Moving into a senior living community can be tricky for many people. Leaving a home after many years, losing a neighborhood, missing familiar faces and places. Yet 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 these one by one. Some of the letters refer to sexual orientation (LGB), others refer to gender or sexual identity (TQ). And when we refer to sexual orientation, we are referring to one’s sexual interest in others. When we talk about gender identity, it is the individual’s chosen gender identity which may differ from 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.
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. Adding to those fears, many LGBTQ elders fear rejection as well. Not only rejection because of how they dress or what sports teams they cheer for. But rejection based on 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. 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.
They find themselves coming out of the closet, again, and may experience some of the same anxieties about living life authentically. 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. 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. And 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, has explained that not everyone in this group has experienced poor health. In fact, most are doing really well. 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. Your senior living community could benefit from their resilience. The question is, how does one create more space in a senior living community for LGBTQ elders?
What You Can Do
- 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.
- 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. Begin a discussion with your administrative and clinical team about the need for good policies to guide staff behaviors.
- 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. Consult the experts. What do you see?
- 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. Tailor your next discussion of a community event with the focus on expanding the community’s awareness of LGBTQ elders.
- Put your education to work. Start having conversations with residents and staff and administrators about LGBTQ elders’ concerns and strengths. You’ll be surprised how quickly your name will pop up for LGBTQ residents and external community members begin to identify you as an “askable” individual. Being askable 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.
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