Learning how to care for LGBT seniors



    For most of us, aging can present numerous challenges, including the ability to maintain good physical and emotional health. But for the nation’s LGBT older adults, growing older may also mean facing a different set of challenges, such as discrimination in health-care services and having to go back into the closet to remain safe.

    According to SAGE (Services and Advocacy for GLBT Elders), an estimated 4-8 percent of seniors today identifies as LGBT, and the percentage is expected to double by 2030, as LGBT baby boomers, who are more likely to be open about their sexual orientation, age.

    The pre-Stonewall generation has been referred to as “Gen Silent,” reflecting their tendency to be “closeted” and their hesitancy to advocate on their own behalf. For many, it was impossible to be openly gay and feel safe. Now at a time in their life when they require services and programs offered by aging-service providers, maybe within a long-term care setting, an adult day-care center or a senior center, many LGBT older adults report heightened fear and anxiety should they disclosure their sexual orientation and/or gender identity. Moreover, silence greatly increases an LGBT older adult’s risk of social isolation and, as a result, decreases their likelihood of successful aging.

    Some people may think that being “out” (disclosing your sexual orientation and/or gender identity) to aging-service providers or health-care practitioners is not important, or they may not see the benefits of accessing aging services that are inclusive and culturally competent. But because of their fear of discrimination in an unfriendly environment, LGBT seniors, according to SAGE, are five times less likely to use aging-related services than their heterosexual peers. Additionally, a 2010 study, “Improving the Lives of Older Adults,” found that a majority of those studied reported being abused or neglected by staff, or isolated and/or discriminated against by other residents.

    Finally, health disparities within our LGBT older-adult population are such that in 2012, the United States Department of Health and Human Services, Administration on Aging (AoA), issued new guidance on the definition of the term “greatest social need” in the Older Americans Act to include “individuals isolated due to sexual orientation or gender identity.”

    Having all been brought up in a society that privileges heterosexuality, we need to recognize that the bias this introduces is not automatically lost because we are in the aging-services field. Knowing about someone’s sexual orientation and gender identity is different from knowing about that person’s sex life. Sexuality, including sexual orientation and gender identity, is an integral part of everyone’s identity, LGBT or not. Being able to discuss one’s sexual orientation and/or gender identity with providers increases the availability of social support, which is crucial to mental health and psychological well-being, and successful aging overall. LGBT people benefit from being able to share their lives with and receive support from family, friends and acquaintances, as do we all.

    It is up to us as individual practitioners to explore and challenge issues of homophobia, transphobia and heterosexism, whether they are our own or those of other people or other institutions/agencies.

    A 2010 study called “Ready to Serve” found that staff training was key in building, understanding and addressing the unique needs of our LGBT older adults. The goal of such training is to ensure that the attitudes, actions and practices of health and other care providers contribute to the creation of aging services that support the safety, inclusion and welfare of our LGBT older adults, their families and their caregivers.

    According to the National Resource Center on LGBT Aging, SAGE’s award-winning resource center, cultural-competency training needs to address the following:

    Cultural awareness: being knowledgeable about what LGBT older adults typically experience when accessing, or thinking about, accessing services.

    Cultural humility: No matter how much we learn about or become aware of a culture, each individual is the expert on their own experience.

    Cultural responsiveness: learning new patterns of behavior and effectively applying them individually and within the organization’s setting.

    As a certified trainer with SAGE, I have had the opportunity over the years to provide training and technical assistance to a number of local and regional aging-services providers. I’m encouraged by the interest and support from Pennsylvania agencies such as AARP, Philadelphia Corporation for Aging, the Department of Aging, Area Agencies on Aging, the Office of Long Term Living and LINK networks.

    Providers can now work towards a SAGECare credential. According to Tim Johnston, SAGE’s assistant director of social enterprise and training, “The SAGECare program provides training on how to create welcoming services for LGBT older adults, as well as a credential that your agency can use to demonstrate your commitment to LGBT inclusion.”

    As advocates and practitioners, we must continue to support the existence of a culturally competent aging network. The array of trainings offered by SAGE is the beginning of the process for providers to insure culturally competent care so that LGBT older adults have the same opportunities as their heterosexual peers to age in a safe and supportive environment. For more information about training and/or SAGECare credential, contact Terri Clark or Tim Johnston.

    Terri Clark, MPH is prevention-services coordinator at Action Wellness and a certified trainer with SAGE.