LGBT Seniors, Invisible No More
Discrimination and legal inequalities take toll on health and health care| From BU Today | By Barbara Moran
Robert B. Hudson says that some members of the health care community “have treated LGBT people with condescension, and that in turn has often led people to put off preventive services.” Photo courtesy of the Boston University School of Social Work
In 2009, according to the U.S. Administration on Aging, about one in eight Americans was over age 65. That adds up to 39.6 million people, or almost 13 percent of the U.S population. By 2030, there will be about 72.1 million in that age group, or about 19 percent of the population.
While many studies have been done on America’s aging population, little research has focused on a group facing special issues as they age: the lesbian, gay, bisexual, and transgender (LGBT) community. Today’s LGBT elders have lived through decades of discrimination, which, it turns out, has huge repercussions as they age. Yet LGBT seniors have been largely ignored in policy on aging.
To help address this oversight, Robert B. Hudson, a School of Social Work professor of social policy and managing editor of the journal Public Policy & Aging Report, devoted an issue to the topic of LGBT seniors, with articles written by a range of researchers, service providers, and advocates involved with LGBT policy concerns. According to Hudson, the issue received more positive feedback “than just about anything else we’ve done.” In his introduction, he writes, “These individuals have remained nearly invisible to the community of advocates, researchers, practitioners, administrators, and politicians who associate themselves with the modern aging enterprise.”
Bostonia recently spoke with Hudson about the insights gained from the project and what steps need to be taken to help aging members of the LGBT community.
Bostonia: Why did you focus an issue of Public Policy & Aging Report on the LGBT community?
Hudson: One thing we’re always trying to do is highlight underrecognized issues, and this is one that really has to be near the top of the list. There is simply not much of a literature devoted to older LGBT people. There is a whole world of aging research and aging agencies that provide a range of benefits to older people, and there is a separate series of agencies and research that address the LGBT population. But they often don’t come together.
Why do you think that is?
Well, as a political scientist, I see it centrally rooted in bureaucratic behavior. The aging agencies are organized around classic aging-related issues like nutrition, social services, and legal services. The LGBT community has never had the same level of attention.
So what’s been the result of that gap?
Massive underservice. When you look at the literature, LGBT access to health care is suboptimal. And that’s for two reasons: one is that some members of the health care community have treated LGBT people with condescension, and that in turn has often led people to put off preventive services. More broadly, LGBT individuals are often denied protections such as survivorship, visitation rights, and living wills, because the legal system does not recognize their living arrangements.
What health issues other than access to health care are specific to LGBT seniors? The Report notes higher levels of smoking and drinking and rates of depression.
The mental health issues are the ones that stand out, and I think it’s something that the larger population does not appreciate. The stressors around discrimination in those communities have been so high for so long that substance abuse issues are much more widespread than the larger public thinks. People ought to know that discrimination has consequences.
The other issue to be mentioned is HIV/AIDS. And again, something that is underrecognized is that people who are HIV-positive are getting older, thanks to drugs that are turning HIV/AIDS into a chronic illness rather than a death sentence. But it is also true that people are contracting AIDS over age 55 at somewhat higher rates than before.
That’s the group you’d think has been the most indoctrinated about safe sex practices.
Indoctrinated, yes, but on the other hand, I think it’s something about aging. I think some people may say, “We’re old, we probably can’t get it.” But in fact, as you get older, the body becomes more fragile, and it may make transmission more likely.
Is there also a lack of safe-sex education, most of which seems targeted at young people, for older adults?
I think that has been the case. A lot of the public health initiatives within the LGBT community are aimed implicitly—if not explicitly—at younger people. The classic imagery we’ve had of older people in general is relevant here; they’re frail and alone or cut off in nursing homes, so they tend to get forgotten and excluded from all sorts of helpful interventions. And then members of the aging community, either through lack of interest—or in some cases, discrimination—may not want to engage with the older gay population. And so older LGBT folks really do fall between the cracks.
LGBT seniors lived through decades of discrimination, with homosexuality a crime or deemed a mental illness. The Report says 82 percent have been victimized at least once. With homosexuality so much more accepted now, it’s hard to realize what they went through.
Well, for somebody my age it’s not hard to remember. I mean, you could get in all sorts of serious trouble by identifying as gay or being seen as gay—bullying, violence, employment discrimination, health care, the whole gamut. I think most people now don’t recognize how tough it was for LGBT people to grow up in the world they did. And if you listen to today’s political debate, there are candidates out there who are inferring things about certain populations—including this one—that are pretty nasty.
What are the major impacts on seniors of coming of age with that level of hostility?
Certainly there are impacts in mental health issues, but also in economic issues. If you were discriminated against at age 20, 30, and 40, trying to get a decent job, trying to get promoted, trying not to get fired, hoping to be invited to the company family picnic, needing to go out on the golf course with the guys where the deals are being made, and they shun you because they suspect you’re not one of them—there are huge career ramifications.
So it really is a lifelong thing. In aging we talk about “cumulative advantage” and “cumulative disadvantage.” If you went to Andover and Harvard when you were younger, you have a better train ride than somebody who didn’t. And in this case, to have been knocked off career and health care and other rails early on by reason of discrimination, a trajectory that might have gone quite high will instead be flat. And in some ways it gets worse in old age. The passage of time amplifies the discriminations you’ve encountered over the course of 30 to 40 years.
The Report says LGBT seniors are twice as likely to live alone as heterosexual seniors, and four times more likely to have no children. How does this affect their support network?
It’s a huge issue. In the case of chronic illness, something like 80 percent of all care is provided by so-called informal supports—mainly family, notably wives, daughters, and daughters-in-law. This is a population that has much lower marriage rates and somewhat higher levels of disaffection from their biological families due to their orientation. There are fewer children, fewer spouses, and the extended family of aunts, uncles, nieces, and nephews may also be thinner. That is compensated for in part by friends, but the lack of family-based informal supports is a concern in this community.
The LGBT community seems to have exceptionally strong social networks, for just those reasons. But in this regard that doesn’t seem to compensate enough. Do you think this will change for the next generation of seniors?
I think over time, with greater acceptance of these communities, yes it will get better. But it’s going to be a long process. It’s interesting the extent to which same-sex marriage has taken hold in many parts of the country, which certainly wasn’t the case 20 years ago. But it’s going to be a very long process.
With gay marriage gaining acceptance and many more gay couples having or adopting children, is it likely their support networks will be strengthened?
I think that’s right, but I think it will vary a lot geographically. There are still a number of states where gays and lesbians cannot adopt children.
Do you think we’ll see gay- and lesbian-specific nursing homes at some point?
Interesting question. There are retirement communities—I don’t know their legal status—that certainly have attracted LGBT people. There are at least two or three dozen retirement areas in various parts of the country that are known to be attractive to members of the LGBT community. It wouldn’t be possible in most nursing homes because it would violate Medicaid reimbursement laws.
So what should be the top priority for the LGBT senior agenda? What should researchers and policymakers be thinking about to best serve this group?
On the policy level, I always think first of Social Security benefits. If you don’t have legally recognized dependents, you can’t get a dependent benefit. If you die and you had a partner, but you were not legally married—and to the federal government you can’t be legally married if you’re gay or lesbian—then there’s no survivor benefit.
In the health care world, prohibitions tied to visitation and to proxies and living wills are big things that have to be overcome.
But I think the biggest issue is in some ways the hardest issue to tackle, and that is acculturation and acceptance: being fully accepted as part of the range of American citizenry. LGBT elders may not be exactly like you, but there are lots of people who aren’t exactly like you, so let’s get over it, old and young alike.
View a copy of the Public Policy & Aging Report issue “Integrating Lesbian, Gay, Bisexual and Transgender Older Adults into Aging Policy and Practice” here.
Barbara Moran (COM’96) is a science writer in Brookline, Mass. She can be reached through her website WrittenByBarbaraMoran.com.