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The Aging LGBT Community


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Title: The Aging LGBT Community

The Aging LGBT Community
Presented by LGBT Boomers and
BeyondCoalition For Arizona State University
Southwest Interdisciplinary Research
LGBT Boomers and BeyondCoalition
  • Presenters
  • Scott Hawthornthwaite Area Agency on Aging,
    Region 1
  • Adero Allison, PhD Transitioning Adults Plus
  • Chris Boutwell One Voice Community Center
  • David Coon, PhD Arizona State University

LGBT Boomers and BeyondCoalition
  • Presenters continued
  • David Prime Timers
  • Brett Petersen Duet
  • Billie Myres Hospice of the Valley
  • Moderator
  • Joan Zecherle Hospice of the Valley

LGBT Boomers and BeyondCoalition The Beginnings
  • Scott Hawthornthwaite
  • Director of Caregiver Services
  • Area Agency on Aging

  • Began as a caregiver support group with Duet
  • Community seminars on legal issues
  • Coalition formed Area Agency on Aging, Duet,
    Hospice of the Valley, Primetimers, One Voice
    Community Center, Transitioning Adults Plus

Monthly Social/Educational Series at One Voice
LGBT Community Center
  • Movies
  • Pride
  • Caring for yourself
  • Housing Options
  • Community Resources

Three Conferences
  • Statewide
  • Breakout Sessions
  • Networking

For More Information on our Upcoming 2nd Annual
Statewide LGBT Boomers and Beyond Conference April
27 28, 2012 Visit our Website
LGBT Aging in AmericaFact and Myths
  • PresenterRev. Adero C E Allison, PhD
    Transitions Adults Plus
  • http//

PresenterChris Boutwell One Voice Community
Center http//
Aging in America
  • 8000 - 10,000 - will reach 65 everyday until 2030
  • The National Gay and Lesbian Taskforce estimates
    that there are more than 3 million gay, lesbian,
    bisexual and transgender Americans over age 65 .
    . .
  • More than One in 10 Same-Sex Couples Include a
    Partner over 65, More than One in Four Include a
    Partner over 55.
  • (The Population Resource Center, 2010)
  • (The National Gay and Lesbian Task Force, 2010)

Aging in America
  • By 2020 the number of gays and lesbians over 50
    in the US will have gone up to nearly six million
  • The number of GLBT Americans over 65 will more
    than double in the next 25 years, from an
    estimated 3 million to 7 million.
  • (The Population Resource Center, 2010)
  • (The National Gay and Lesbian Task Force, 2010)

GLBT Aging Stats Trends
  • 1980s est. GLBT elderly population ranged from
    from 1.75 million lesbians and gay men age 65 and
    older to 3.5 million 60 and older
  • Gay, lesbian and bisexual population of the
    United States currently est. somewhere between 3
    and 8
  • No national data on transgender people in the US
  • (Outing Age, 2010)
  • ( The National Gay and Lesbian Task Force, 2010)

GLBT Aging Stats Trends
  • A 1999 study conducted for Senior Action in a Gay
    Environment found that 65 of 253 gay and lesbian
    seniors surveyed in New York City reported living
  • Only 36 of all people 65 years or older in New
    York City lived alone at the same time.
  • (Outing Age, 2010)
  • ( The National Gay and Lesbian Task Force, 2010)

LGBT Older Adults Are
  • Twice as likely to age as a single person
  • Twice as likely to live alone
  • Three to four times less likely to have children
    to support them
  • More likely to develop mental health and
    substance abuse issues
  • A life time of fear creates hesitation
  • (National Resource Center on LGBT Aging, 2011)

LGBT General Statistics
  • 12 care for non
  • relatives
  • 14 care for friends
  • 18 care for partners
  • 36 care for parents
  • 1 in 5 unsure who will take care of them
  • (National Resource Center on LGBT Aging, 2011)

40 expect medicare to pay for care (it
doesn't). NOT included in FMLA for partner
care Denied decision making and
visitation Excluded from end of life decisions
Narrative - Safe HousingPersonal Experience Rev.
Adero C E Allison, PhD
  • We visited a transgender woman from our church
    who had been admitted to a facility for care.
    Upon visiting her it was noted that she was in a
    room with and treated as a man. She was not
    helped from her bed to her powerchair for weeks
    at a time, keeping her isolated in her room. A
    used urinal was left on her bedstand (the one
    meals are served on). It was there on two
    different visits even though we complained to the
    director of the facility. She was unshaven with
    her hair not combed and matter in eyes on most
    visits. It was striking that her non-ambulatory
    roommate appeared clean and cared for.
  • (Allison, 2011)

Narrative - Assisted Living Personal Experience
Rev. Adero C E Allison, PhD
  • A Care Manager took two women to visit an
    assisted living community to determine whether
    this would be a good alternative to their condo.
    The Sales Person informed them that no two women
    could live together in their community. The rules
    prohibit cohabitation by any other than married
    individuals. It was not clear whether couples
    were asked to produce their marriage certificates
    with their applications.
  • (Allison, 2010)

Implications LGBT do not share the benefits of
shared income that are mostly covered by marriage.
Narratives- Personal ChoiceFrom Andres
Fernandez, Owner and Operator of Comona Care Homes
  • Narrative 1 When working in a hospice, man
    dying of aids was told by the staff to take down
    the calendar in his room that depicted men with
    leather on. The man was on his death bed. This
    has Implications for cultural understanding.
    Only people there at his side when he died were
    friends from the gay community, other leather
    enthusiasts and drag queens.
  • Narrative 2 - A man dying unexpectedly in the
    hospital had no family by his side, only his
    partner of 6 months. The man's family has not
    seen or spoken to him in over a decade. They
    force his partner to leave the hospital, and the
    man died alone without his partner, or his
  • Implications LGBT need to go through rigorous
    processes to ensure their wishes are met, these
    are mostly covered by marriage. Even these
    processes do not assure compliance.
  • (Fernandez, A., 2011)

Narratives - Effective Legal Protection
  • Narrative 3 Clay (77) and Harold (88) - Sonoma
    County separates a gay couple of 20 years (having
    all the legal paperwork to ensure their wishes
    are respected). Harold fell and was admitted to
    the hospital. The County refused to allow
    visitation regardless of the power of attorney,
    will, end of life wishes, etc. They not only
    separated the men, but placed Clay in a nursing
    home away from Harold. They then sold all of
    their belongings. Clay was held against his will
    in the home for three months, during that time
    Harold passed away.

(Superior Court of California County of Sonoma ,
Narratives - Respect
  • Staff in nursing home doesnt want to touch the
    lesbian, so she doesn't get bathed.
  •  Staff threatened to out a man if he complained
    about his negligent care.
  • In one home where a couple was sharing a room, a
    staff member walked in on them being intimate.
    She separated them, and placed one of them in a
    psychiatric ward, where they were placed in
  • (Geyer, G., 2011)

Myths and FactsTrue or False
FALSE - This falsehood can be traced directly to
the discredited research of Paul Cameron and his
Family Research Institute, specifically a 1994
paper he co-wrote entitled, "The Lifespan of
Homosexuals. FALSE - The rates of HIV/AIDS
among older adults 50 and over have increased
more than 61 from 2001 to 2007. Research shows
that those age 50 and older now comprise 27 of
the overall population of people living with
HIV/AIDS, and by 2015 will become the majority of
all people living with HIV /AIDS. In addition,
the latest national data show that adults 50 and
older account for.
  • Gay people don't live nearly as long as
  • Older adultsthose age 50 and olderare not at
    risk for HIV or AIDS.
  • (Southern Poverty Law Center, 2011 )
  • (LGBT Aging Center, 2011)

Myths and FactsTrue or False
  • Older adults are not sexually active.
  • Older adults are less likely to be tested for
    HIV/AIDS than other age groups.
  • (LGBT Aging Center, 2011)
  • FALSE - Research shows heterosexual and LGBT
    older adults are sexually active well into their
    mid-80s, with a 2007 national study showing 53
    of adults age 65-74 and 26 of adults age 75-85
    as being active with one or more partners.
  • TRUE - Older adults are less likely to be tested
    because they are not perceived to be at risk,
    including being sexually active and/or
    intravenous drug users.In addition, doctors are
    less likely to ask older patients about sexual

  • Outing Age Public Policy Issues Affecting Gay
    Lesbian Bisexual and Transgender Elders by Sean
    Cahill, Ken South and Jane Spade
  • Find the Dollars You Deserve A Roadmap to Federal
    Funding for Aging Services Navigating the
    Federal Government for Lesbian, Gay, Bisexual and
    Transgender Organizations http//www.thetaskforce.
  • Caring for caregivers The issuesand
    interventionsare different for racial and
    ethnic-minority caregivers. By Rebecca A. Clay
    February 2009, Vol 40, No. 2 http//
  • Gay and Lesbian Retirement Communities Gays and
    lesbians over 50 find friendship, community and
    mutual support, By Sharon O'Brien -
  • Population Resources Center Providing the
    Demographic Dimension of Public Policy

    AND BISEXUAL SENIORS A Human Rights Campaign
    Foundation Report January 29, 2004
  • Senior-care providers face more gay, lesbian,
    bisexual and transgender clients, report
    indicates from Pioneer Press December 22, 2010
  • 10 Anti-Gay Myths Debunked By Evelyn Schlatter
    and Robert Steinback, Southern Poverty Law Center
  • LGBT Aging Center http//

Lesbian, Gay, Bisexual Transgender Issues and
Family Caregiving
  • David W. Coon, Ph.D.
  • College of Nursing Health Innovation
  • Arizona State University

Considering the Sociocultural Context
  • Who are LGBT caregivers?
  • Sociocultural influences can shape
  • Signs and symptoms of CR/CG distress CRs/CGs
    understanding of their feelings, thoughts,
    behavior views of others and the environment
    help-seeking behavior, treatment practice
  • Sociocultural context can also create additional
    barriers language barriers, culturally
    insensitive services, financial constraints
  • Professionals carry their own sociocultural

Contextual Considerations(CHESS Model)
  • Cultural cross-cultural differences
    individual versus collective/familial rights.
  • Historical mentally ill, less than, perverts,
    sinners, criminals.
  • Employment/Financial employment
    discrimination, extra legal fees, visiting
    rights, decision-making, insurance.
  • Social Support blended families, role
    relaxation, independence/realistic expectations,
    limited formal services.
  • Spiritual organizations as agents of
    intolerance oppression creating new models of
    meaning finding a home.
  • (Coon, 2001 Coon Burleson, 2006)

C Cultural context Cultural contexts vary in openness about personal issues including health, mental health, death and dying, treatment and ramifications of violating prohibitions. Cultural attitudes may influence whether caregivers withhold or alter information, avoid personal contact, or opt for more anonymous services to protect themselves and/or preclude family interference. Cultural context is related to use of non-traditional health care service providers must be open and informed about these methods in order to enhance goal alignment with clients.
H Historical context Relevant historical events and processes include changes in attitudes about people different from us (womens liberation, civil rights movement, LGBT pride, HIV/AIDS epidemic). Historical changes differentially affect older and younger cohorts of caregivers in ways that impact their knowledge about and willingness to utilize services.
E Employment, financial, and legal contexts Impacts of caregiving on employment are compounded by discrimination. Lack of legal protection for some types of partners (LGBT, co-habitating seniors) prevents access to health benefits, allows interference by blood relatives or facility personnel in visiting rights and decision-making.
S Social support context Service providers should avoid the inaccurate stereotypical views about support networks (both positive and negative). Future cohorts of caregivers may have smaller support networks depending on social and historical events (recession, natural disasters, war, anti-immigration legislation, work re-entry, AIDS epidemic), and thus may need more assistance.
S Spiritual context Religious coping, although frequently reported, is not turned to or perceived as effective by all. If caregivers and recipients adapt or discard religious doctrine and spiritual beliefs, they may face loss of cultural community connections. In areas with large populations, churches and temples may exist to serve the different types of communities in other areas, extant institutionalized religions may not provide effective support or actively discriminate against them.
Moving from Awareness toIncreasing Cultural
  • Within these sociocultural contexts providers
    need to
  • explore the physical, psychological and social
  • demonstrate respect
  • encourage CR/CG to share their personal and
    family stories
  • encourage CR/CG use of their own descriptors
  • explore the target complaints of LGBT CRs/CGs
    within their contexts

Moving from Awareness toIncreasing Cultural
  • Acknowledge routine use of nontraditional
    therapies/helpers and incorporate
  • Respect and incorporate views regarding family,
    extended family, community
  • Move from cultural awareness to cultural
    competence through continued training,
    supervision and consultation.
  • Recognize the meaning of social shifts
  • (e.g., Stonewall, civil rights movement, sexual
    revolution, dont ask, dont tell, gay marriage)

Identifying Obstacles to LGBT Service Utilization
  • Multiple Levels (individual, interpersonal,
    systems, community, policy).
  • Hatred, Discrimination, Intolerance.
  • Individual/Interpersonal
  • Coming Out Perceived Benefit or Burden?
  • Internalized and externalized heterosexism.
  • LGBT Professional and the LGBT CR/CG Parallel

Identifying Obstacles to LGBT Service Utilization
  • Institutional/Organizational Barriers
  • Community Level
  • (ageism cg burnout respect for level of
  • Policy Level
  • Lack of domestic partner benefits
  • Lack of anti-discrimination policies protecting
    employment, public housing and social services.

Overcoming Obstacles to LGBT Service Utilization
  • Multiple Levels of intervention
  • Individual/Interpersonal
  • Build on patient/caregiver strengths
    reconceptualize social support.
  • Recognize cohort differences.
  • Outness can only be fostered not forced.

Overcoming Obstacles to LGBT Service Utilization
  • Organizational/Systems Level
  • Zero Tolerance for Discrimination.
  • Improve availability/accessibility (info
  • Safe Place Symbols.
  • Community Advisory Board/Partners.

Overcoming Obstacles to LGBT Service Utilization
  • Organizational/System
  • Recognize awareness-competence continuum is
    life-long. Adopt ongoing training and
  • Move from service to change agency.
  • Shift one Brick, Change the Wall.

Overcoming Obstacles to LGBT Service Utilization
  • Community Policy Levels
  • Use inclusive definition of NFCSP/JCAHO to
    assess needs and develop service components.
  • Educate communities of need to revise FMLA,
    eliminate unequal treatment in medicaid
    spend-down and support domestic partner

DISC(u)SS Model of Service Barriers and
Intervention Opportunities
  • D- Discrimination, Insensitivity, Harassment
  • I - Individual/ Interpersonal level
  • S - System/Organizational level
  • C(u) - Community level
  • S - System level
  • S - Social Policy level
  • (Coon, 2001 Coon Burleson, 2006)

Acronym Examples of Barriers Examples of Current or Potential Strategies to Overcome Barriers
D Discrimination, Insensitivity, Harassment (throughout levels) Fears of discrimination, including hate crimes, loss of employment, and social stigma, stop many caregivers and care recipients from help-seeking. Health care providers, nursing homes, and senior centers sometimes discriminate against clients, who then retreat from seeking care. Caregivers/care recipients may face double, triple or quadruple jeopardy racism, ageism, xenophobia, heterosexism. Provide a safe place where minority caregivers can talk openly. Honor staff members rights to privacy, and assign staff to work with caregivers based on competence, rather than solely on cultural identity. Remain mindful of the pervasive impact of discrimination adopt a zero tolerance policy for discrimination and apply uniformly adopt inclusive language and challenge discriminatory language in both verbal and written communications.
I Individual/ Interpersonal level Caregiver-care recipient dyads may be differentially out across different contexts. Sociocultural contexts may influence caregivers self-identification. Caregivers may be suspicious of agencies and professionals. Openly discuss limits to confidentiality and strategies to protect privacy. Respect individuals levels of outness and self-identification in light of their sociocultural contexts. Provide referrals to culturally-sensitive informal and formal care resources. Recognize that suspicion of health care and social service professionals may be realistic, based on past experiences.
Acronym Examples of Barriers Examples of Current or Potential Strategies to Overcome Barriers
S System/ Organizational level Health care systems, insurance companies, and service agencies often have explicit or implicit discriminatory policies. Few organizations provide domestic partner benefits. Care-related decision-making power is often automatically given to biological relatives, regardless. Applicants for long term care may be discriminated against. Educate staff about culturally appropriate and culturally sensitive resources for caregiving, and request feedback from clients about referrals. Create a safe place symbol to indicate that agencies are sympathetic to and have received diversity training. Foster staff participation at continuing education presentation, consultation, and formal staff trainings on diversity topics.
C(u) Community level Some communities actively reject other groups. Many geographic regions and municipalities have minimal protection for LGBT persons ist attitudes (their own or others) deter some minority caregivers from accessing available services. Ageism and cultural expectations that we take care of our own in our communities may limit availability of formal support for elders and caregivers who need it. Encourage communities to take advantage of inclusive definition of National Family Caregiver Support Program (NFCSP) to assess needs develop services. Promote stronger ties between agencies serving culturally diverse groups and agencies working under NFCSP to ensure inclusion of diverse communities needs. Rally communities to help develop broadly inclusive culturally-sensitive caregiving related services. Promote use of safe place symbols.
Acronym Examples of Barriers Examples of Current or Potential Strategies to Overcome Barriers
S S System/ Social Policy level Even decades-long partnerships are often not recognized by government entities. Inability for domestic partners to access Social Security spousal benefits, disability benefits, and retirement benefits, tax benefits and equal treatment in Medicaid spend-down. Encourage and support diverse representation and full involvement in White House Conference on Aging to help older adults from all types of backgrounds. Train home care assistants in diversity awareness and competence to ease access to mainstream home health services. Build partnerships across community organizations to create local systems of caregiver support.
Emerging Promising Practices
  • Information and Referral.
  • Published material.
  • Education Workshops Forums.
  • Support Groups Counseling.
  • Online Information Support.
  • Skills training.

Some Readings
  • American Society on Aging. Outword Newsletter
    of the Lesbian and Gay Aging Issues Network of
    the American Society on Aging. San Francisco
    American Society on Aging.
  • Cahill, S., South, K., Spade, J. (2000).
    Outing Age Public policy issues affecting gay,
    lesbian, bisexual and transgender elders. New
    York The Policy Institute of the National Gay
    and Lesbian Task Force Foundation.
  • Coon, D.W. (2007). Exploring interventions for
    LGBT caregivers Issues and examples. Journal
    of Gay and Lesbian Social Services Issues in
    Practice, Policy and Research, 18, 109 128.
  • Coon, D. W. Burleson, M. H. (2006). Working
    with gay, lesbian, bisexual, and transgender
    families. In Yeo, G. Gallagher-Thompson, D.
    (Eds.) Ethnicity the dementias (2nd ed.) (pp.
    343-358). New York Routledge Taylor Francis

Some Readings
  • Coon, D.W., Keaveny, M., Valverde, I., Dadvar,
    S., Gallagher-Thompson , D. (In press).
    Evidence-based psychological treatments for older
    adults. Washington D.C. American Psychological
    Association Press.
  • Coon, D.W. Zeiss, L.M. (2003). The families we
    choose Intervention issues with LGBT
    caregivers. In Coon, D. W., Gallagher-Thompson,
    D. Thompson, L. (Eds.). Innovative
    interventions to reduce dementia caregiver
    distress A clinical guide (pp. 267-295). New
    York Springer
  • Family Caregiver Alliance (2002). Legal Issues
    for LGBT Caregivers. Available free online at

Some Readings
  • Family Care Giver Alliance (2011) Special
    concern of LGBT caregivers. Available free
    online at
  • Fredriksen-Goldsen, K. I., Muraco, A. (2010).
    Aging and sexual orientation A 25-year review
    of the literature. Research on Aging, 32,
  • Tully, C. T. (2000). Empowerment and older
    lesbians and gays. In C. T. Tully, Lesbians,
    gays, the empowerment perspective (pp.
    195-229). New York Columbia University Press.

Community Programs and Resources in Maricopa
LGBT Boomers and BeyondCoalition
Social Prime Timers
For More Information Visit http//phxprimetimers.
One Voice Community Center
  • Our Mission To serve as a cultural focal point
    uniting LGBT individuals and organizations.
  • We reinvest in the community by providing
  • Vital education
  • Social and wellness programs
  • Information about other advocacy groups
  • A space for support groups

Other Arizona LGBT Resources
Tucson Wingspan Prescott
Pride Center Northla
nd Cares Parents
Friends of Lesbians and Gays (PFLAG)
Nationwide with 9 AZ locations Bullhead City,
Lake Powell, Payson, Phoenix, Yuma, Tucson,
Winslow, Sierra Vista, Flagstaff
Area Agency on Aging
  • Funded by the Older Americans Act of 1965
  • 625 AAA nationally.  Every citizen in the US is
    covered by an AAA.
  • 2001 Older Americans Act updated to include the
    National Family Caregiver Support Program.  These
    funds were used to start the LGBT support group.
  • AAA in Phoenix has a long history of serving
    diverse populations including  elder refugees and
    persons with HIV and AIDS through their Care
    Directions Program.

PresenterBrett Petersen, MSWDuetwww.Duetaz.or
Working with Caregivers
Caregiver Statistics
  • One in four U. S. households involved in care
  • 92 of care receivers are related to caregivers
  • 73 of caregivers are women
  • Average caregiver is 46 years old
  • Average care receiver is 77 years old
  • 64 of care givers are also employed
  • (The National Alliance for Caregiving, 2005)

Caregiving - LGBT
  • Are more likely to be a friend or chosen family
    vs. a spouse or a child
  • Tend to be closer in age to the person they are
  • May deal with more discrimination toward the
    person they are caregiving when connecting with
    resources and support
  • May need to address more legal issues to advocate
    for the person they are caregiving and as a
  • (LGBT Movement Advancement Project and Services
    and Advocacy for Gay, Lesbian, Bisexual and
    Transgender Elders, 2010)

  • Caregiving in the US Executive Summary conducted
    by The National Alliance for Caregiving in
    collaboration with AARP, 2005,
  • Improving the Lives of LGBT Older Adults Report
    authored by LGBT Movement Advancement Project and
    Services and Advocacy for Gay, Lesbian, Bisexual
    and Transgender Elders, 2010,

Hospice of the ValleyPresenterBillie Myres,
LPC, Bereavement Counselor
LGBT Bereavement Support
LGBT Bereavement Support
  • History
  • Open, on-going group
  • Closed, six week groups
  • Who attends

LGBT Bereavement Support
  • Why they attend
  • Stories
  • Challenges

602 530-6900, Jennifer Klingberg,
RN, BSN Community Liaison, jklingberg_at_hov.orgJoa
n Zecherle,
Hospice of the Valley Contact Information
  • For a copy of this PowerPoint presentation
  • Visit our Website
  • http//