Lesbian, Gay, Bisexual, and Transgender Issues in Aging. Aging and homosexuality are two topics that most people have an opinion about.

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1 Lesbian, Gay, Bisexual, and Transgender Issues in Aging 1 Lesbian, Gay, Bisexual, and Transgender Issues in Aging Aging and homosexuality are two topics that most people have an opinion about. Separately these topics are covered in great depth, with both subjects eliciting strong, and sometimes polarizing views. Despite the breadth of research and media coverage that these topics receive individually, it is rare to see these subjects discussed simultaneously. All people get older, and those who identify as Lesbian, Gay, Bisexual, and Transgendered (LGBT) are not excluded from the aging process. Unfortunately, the lack of knowledge and attention paid to this population has made LGBT aging adults invisible to researchers and professionals which has acted to perpetuate stereotypes about those who are both gay and aging (Grossman, D Augelli, & O Connell, 2008). The aging population of LGBT adults is not one to be glossed over by professionals. LGBT adults have unique needs and as their population is growing it is also changing. In 2003 there were an estimated one to three million Americans over the age of 65 who identified themselves as lesbian, gay, bisexual, or transgender (McFarland & Sanders, 2003). The baby boomers will greatly influence the population of aging adults, with the number of LGBT boomers projected to double by the year 2030 (Haber, 2009). As the prevalence of LGBT aging adults increases, it important that clinicians take special consideration to be educated about the needs of this unique and diverse population. In an effort to encourage conversation about this growing population, this paper will discuss current LGBT aging issues, LGBT Baby Boomers, health care, housing, and policy concerns, and the future of LGBT issues in the aging population.

2 Lesbian, Gay, Bisexual, and Transgender Issues in Aging 2 For the purposes of this paper, the terms LGBT, homosexual, and gay will be used interchangeably. Current LGBT Aging Issues The scarcity of research on the population of elders who currently identify as LGBT is directly related to the history of the aging homosexual population. The current group of gay elders aged 65 and older were tasked with coming out before the era of gay rights and the sexual revolution, making it less likely for those adults to have been out as a younger adult. Because of stereotypes and social stigma surrounding homosexuality, many of these individuals participated in heterosexual relationships and marriage as a cover, unable to openly express their sexual preference (McFarland & Sanders, 2003). The environment that older gays grew up in was one that vilified gays and labeled them as sinners and criminals. In 1952 the Diagnostics and Statistical Manual of Mental Disorders (DSM) listed homosexuality as a sociopathic psychological disturbance and it was not until 1973 when the American Psychological Association removed homosexuality as a psychological disorder (Haber, 2003). The oppression and social stigma that LGBT older adults have endured have affected their mental, physical, and social health, as well as their comfort level with being out publicly. Current LGBT elders are twice as likely to live alone and four times less likely to have assistance from children. Singlehood later in life and the lack of social supports have correlated with a variety of negative outcomes, including loneliness and declines in mental and physical health (Haber, 2003). Further, older LGBT persons are likely to have experienced homophobia in their younger years and are less likely to be out publicly as an older adult as a byproduct of a

3 Lesbian, Gay, Bisexual, and Transgender Issues in Aging 3 lifetime of homophobia and social stigma surrounding their sexual orientation (Haber, 2003). LGBT elders experienced discrimination about their sexual orientation, the use of slang and offensive language (e.g. being called queer or fag ), being viewed as unequal compared to heterosexuals, and verbal and physical abuse based on sexual orientation (McDougall, 1993). According to Grossman et al. (2002), 63% of people surveyed reported experiencing verbal abuse base on their sexual orientation, 29% experienced threats of violence, 16% were assaulted, 11% had objects thrown at them, and 12% were assaulted by a weapon (Grossman et al., 2002). The impact of abuse and discrimination has created an environment where not only are gay individuals less comfortable being out, they also experience self-hatred because of the differences in sexual orientation (McDougall, 1993). The social stigma and hostile views that LGBT elders experienced earlier in their lives have influenced their participation in social activities later in life, making LGBT seniors less likely to take advantage of needed social programs like senior centers, meal programs, food stamps, and counseling programs (Haber, 2003). It is easy to see that historical context and the conditions in which homosexual elders lived through may influence the unique needs later in life and may be hesitant to access services because they are coping with the stigma attached to growing up gay during a time of oppression (McFarland & Sanders, 2003). LGBT Baby Boomers Although it is important for clinicians to recognize the unique needs of the current population of elderly LGBT people, it is also necessary to recognize the changing face of the aging population. The first of the baby boomers reached retirement age in 2011 and by 2030 one

4 Lesbian, Gay, Bisexual, and Transgender Issues in Aging 4 in five people in the United States will be over 65 years old (Haber, 2003). Baby boomers, partly because of their population size, have revolutionized health care, public schools, and the housing market. Their life experiences are rooted in Vietnam, civil rights, and the gay liberation movement. While aging LGBT pre-boomers were vilified as being sick, criminal, sinners, the LGBT boomer cohort experience a revolution in the acceptance of being gay (McFarland & Sanders, 2003). The LGBT Boomers lived in an era where the rights of LGBT individuals experienced more advocacy and acceptance, resulting in more openly gay aging individuals compared to previous generations with 44% of LGBT boomers are completely out and 32% are mostly out. The Stonewall riots that sparked the gay rights movement occurred at time when they youngest boomer was 5 years old and the oldest boomer was 23 years old. Aging LGBT boomers were able to assimilate into the mainstream population during their younger adult years and are more likely to demand acceptance for their lifestyle, and advocate for themselves and for programs, agencies, and services that support the needs of LGBT elders (Haber, 2003). Even though the growing LGBT boomers are more likely to be open to participating in research, studies on gays who are aging are scarce and the research design is often flawed. Even studies that are large in sample size are samples of convenience and almost always are comprised of surveys from populations that are self-identified as gay (Haber, 2003). When samples are self-identified, the data is biased toward those who are comfortable with providing information and are open with providing information about their sexuality. Most surveys that use selfidentification as a part of their methodology tend to be comprised middle-class, Caucasian, educated men (Grossman et al., 2002). Another difficulty with research on this population is the diverse nature of those who identify as LGBT. Surveys do not take into consideration variations in socioeconomic status, cultural background, family history, religious background or the

5 Lesbian, Gay, Bisexual, and Transgender Issues in Aging 5 differences between gay men, lesbians, bisexuals, and transgendered people. For LGBT boomers these variations are both important and influential when it comes to their individual needs (Haber, 2003). For example, the concerns of older bisexual and transgender people may differ greatly from the needs of gay males or lesbians. Since most studies are limited to a population comprised of middle-class, educated, Caucasians comprised mostly of gay males and lesbians, their results may not offer a good picture of the needs of people who identify as bisexual or transgender. Since LGBT people are often clumped together in one group, studies are rarely generalizable to the entire LGBT aging population and care should be taken when applying results uncovered by research to individuals (Haber, 2003). Health Care, Housing, and Policy Concerns of LGBT Elders Although studies may vary regarding the LGBT aging population, the problems and barriers regarding LGBT individuals are shared. Many social and community programs are not are welcoming to gay seniors. One half of federally funded senior centers are not open to LGBT elders who are publicly out or known to be gay (Haber, 2003). An Australian study by Phillips and Marks (2008) examined retirement communities literature and advertising and found that the homosexual presence was silenced. The focus group in the study cited feelings of invisibility and reported that retirement communities made them feel unwelcome (Phillips and Marks, 2008). Phillips and Marks (2008) noted that governmental provisions for services for aging lesbians are both equitable and inclusive but despite these policies, care facilities for the aging population and print media advertising for them are still marginalizing of any group that is

6 Lesbian, Gay, Bisexual, and Transgender Issues in Aging 6 non-heterosexual. The dissonance between government policies and reality indicates that there is a need for the education of professionals in aged care facilities (Phillips & Marks, 2008). In the United States, gay elders are also more likely than heterosexual elders to experience unwelcome housing options if they are able to find nursing homes and retirement communities that are open to accepting openly gay elders at all (Haber, 2003). Some elders fear that they may have to go back into the closet in order to be accepted in retirement communities and nursing homes. Others are deterred from accessing supportive programs in the community, particularly those involved in health care, because they fear discrimination from the health care system. A survey conducted by McFarland and Sanders (2003) cited that 33% of gay elders reported a lack of understanding from health care providers as a barrier that prevents them from accessing community and home health care programs (McFarland & Sanders, 2003). When gay elders do seek out medical care, only 25% of older adults are completely open about their sexual orientation to their medical care providers because they fear experiencing homophobia and discrimination (Haber, 2003). In addition to barriers in health care and finding housing, homosexual couples experience inequality with regard to social security spousal benefits. Although heterosexual couples have access to spousal benefits, homosexuals are not granted the same access to social security, 401(k) and pension plans, health insurance, and inheritances from their partners (Haber, 2003). Although progress is being made at the state level, with several states legalizing marriage for homosexual couples, the federal government does not currently recognize these marriages under the 1996 Defense of Marriage Act (Haber, 2003). LGBT individuals are also cut out of other federal benefits. There is little assistance for the aging gay population diagnosed with HIV/AIDS. Federal government screenings for

7 Lesbian, Gay, Bisexual, and Transgender Issues in Aging 7 HIV/AIDS stops at age 64, despite a recent rise in HIV/AIDS cases among people over the age of 50 (Haber, 2003). Another issue is the lack of coverage for domestic partnerships under the Family Medical Leave Act (FMLA). FMLA guarantees leave to employees who need to care for their spouses and children, but excludes homosexuals who may need to take leave to care for an ailing partner (Haber, 2003). Though several federal programs have excluded gay seniors from their coverage, some changes have been made to improve the care of LGBT seniors. President Obama has issued a memorandum requiring that visitation rights be extended to homosexual partners in all hospitals receiving Medicare and Medicaid benefits (Cook-Daniels, 2011). State marriage and partnership equality laws are not the only victories for LGBT Aging Adults. Florida s law banning the adoption of children by homosexual couples was found to be unconstitutional in 2008 on the basis that there is no legal or scientific reasoning for sexual orientation alone to prohibit one from adopting a child (Haber 2003). In 2011, Barack Obama became the first President of the United States to support Marriage Equality. Conversely, some states have seen legal defeats in policies that affect LGBT aging individuals, with some states voting down marriage equality rights that would allow homosexual more freedoms (Haber, 2003). In addition, legal documents that may be effective in heterosexual relationships may not be effective in homosexual relationships. Homosexual marriages and civil unions are still in a volatile place legally and some living wills and power of attorney forms may still be contested when it comes to granting rights to aging LGBT individuals (Haber, 2003). The Future of LGBT Issues in the Aging Population

8 Lesbian, Gay, Bisexual, and Transgender Issues in Aging 8 In her article Cook-Daniels (2011) cites that there have been three new LGBT policy documents that are focused specifically on aging, Outing Age 2010: Policy Issues Affecting LGBT Elders, Improving the Lives of LGBT Older Adults, and Still Out, Still Aging: the MetLife Study of LGBT Baby Boomers. These articles address the unique issues surrounding health care, social security, and living conditions that the aging LGBT community faces (Cook- Daniels, 2011). In addition, community programs like SAGE (Services and Advocacy for GLBT Elders) have gained in popularity acts to bridge the gap between gay seniors in New York and social programs that offer professional counseling, and clinical and social services. Many other states are adopting models similar to SAGE to advocate for the rights of aging LGBT adults (Haber, 2003). In addition, 2010 marks the year that SAGE utilized the services of a federal lobbyist to raise awareness about the needs of LGBT elders (Cook-Daniels, 2011). Conclusion In the 1950s LGBT individuals were criminals, who were labeled as sick and sinners. By the 1970s the gay rights movement got underway and the American Psychological Association removed the sociopathic disorder label from the condition of homosexuality from the DSM (Haber, 2003). In 2010 groups that support and advocate for LGBT aging adults sent a lobbyist to Washington and in 2011 President Barack Obama became the first president to support marriage equality, which could carry with it the collateral benefit of spousal Social Security benefits for the aging LGBT population. Aging individuals who identify as gay benefit from legislation that supports the aging population and also legislation that supports the gay community.

9 Lesbian, Gay, Bisexual, and Transgender Issues in Aging 9 Clinicians need to be aware of the changing landscape of gay rights and policy, the history of aging gay seniors, and how growing up gay in the era before gay rights has impacted the aging population. The aging cohort of baby boomers will bring new challenges, changes, and perspectives on LGBT aging adults. Clinicians must realize that research on the aging gay population is limited but offers a snapshot of the unique needs of this growing population. Under the guidelines of the WHO-ICF, it is the job of the clinician to advocate for our clients, further develop clinically relevant research, empower patient preferences (Threats, 2012). For clinicians to provide optimal care for their clients, they must stay informed on the unique needs of their patients and should also be aware of the opportunities there are to advocate for their patients and connect them to the services they need. As the population of LGBT aging individuals grows it is imperative that clinicians keep an open mind and realize that providing quality, client-centered therapy requires understanding the values of an individual and the ability to use that knowledge to make-informed decisions about their care.

10 Lesbian, Gay, Bisexual, and Transgender Issues in Aging 10 References Cooke-Daniels, L. (2011, January/February). Lesbian, Gay, Bisexual, and Transgender Aging Issues Become Federal Concerns. Victimization of the Elderly and Disabled, Grossman, A., D Augelli, A., & O Connell, T. (2002). Being Lesbian, Gay, Bisexual, and 60 or Older in North America. Journal of Gay & Lesbian Social Services, 13 (4), Haber, D. (2009). Gay Aging. Gerontology & Geriatrics Education, 30 (3), McDougall, G. (1993). Therapeutic Issues with Gay and Lesbian Elders. Clinical Gerontologist, 14 (1), McFarland, P. & Sanders, S. (2003). A Pilot Study about the needs of Older Gays and Lesbians: What Social Workers Need to Know. Journal of Gerontological Social Work, 40 (3), Phillips, J., & Marks, G. (2008). Ageing Lesbians: Marginalising Discourses and Social Exclusions in the Aged Care Industry. Journal of Gay & Lesbian Social Services, 20 (1/2), Threats, T. (retrieved 2012, November 9). Communication Disorders and the ICF. Retrieved from