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Sexuality

Creating Positive Spaces for LGBTQ Elders in Senior Living Communities

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Jane Fleishman, PhD, MEd, MS, Certified Sexuality Educator, is an accomplished educator, writer, program developer, and researcher. She holds a PhD in Human Sexuality from the Widener University Center for Human Sexuality Studies. Jane focuses her work on human sexuality for older adults, parents, teens, and members of the LGBTQ population. Her work has helped … Continued

Moving into a senior living community can be tricky for many people. Leaving home after many years, losing a neighborhood, and missing familiar faces and places can easily overwhelm seniors. Moreover, for LGBTQ elders, moving into a new community brings additional challenges. Anxiety abounds, but senior living communities can do something about it.

Unscrambling the Alphabet Soup

When we speak of our elders in the LGBTQ community, let’s start by unscrambling the letters. We are talking about people who self-identify as lesbian, gay, bisexual, transgender, queer (and even more). Let’s take the time to discuss this one by one. Some letters refer to sexual orientation (LGB), and others refer to gender or sexual identity (TQ). When we refer to sexual orientation, we refer to one’s sexual interest in others. When discussing gender identity, the individual’s chosen gender identity may differ from the one they were assigned at birth.

Lesbians and gay men are generally attracted to people of the same gender, bisexuals are attracted to more than one gender, transgender people are those whose gender identity is different from their biological sex, and people who identify as queer can cover a whole spectrum from asexual, intersex, polyamorous, kinky, two-spirit, and more. It’s complicated and here’s a longer glossary from a recent study on gender diverse individuals’ health if you’d like to understand these terms more completely. 

Fearing Rejection 

Many older adults have fears contemplating a move to senior living. What if they are shunned by their peers? By professionals? By administrators? If they are single, they may worry about loneliness. If they are in a relationship, they may worry about being different. Consequently adding to those fears, many LGBTQ elders fear rejection as well. Rejection is not limited to how they dress or what sports teams they cheer for; it can also be their gender identity and sexual orientation. That is what many LGBTQ elders fear.

Coming Out of the Closet, Again

Many of our LGBTQ elders have memories of the 1950s and earlier, when they lived a closeted existence. Consequently, coming out as LGBTQ meant that, in recent years, they have experienced legal and societal gains that have allowed them rights and respect and a way out of the closet. For these individuals, moving from their beloved communities, where they have been able to live freely (sometimes for the first time in their lives), may create stress, anxiety, and a new-found problem. 

Many seniors find themselves coming out of the closet, again, and may experience some of the same anxieties about living life authentically. In addition, a recent study of LGBTQ elders experiences in senior living communities found that these elders were burdened by the emotional effort expended to hide parts of their identity, assess their environments for discrimination, and their lack of comfort with health care providers. One of the study participants said, 

“Would we be living together? Could we hold hands? Could we put our arms around each other watching television when everybody else is straight? I mean, socially it would be totally uncomfortable. What would it be like if my partner came to visit? How would we visit that would be acceptable to the rest of the facility?”

Concerns About Health Care

There are currently 2.7 million LGBTQ individuals over 50 who constitute 3% of the U.S. population. Of those, 1.1 million are over 65. In addition, those numbers are expected to double by 2060. These individuals are concerned about health disparities after a lifetime of political, economic, and social inequity. They are an invisible, undercounted, and under-served minority. Many cannot afford health care. Almost 50% of all elders 50 years of age or older are living with HIV. 

Approximately 13% report being denied health care or having received poor health care in the past. Among transgender elders, cardiovascular disease remains high. Many have other chronic physical conditions. For many, they have faced housing discrimination based on their sexual orientation or gender identity. Moreover, many distrust health care providers.

Aging with Pride

According to the results of Aging With Pride, a national health, aging, and sexual/gender study, the principal investigator, Karen Fredriksen-Goldsen, explained that not everyone in this group has experienced poor health. In fact, most are doing really well, and In my own research on LGBTQ elders, resilience was reported at very high rates across the genders. Many LGBTQ elders have worked for years to be accepted and recognized for who they are. In other words, your senior living community could benefit from their resilience. However, the question is, how does one create more space in a senior living community for LGBTQ elders?

What You Can Do

  1. Become familiar with the LGBTQ community. You could watch a film like Gen Silent, read a book about LGBTQ elders, go to a respected website. Then use what you’ve learned to start getting familiar with the concerns and strengths of LGBTQ elders in the community.
  2. Get familiar with your own community. Review your community’s policies. Most senior living communities lack written policies about sexual health and even fewer have policies about the health of sexual or gender minorities. In other words, begin a discussion with your administrative and clinical team about the need for good policies to guide staff behaviors.
  3. Take a look around you. On the walls of your offices, in the promotional literature you send out, the residents you highlight on your website, the residents who attend community-wide events. So to sum it up, Consult the experts. What do you see? 
  4. Conduct training and sponsor events. Ones that provide opportunities for staff and residents to see positive experiences of LGBTQ elders. For example, Senior Living Residences’ communities are involved in SAGECare, a unique set of trainings for staff. Therefore, tailor your next discussion of a community event with the focus on expanding the community’s awareness of LGBTQ elders. 
  5. Put your education to work. Start having conversations with residents and staff and administrators about LGBTQ elders’ concerns and strengths. Moreover, you’ll be surprised how quickly your name will pop up for LGBTQ residents and external community members begin to identify you as an “ask-able” individual. Being ask-able doesn’t mean you have to have all the answers. On the contrary, knowing how to get your questions answered is most important for you and for your community members.

Remember, many of the LGBTQ elders who live or would like to live in your community may have never spoken publicly about their gender or sexual identity to a health care professional before. Your ability to reach out to them could open up new worlds. Not just for them but for your entire community.

References

Fleishman, J. M. (2020). The Stonewall Generation: LGBTQ Elders on Sex, Activism, and Aging. Boston: Skinner House Press. https://www.uuabookstore.org/The-Stonewall-Generation-P18643.aspx 

Fleishman, J. M., Crane, B., & Koch, P. B. (2020). Correlates and predictors of sexual satisfaction for older adults in same-sex relationships. Journal of homosexuality, 67(14), 1974-1998. https://doi.org/10.1080/00918369.2019.1618647

Fredriksen Goldsen, K., Kim, H. J., Jung, H., & Goldsen, J. (2019). The evolution of aging with pride—National health, aging, and sexuality/gender study: Illuminating the iridescent life course of LGBTQ adults aged 80 years and older in the United States. The International Journal of Aging and Human Development, 88(4), 380-404. https://doi.org/10.1177/0091415019837591

Fredriksen-Goldsen, K. I., & Kim, H. J. (2017). The science of conducting research with LGBT older adults-an introduction to aging with pride: National health, aging, and sexuality/gender study (NHAS). https://doi.org/10.1093/geront/gnw212

Furlotte, C., Gladstone, J. W., Cosby, R. F., & Fitzgerald, K. A. (2016). “Could we hold hands?” Older lesbian and gay couples’ perceptions of long-term care homes and home care. Canadian Journal on Aging/La Revue canadienne du vieillissement, 35(4), 432-446. https://doi.org/10.1017/S0714980816000489  

Johnston, T. R. (2019). Welcoming LGBT Residents: A Practical Guide for Senior Living Staff. New York: Routledge. https://www.routledge.com/Welcoming-LGBT-Residents-A-Practical-Guide-for-Senior-Living-Staff/Johnston/p/book/9780367027346 Streed Jr, C. G., Beach, L. B., Caceres, B. A., Dowshen, N. L., Moreau, K. L., Mukherjee, M., … & Singh, V. (2021). Assessing and Addressing Cardiovascular Health in People Who Are Transgender and Gender Diverse: A Scientific Statement from the American Heart Association. Circulation. https://doi.org/10.1161/CIR.0000000000001003

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