When it’s time to start considering a move to a senior care facility, it’s an emotional process for anyone. But LGBTQ seniors face additional challenges and fears when taking this step.
For one, research shows many senior facilities are not particularly welcoming to LGBTQ people, and housing discrimination laws that protect them are murky. There’s a patchwork of state, federal and local ordinances and laws vary depending on the type of housing or funding stream, says Tim R. Johnston, Senior Director of National Projects for SAGE, a nonprofit that advocates for LGBTQ older people.
High-quality senior housing is also expensive, presenting an extra challenge for a community already facing higher rates of poverty. While LGBTQ-focused senior facilities are on the rise, there are still far too few for the entire community, Johnston says. But here’s the good news: Whether you or your loved one are beginning to consider this move, a growing number of facilities are receiving training to become LGBTQ-welcoming, including those focused on low-income housing, and there are also some alternative housing options out there.
The importance of affirming housing for older LGBTQ adults
A common concern for anyone entering a senior care facility is elder abuse. Larry Nelson, a 68-year-old gay man in San Francisco who has volunteered for 10 years with Openhouse, a nonprofit that supports LGBTQ seniors, worried about this when his mother moved into a facility. His worst fears were realized when she was physically abused by a nurse, who was later fired.
Now, as Nelson ages and considers his own options, he says he fears that homophobia could exacerbate his risk of abuse and worries about being vulnerable in a facility that mistreats or disrespects him.
Many LGBTQ seniors harbor fears around being out and getting mistreated at long-term care facilities, says Jesus Ramirez-Valles, director of San Francisco State University’s Health Equity Institute and author of “Queer Aging.” “When they were young, many LGBTQ Baby Boomers left to the major cities to create their own communities,” says Ramirez-Valles. “Now, they’re faced with the idea of going to retirement facilities or housing communities where they may face the same thing they ran away from.”
Johnston notes that, additionally, we can’t forget the lived experience and perspective of older LGBTQ people, many of whom spent the majority of their lives in the closet to maintain their safety, housing and employment. “While going into a senior housing environment is stressful and anxiety-inducing for anyone, you’re also worried about your own personal safety and ability to be out, so it adds an extra layer of stress,” he says. “We see that in reaction to that, a lot of folks decide to go back into the closet until they know if it’s safe to be out.”
But a senior facility is also their home, Johnson says, and it’s paramount to their well-being that they live in an affirming environment where they feel free to live openly as their authentic selves.
Several factors that make this more challenging:
The insidiousness of discrimination in some facilities. Ramirez-Valles says discrimination isn’t always overt and could look like restricting visitors, strictly defining who qualifies as a partner, monitoring or restricting Internet usage or TV access to LGBTQ content and limiting activities.
Shortage of LGBTQ-affirming facilities. There are only a handful of LGBTQ-focused senior facilties in the country, says Johnston, and while they’re growing in number, it’s far from enough to accommodate the entire community. According to Pew Research Center, as of 2016, 3.8% of Americans aged 52 and up identify as LGBT, and SAGE estimates there will be 7 million LGBTQ elders in America by 2030. This leaves the majority with options not geared toward the community specifically, though this isn’t inherently a problem if the facility has been trained to support LGBTQ seniors and has appropriate policies in place, Johnston says.
Smaller support systems. On top of these worries, compared to the general population, LGBTQ older adults have a smaller support system. They are three to four times less likely to have children and twice as likely to be single and have less traditional family and caregiver support, according to SAGE.
Lacking legal protection. While our culture has certainly progressed with LGBTQ rights, says Johnston, some housing discrimination will remain legal until The Equality Act is passed. This legislation has so far only passed in the House of Representatives and would implement uniform federal non-discrimination laws for LGBTQ people in critical categories, such as housing, education, medical care and financial services. Currently, the only federal protection is for employment, and that was only recently granted via a Supreme Court case.
A variety of facility options for LGBTQ seniors
In addition to considering whether a facility is LGBTQ-focused or welcoming, you’ll want to take other factors into account.
Private vs. public housing: Private housing offers a higher level of care but typically starts at a staggering $5,000 per month, Ramirez-Valles says. This can be challenging for the LGBTQ community since they already face financial disadvantages, he explains. This is partly due to discrimination but also because seniors didn’t have marriage equality for much of their lives and therefore don’t have spousal benefits.There are also public housing options, though these facilities tend to have lower budgets that can (but don’t always) translate to less staffing and a lower quality of care, Johnson says. Additionally, some cities now offer affordable housing through public and private sector partnerships, Ramirez-Valles says. For example, in Chicago, San Francisco and Los Angeles, the local LGBTQ community center or a nonprofit co-developed housing projects with developers.
Level of assistance: Some facilities only offer independent living, assisted living or skilled nursing, each providing varying levels of hands-on personal and medical care. There are also continuing care retirement communities (CCRCs) that have all options on one campus, allowing residents to move between facilities as medical needs change.
Keep in mind that traditional senior facilities aren’t the only option. While aging in place is increasingly common with everyone, Ramirez-Valles says, it’s especially appealing to the LGBTQ community since it allows them to stay put in the safety of their home.
Nelson considered eventually moving to an LGBTQ-friendly retirement home in California, but he got cold feet after it nearly burned down twice in wildfires. He already owns and loves his condominium, and if he moved out, he’d lose the tax write-offs. Now he’s considering aging in place and making room in his den for a trusted caregiver, which should be covered by his long-term care insurance.
Ramirez-Valles says in some cities, such as Chicago and New York, there are also grassroots efforts to create LGBTQ living-in-place neighborhoods. “These aren’t institutionalized, but informal communities or networks of people trying to age in place together,” he says. “They offer access to transportation, social and emotional support, entertainment, help with groceries and resources in your neighborhood.”
Questions to determine a senior care facility’s LGBTQ-friendliness
If you’re considering moving yourself or a loved one to a care facility and want to assess if they’re truly welcoming of LGBTQ seniors, make sure to ask these questions:
What is their non-discrimination policy? Look for a non-discrimination policy that includes sexual oriention, gender identity and gender expression, recommends SAGE. Johnston also suggests looking for visual signs of inclusion, whether it’s photos of same-sex or gender-diverse people in their marketing materials, rainbow flags in an office or a diversity and inclusion statement posted in the building.
What percent of your residents are LGBTQ? Johnston says the facility may not have an exact number or might not share this information for privacy reasons, but it’s worth at least asking if there are any out residents.
Do you have any LGBTQ-specific certifications or cultural competency training? Training programs such as SAGECare helps staff understand the needs of LGBTQ elders and more proactive and sensitive to bullying and discrimination, from residents and employees, Johnston says. If the facility you’re considering hasn’t had any training, ask if they’re willing to do so, Johnston suggests, since consumer demand will encourage more facilities to invest in it.
What enrichment activities do you offer? “The primary life-saving component for senior citizens, queer or not, is engagement,” Nelson says. “Ask what the social engagement activities are, what amenities are offered, and what transportation they provide.” For example, he says, do they offer group trips to the theater? Will they take you to see a friend? Do they provide activities that resonate with LGBTQ residents, like those timed to Pride?
Can I speak to some current residents? When Nelson toured a retirement facility, he made sure to ask residents about their experiences. He encourages doing this to get the real scoop and to see if you feel any representation there rather than just relying on the marketing materials. He recommends asking the facility in advance of your tour to ensure this happens. If that’s not possible, Ramirez-Valles suggests at least asking for reviews and referrals.
Can you address my specific health needs? For example, Ramirez-Valles says seniors with HIV may face discrimination, and there is still much being discovered about the medical needs of aging HIV patients. Transgender seniors may also have specific health needs that not all facilities are able or willing to care for. Ensure they have the required competency and will treat you with dignity. Keep other LGBTQ-friendly senior living options open.
Resources for starting your search
As you begin to look at housing options, Nelson suggests first looking up your state’s department of aging and adult services to see if they offer resources or advice.
Additionally, if your area has an LGBTQ community center, ask for their recommendations for affirming housing options since they will likely know where to refer you. Some areas also have nonprofits that can assist you in this process; for example, Openhouse in San Francisco, the nonprofit Nelson volunteered with, helps LGBTQ seniors find affirming, affordable housing.
Any major life transition is hard, and the thought of sending yourself or a loved one to a senior care facility can be even harder if there are concerns about whether it’s LGBTQ-friendly. But rest assured that as awareness grows of the needs of the aging LGBTQ community, more resources and options are arriving.
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