Eldercare Voices: Understanding the Unique Health Needs and Vulnerabilities of LGBT Older Adults

David Griffith

Why should providers in the medical and social services spheres care about the sexual orientations and gender identities of the older adults they serve?

Despite the progress we’ve seen around LGBT acceptance over the past several years, many in the aging services field are just catching up to understanding the needs of LGBT older adults and the ways that sexual orientation and gender identity can impact a person’s access to services, support networks and health outcomes. 

We still sometime hear providers say that sexual orientation is a private matter – something that should be kept between two people behind their bedroom doors. We hear some providers confidently say that they don’t have LGBT people using their services, thus suggesting that they are able to determine the orientations and identities of everyone who enters their agency’s doors. We hear, in some comments made, underlying assumptions that older adults lose any sort of sexual identity later in life. Or, we hear from various providers the well-meaning tenet that “We treat everybody the same,” which while sounding good on its surface, most often amounts to treating everybody under an inferred assumption that they are straight.

I would counter that being familiar with the sexual orientations and gender identities of the older adults we serve who chose to share this information with us, and having comfort in working with LGBT populations, will lead to more effective services and better outcomes. There are still many barriers to care and many persisting health disparities that adversely impact LGBT elder communities. By working to make our services more LGBT-inclusive and improving access to services for LGBT older adults, we can better help LGBT individuals to assemble the medical, social, emotional and financial supports needed to age successfully.

The majority of LGBT older adults have experienced lifetimes of discrimination, including decades of their lives during which homosexuality was criminalized and labeled as a mental disorder. As a result of this long-term social stigmatization and legal mistreatment, many LGBT older adults deal with a complex array of social, emotional and physical health needs, including elevated rates of social isolation, depression, suicidal ideation, HIV/AIDS, chronic illness and premature mortality.

LGBT older adults, when compared to their non-LGBT counterparts, are disproportionately likely to be single, childless and living alone. These factors are largely consequences of past legal restrictions to marriage and adoption, as well as exclusionary societal definitions of family. Painfully contributing to this isolation is the fact that many LGBT older adults have also become estranged from their biological family members over the course of their lives.

According to the Movement Advancement Project, 80 percent of caregiving in the United States is provided by family members. LGBT elders aging without such a familial support network are therefore disproportionately likely to have to rely on formal systems of care. Yet, these systems of care are in many ways unprepared to serve the unique and complex needs of LGBT older adults.

There are also financial challenges that result in disproportionate hardship for this population. Decades of institutional discrimination have severely cut short the lifetime earning potential of a large segment of the LGBT community. Data from UCLA's Williams Institute suggest that 24 percent of lesbians and 15 percent of gay and bisexual men are poor, compared to 19 percent and 13 percent of heterosexual women and men, respectively. A 2014 report from SAGE (Services and Advocacy for GLBT Elders) found that LGBT older adults were far more concerned than non-LGBT elders about their financial security and ability to retire.

Transgender communities, in particular, face these economic hardships and the financial insecurity that hinders successful aging. Lifetime experiences with discrimination in housing, education and employment are even more pronounced for transgender people than for LGB people. The 2010 National Transgender Discrimination Survey found that trans individuals were nearly four times more likely to have a household income of less than $10,000 per year compared to the general population.

These economic and health disparities leave many LGBT elders dependent on social services and entitlement programs like Medicaid, Medicare and Social Security, making the political debates swirling around these policies at the present of particular relevance to LGBT older adults and those who serve them.

The future of the Affordable Care Act (ACA) will deeply impact LGBT communities –  particularly more vulnerable subsets of the community including LGBT people of color, transgender individuals and older adults. The ACA was monumental in starting to close the disparities in health insurance coverage within LGBT communities. It was the first federal law to prohibit discrimination against LGBT people in the health system. Section 1557 of the ACA also issued explicit protections for transgender individuals, barring insurers from refusing coverage or charging more for a plan based on a person’s gender identity. The current political uncertainty surrounding the ACA leaves millions of people at risk of losing their insurance coverage, opens the possibility of LGBT people being legally discriminated against and worsens the health disparities that affect LGBT communities.     

The Senate’s proposed ACA repeal bill would cut Medicaid spending by nearly $800 billion over the next 10 years. These cuts will disproportionately impact low-income older adults, including LGBT elders, who depend on Medicaid funding for long-term care and other essential health services. Adding to the dangers of the proposed cuts are demographics. With the aging of the Baby Boomer generation, the size of the LGBT older adult population is expected to double by 2030. This is a time when we need to be improving the ability of the aging services network to effectively address the unique needs of this growing population. Cutting benefits, undoing non-discrimination protections and making it harder for LGBT older adults to access services will instead worsen the existing health care and financial disparities that already harm the community.  

David Griffith is the Director of Programs & Outreach for the LGBT Elder Initiative, a Philadelphia-based non-profit dedicated to helping lesbian, gay, bisexual, and transgender older adults to age successfully. He received his Master of Science in Social Policy (MSSP) and Master of Social Work (MSW) from the University of Pennsylvania’s School of Social Policy & Practice. To learn more about the LGBT Elder Initiative, visit www.lgbtelderinitiative.org.