-02-2008/aids_prevention_for_50plus_pushed.html

AIDS Community Research Initiative of America (ACRIA)

ACRIA is the first-ever activist, community-based approach to the study of new treatments for HIV. ACRIA studies the lives and needs of people with or at risk for HIV through its Behavioral Research Program; offers critical HIV healthcare education to HIV-positive people and their caregivers all around the world through its HIV Health Literacy Program; and provides a variety of consulting services (technical assistance, monitoring and evaluation, curriculum development, and Web-based learning among them) to strengthen AIDS and other service organizations across the country, enabling those groups to better serve their own clients. Additionally, through the ACRIA Center on HIV and Aging, the organization is recognized as an international authority on the emerging issue of older adults and HIV.

Web site: http://www.acria.org/

Additional resources: https://www.dropbox.com/s/eablp1lb1y6eyqh/Policy%20Recommendations%20Older%20Adults%20with%20HIV.pdf

American Society on Aging

The American Society on Aging is an association of diverse individuals bound by a common goal: to support the commitment and enhance the knowledge and skills of those who seek to improve the quality of life of older adults and their families. The membership of ASA is multidisciplinary and inclusive of professionals who are concerned with the physical, emotional, social, economic, and spiritual aspects of aging.

Web site: http://www.asaging.org/

Additional resources:

http://www.asaging.org/lain

http://www.asaging.org/national-resource-center-lgbt-aging-sage

FORGE Transgender Aging Network

The Transgender Aging Network (TAN) exists to improve the lives of current and future trans/SOFFA (significant others, friends, family, and allies) elders by the following: identifying, promoting communication among, and enhancing the work of researchers, service providers, educators, advocates, elders, and others who are interested in trans/SOFFA aging issues; promoting awareness of concerns, issues, and realities; advocating for policy changes in public and private institutions, services, organizations, programs, etc.; and providing communication channels through which trans/SOFFA elders can give and receive support and information.

Web site: http://forge-forward.org/aging/

Additional Resources:

http://www.lgbtagingcenter.org/

http://www.grayprideparade.com/

Gay Men’s Health Crisis (GMHC)

GMHC is the world’s first and leading provider of HIV/AIDS prevention, care, and advocacy. Building on decades of dedication and expertise, we understand the reality of HIV/AIDS and empower a healthy life for all. GMHC’s mission is to fight to end the AIDS epidemic and uplift the lives of all affected.

Web site: http://www.gmhc.org/

Additional resources:

http://www.gmhc.org/about-us/links

http://www.gmhc.org/blog

The Graying of AIDS

The Graying of AIDS combines portraits and oral histories of both long-term survivors and older adults who contracted HIV later in life with HIV/AIDS information to increase awareness, sensitivity, and collaboration among caregiving professionals.

Web site: http://www.grayingofaids.org/

Additional resources:

http://www.grayingofaids.org/modes-of-transmission/

http://www.grayingofaids.org/glossary/

http://www.grayingofaids.org/resource-links/

http://www.grayingofaids.org/training-materials/

Lambda Legal

Lambda Legal is the oldest and largest national legal organization whose mission is to achieve full recognition of the civil rights of lesbians ,gay men, bisexuals , transgender people,and those with HIV, through impact litigation, education, and public policy work. As a nonprofit organization, we do not charge our clients for legal representation or advocacy, and we receive no government funding. We depend on contributions from supporters around the country.

Web site: http://www.lambdalegal.org/

Additional resources:

http://www.lambdalegal.org/know-your-rights

http://www.lambdalegal.org/states-regions

http://www.lambdalegal.org/help

http://www.lambdalegal.org/publications/all

http://www.lambdalegal.org/our-work

The LGBT Aging Project/Third Sector New England

A nonprofit organization dedicated to ensuring that lesbian, gay, bisexual, and transgender older adults have equal access to the life-prolonging benefits, protections, services, and institutions that their heterosexual neighbors take for granted.

Web site: http://www.lgbtagingproject.org/

Additional resources:

http://www.lgbtagingproject.org/resources-for-lgbt-seniors/

Medicare Rights Center

The Medicare Rights Center is a national, nonprofit consumer service organization that works to ensure access to affordable health care for older adults and people with disabilities through counseling and advocacy, educational programs, and public policy initiatives.

Web site: http://www.medicarerights.org/

Additional resources:

http://www.medicarerights.org/resources/additional-resources/

http://www.medicarerights.org/resources/consumer-fact-sheets/

http://www.medicarerights.org/resources/newsletters/medicare-watch/archive/6-26-14/

National Association of Area Agencies on Aging (N4A)

The National Association of Area Agencies on Aging (N4A) is the leading voice on aging issues for Area Agencies on Aging and a champion for Title VI Native American aging programs. Through advocacy, training, and technical assistance, we support the national network of 618 AAAs and 246 Title VI programs. We advocate on behalf of our member agencies for services and resources for older adults and persons with disabilities.

Web site: http://www.n4a.org/

Additional resources:

http://www.n4a.org/programs/resources-lgbt-elders/

http://www.n4a.org/files/programs/resources-lgbt-elders/InclusiveServicesGuide2012.pdf

http://www.n4a.org/pdf/ReadyToServe1.pdf

http://www.n4a.org/files/programs/resources-lgbt-elders/newTransClientFactSheet.pdf

National Caucus & Center on Black Aged

NCBA is a 501(c) (3) not-for-profit organization dedicated to preserving the dignity and enhancing the lives of low-income elderly African-Americans. As one of the largest minority focused organizations in the USA, NCBA addresses the needs of its constituency in the areas of health, affordable housing, and employment. NCBA works to facilitate the sharing of resources, information, and experience across a spectrum of policymakers, legislators, advocacy, and service organizations to address the issues that impact the quality of life for America’s elderly minority population.

Web site: http://users.erols.com/ncba/

Additional resources:

http://www.ncba-aged.org/Resources.php

National Center for Transgender Equality

The National Center for Transgender Equality is a national social justice organization devoted to ending discrimination and violence against transgender people through education and advocacy on national issues of importance to transgender people. By empowering transgender people and our allies to educate and influence policymakers and others, NCTE facilitates a strong and clear voice for transgender equality in our nation’s capital and around the country.

Web site: http://transequality.org/

Additional resources:

http://transequality.org/Resources/index.html

http://transequality.org/Resources/links.html

National Senior Citizens Law Center

This center espouses that poor seniors have a right quality health care, long-term services, and supports and that all seniors have a right to enough income to meet their basic needs. We advocate at the administrative and legislative levels to ensure that laws and regulations work for poor seniors. We train over 10,000 advocates and service providers on the rights of poor seniors every year. We litigate as necessary to ensure poor seniors have the benefits and services they need.

Web site: http://www.nsclc.org/

Additional resources:

http://www.nsclc.org/index.php/tag/lgbt/

The National Gay and Lesbian Task Force

The mission of the National Gay and Lesbian Task Force is to build the power of the lesbian, gay, bisexual, and transgender (LGBT) community from the ground up. We do this by training activists, organizing broad-based campaigns to defeat anti-LGBT referenda and advance pro-LGBT legislation, and building the organizational capacity of our movement. Our Policy Institute, the movement’s premier think tank, provides research and policy analysis to support the struggle for complete equality and to counter right-wing lies. As part of a broader social justice movement, we work to create a nation that respects the diversity of human expression and identity and creates opportunity for all.

Web site: http://www.thetaskforce.org/

Additional resources:

http://www.thetaskforce.org/issues

http://www.thetaskforce.org/reports_and_research