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"Relying on others for health care as a result of failing health is a profoundly frightening experience for most seniors. For lesbians and gay men, the fear is even greater because they are forced to depend on networks and social institutions that have traditionally been known to be intolerant of them."
The Gerontologist (2003)

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Homosexual Seniors Face Stigma

by William Kanapaux
Geriatric Times November/December 2003 Vol. IV Issue 6

In 1969, gay activists took a stand against police harassment at the Stonewall Inn in New York City, representing the start of the gay rights movement. While the movement brought changes that many take for granted today, gay and lesbian seniors remember a different time, when homosexuality needed to remain hidden from the public and its institutions.

Those experiences have a direct impact on the care gay and lesbian seniors receive. A study that appeared in April of this year in The Gerontologist examined the barriers and challenges that need to be addressed when treating this population (43[2]:192-202).

"Relying on others for health care as a result of failing health is a profoundly frightening experience for most seniors," the report said. "For lesbians and gay men, the fear is even greater because they are forced to depend on networks and social institutions that have traditionally been known to be intolerant of them."

Gay and lesbian patients encounter negative reactions from service providers at all ages, but the experience can be especially difficult for seniors. "Gay and lesbian elders who grew up prior to the era of gay liberation face considerable obstacles to accessing health care," according to the report.

Overt discrimination by medical professionals and the public has caused many gay and lesbian seniors to adopt a strategy of keeping their sexual orientation hidden. Even those who are open about their sexual orientation in their personal lives withhold that information when they require health care services, according to the report.

Senior health care systems can be even more homophobic or hetero-centric than other parts of health care, the researchers wrote, partly because aging networks have gone mostly unchallenged in attitudes and practices toward gay and lesbian seniors.

Social service agencies that work with older people are perhaps more advanced than the medical community in dealing with issues specific to gay and lesbian seniors, David O. Staats, M.D., associate professor of clinical medicine at the University of Illinois at Chicago, told Geriatric Times. Staats directs educational activities in the section of geriatric medicine at the university.

A primary reason for that, he said, is the work of the New York City-based Senior Action in a Gay Environment (SAGE), the nation's oldest and largest social service agency for lesbian, gay, bisexual and transgender (LGBT) seniors. Beyond providing direct services in New York City, Staats said, SAGE has replicated its approach across the country and created a training guide for social service agencies to recognize the needs of gay and lesbian clients and to help overcome the institutionalized homophobia that may exist within an organization.

"I think that this has had a broad impact on the care of LGBT elders across the country," Staats told GT.

The main criticism of the treatment of aging in this country is the failure to recognize that the family is an essential unit of treatment, Staats said. For gay and lesbian seniors, this becomes an issue of recognizing that the patient may not have a traditional family and that a partner or sibling is a critical component of the person's care.

Most gay and lesbian seniors have support networks other than biological family, The Gerontologist reported. They often have larger social networks than do heterosexual seniors, yet these are unrecognized by health care professionals. Further, same-sex partners lack the rights given to family members in terms of visitations, decision-making and caregiving. The situation is made worse when health care workers call on biological family to make care decisions for the patient, rather than recognize the role of "fictive kin" in the patient's life.

One way to address this is by asking about sexual preferences in a matter-of-fact way when screening an older patient, Staats said. This makes any answer acceptable. Do you have sex with men? Do you have sex with women? Do you have sex with both?

A clinician also can ask patients who come alone to the office who they would like to have make decisions on their behalf should something happen, he said. That becomes a way to begin discussing the patient's family constellation.

Staats, who is also chair of the Long Term Care and Assisted Living Professional and Technical Advisory Committee for the Joint Commission on the Accreditation of Healthcare Organizations, said that even with older seniors, the degree of being "out" can vary. While some patients may not acknowledge being gay even though they clearly are, others may be very open about it.

For social service agencies, finding the people who are most in need of services is always a challenge, Staats said. Isolation bothers many older people, and gay and lesbian elders are no different.

The Gerontologist study found, "Even though gay and lesbian organizations are well positioned to develop and provide advocacy and support services for their aging members, the needs of seniors are poorly understood within these networks and are now only beginning to be addressed." The youth-oriented culture often associated with gay and lesbian communities can isolate seniors, a phenomenon that is changing to a certain degree. In a first for the two organizations, SAGE held a seminar at the AARP meeting in Chicago in September.

Staats feels that the need to reach out to seniors should be the responsibility of gays and lesbians in their 40s and 50s, not their 20s. "I want to be cared for by a person whose testosterone storm has passed," he said. "Someone who has enough experience, maturity, caring and wisdom to be capable of rendering sensitive care."


About two and a half years ago, Edith Lederberg, executive director of the Area Agency on Aging in Broward County, Fla., became inspired to start a gay and lesbian adult day care center for frail elders in Ft. Lauderdale and began looking for a suitable location. Her goal was to find a place that would feel like home to members, not in the middle of the city but in a residential area surrounded by homes and gardens.

Broward County has a large number of elders, with about 175,000 seniors over 75. Consequently, adult day care is a critical need, Lederberg told GT. "I think we have more day care programs in Broward County than probably any other county in the country."

When word got out about the agency's plan, it received media attention from all over the world. As it turned out, Lederberg told GT, hers would be the first such program anywhere, including San Francisco and New York's Greenwich Village.

Lederberg added, "I was surprised and amazed, truthfully. What is the gay and lesbian population doing with the frail elders?"

Gay and lesbian seniors are having problems in nursing homes, which frequently separate partners, and very few congregate living facilities cater to the gay population, she said. "It just surprised me that no one had ever done this."

Lederberg estimates that Broward County has about 40,000 openly gay and lesbian residents, plus a significant number of gay and lesbian seniors who have never made their sexual preferences known to the community at large. Many of those closeted seniors, she said, are either living alone or with partners who are taking on the burden of caregiving without additional supports.

The Sunshine Cathedral, a Ft. Lauderdale church that serves the gay and lesbian community, owned two buildings on its property that Lederberg felt had the potential to be converted into a day care center. However, because of special zoning laws and various bureaucratic hurdles, the process of actually opening the center has taken much longer than expected.

The finishing touches on the center should be completed soon, and Lederberg hopes to open the center at the beginning of the new year. The facility will be able to care for about 25 seniors at any given time. The agency plans to fund the center at $200,000 a year, primarily through Title 3E federal funds, and will seek contributions from the community to help support the program once it has grown to full size, she said.

Slow to Change

"The difficulty in undertaking change in an environment in which older gays and lesbians are profoundly silent cannot be underestimated," according to the report in The Gerontologist.

It is important that health care professionals not blame gay and lesbian seniors for their lack of visibility, but recognize the cause of their mistrust of health care systems and acknowledge that they have used hiding as a strategy for responding to discrimination. The study further noted: "Developing outreach strategies, adapting assessment tools, improving communication, and creating open and supportive environments are all necessary changes."

Another aspect of making health care settings accepting of gay and lesbian seniors is to make them accepting for the gay and lesbian professionals who work in them, the report said. "If gay and lesbian employees and volunteers are not visible, it is more likely that elders will not be comfortable in being visible."