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Gen-Silent in Fort Lauderdale

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LGBT Seniors, Invisible No More

LGBT Seniors, Invisible No More

Discrimination and legal inequalities take toll on health and health care

05.25.2012By Barbara Moran
LGBT Senior Citizens, social policy, social work, Robert B Hudson, Boston University School of Social WorkRobert B. Hudson says that some members of the health care community “have treated LGBT people with condescension, and that in turn has often led people to put off preventive services.” Photo courtesy of the Boston University School of Social Work

In 2009, according to the U.S. Administration on Aging, about one in eight Americans was over age 65. That adds up to 39.6 million people, or almost 13 percent of the U.S population. By 2030, there will be about 72.1 million in that age group, or about 19 percent of the population.

While many studies have been done on America’s aging population, little research has focused on a group facing special issues as they age: the lesbian, gay, bisexual, and transgender (LGBT) community. Today’s LGBT elders have lived through decades of discrimination, which, it turns out, has huge repercussions as they age. Yet LGBT seniors have been largely ignored in policy on aging.

To help address this oversight, Robert B. Hudson, a School of Social Work professor of social policy and managing editor of the journal Public Policy and Aging Report, devoted an issue to the topic of LGBT seniors, with articles written by a range of researchers, service providers, and advocates involved with LGBT policy concerns. According to Hudson, the issue received more positive feedback “than just about anything else we’ve done.” In his introduction, he writes, “These individuals have remained nearly invisible to the community of advocates, researchers, practitioners, administrators, and politicians who associate themselves with the modern aging enterprise.”

BU Today recently spoke with Hudson about the insights gained from the project and what steps need to be taken to help aging members of the LGBT community.

Public Policy & Aging Report, Integrating Lesbian, Gay, Bisexual and Transgender Older Adults into Aging Policy and Practice

BU Today: Why did you focus an issue of Public Policy and Aging Report on the LGBT community?

Hudson: One thing we’re always trying to do is highlight under recognized issues, and this is one that really has to be near the top of the list. There is simply not much of a literature devoted to older LGBT people. There is a whole world of aging research and aging agencies that provide a range of benefits to older people, and there is a separate series of agencies and research that address the LGBT population. But they often don’t come together.

Why do you think that is?

Well, as a political scientist, I see it centrally rooted in bureaucratic behavior. The aging agencies are organized around classic aging-related issues like nutrition, social services, and legal services. The LGBT community has never had the same level of attention.

So what’s been the result of that gap?

Massive under service. When you look at the literature, LGBT access to health care is suboptimal. And that’s for two reasons: one is that some members of the health care community have treated LGBT people with condescension, and that in turn has often led people to put off preventive services. More broadly, LGBT individuals are often denied protections such as survivorship, visitation rights, and living wills, because the legal system does not recognize their living arrangements.

What health issues other than access to health care are specific to LGBT seniors? The Report notes higher levels of smoking, drinking, and rates of depression.

The mental health issues are the ones that stand out, and I think it’s something that the larger population does not appreciate. The stressors around discrimination in those communities have been so high for so long that substance abuse issues are much more widespread than the larger public thinks. People ought to know that discrimination has consequences.

The other issue to be mentioned is HIV-AIDS. And again, something that is underrecognized is that people who are HIV-positive are getting older, thanks to drugs that are turning HIV-AIDS into a chronic illness rather than a death sentence. But it is also true that people are contracting AIDS over age 55 at somewhat higher rates than before.

That’s the group you’d think has been the most indoctrinated about safe sex practices.

Indoctrinated, yes, but on the other hand, I think it’s something about aging. I think some people may say, “We’re old, we probably can’t get it.” But in fact, as you get older, the body becomes more fragile, and it may make transmission more likely.

Is there also a lack of safe-sex education, most of which seems targeted at young people, for older adults?

I think that has been the case. A lot of the public health initiatives within the LGBT community are aimed implicitly—if not explicitly—at younger people. The classic imagery we’ve had of older people in general is relevant here; they’re frail and alone or cut off in nursing homes, so they tend to get forgotten and excluded from all sorts of helpful interventions. And then members of the aging community, either through lack of interest—or in some cases, discrimination—may not want to engage with the older gay population. And so older LGBT folks really do fall between the cracks.

LGBT seniors lived through decades of discrimination, with homosexuality a crime or deemed a mental illness. The Report says 82 percent have been victimized at least once. With homosexuality so much more accepted now, it’s hard to realize what they went through.

Well, for somebody my age it’s not hard to remember. I mean, you could get in all sorts of serious trouble by identifying as gay or being seen as gay—bullying, violence, employment discrimination, health care, the whole gamut. I think most people now don’t recognize how tough it was for LGBT people to grow up in the world they did. And if you listen to today’s political debate, there are candidates out there who are inferring things about certain populations—including this one—that are pretty nasty.

What are the major impacts on seniors of coming of age with that level of hostility?

Certainly there are impacts in mental health issues, but also in economic issues. If you were discriminated against at age 20, 30, and 40, trying to get a decent job, trying to get promoted, trying not to get fired, hoping to be invited to the company family picnic, needing to go out on the golf course with the guys where the deals are being made, and they shun you because they suspect you’re not one of them—there are huge career ramifications.

So it really is a lifelong thing. In aging we talk about “cumulative advantage” and “cumulative disadvantage.” If you went to Andover and Harvard when you were younger, you have a better train ride than somebody who didn’t. And in this case, to have been knocked off career and health care and other rails early on by reason of discrimination, a trajectory that might have gone quite high will instead be flat. And in some ways it gets worse in old age. The passage of time amplifies the discriminations you’ve encountered over the course of 30 to 40 years.

The Report says LGBT seniors are twice as likely to live alone as heterosexual seniors, and four times more likely to have no children. How does this affect their support network?

It’s a huge issue. In the case of chronic illness, something like 80 percent of all care is provided by so-called informal supports—mainly family, notably wives, daughters, and daughters-in-law. This is a population that has much lower marriage rates and somewhat higher levels of disaffection from their biological families due to their orientation. There are fewer children, fewer spouses, and the extended family of aunts, uncles, nieces, and nephews may also be thinner. That is compensated for in part by friends, but the lack of family-based informal supports is a concern in this community.

The LGBT community seems to have exceptionally strong social networks, for just those reasons. But in this regard that doesn’t seem to compensate enough. Do you think this will change for the next generation of seniors?

I think over time, with greater acceptance of these communities, yes it will get better. But it’s going to be a long process. It’s interesting the extent to which same-sex marriage has taken hold in many parts of the country, which certainly wasn’t the case 20 years ago. But it’s going to be a very long process.

With gay marriage gaining acceptance and many more gay couples having or adopting children, is it likely their support networks will be strengthened?

I think that’s right, but I think it will vary a lot geographically. There are still a number of states where gays and lesbians cannot adopt children.

Do you think we’ll see gay- and lesbian-specific nursing homes at some point?

Interesting question. There are retirement communities—I don’t know their legal status—that certainly have attracted LGBT people. There are at least two or three dozen retirement areas in various parts of the country that are known to be attractive to members of the LGBT community. It wouldn’t be possible in most nursing homes because it would violate Medicaid reimbursement laws.

So what should be the top priority for the LGBT senior agenda? What should researchers and policymakers be thinking about to best serve this group?

On the policy level, I always think first of Social Security benefits. If you don’t have legally recognized dependents, you can’t get a dependent benefit. If you die and you had a partner, but you were not legally married—and to the federal government you can’t be legally married if you’re gay or lesbian—then there’s no survivor benefit.

In the health care world, prohibitions tied to visitation and to proxies and living wills are big things that have to be overcome.

But I think the biggest issue is in some ways the hardest issue to tackle, and that is acculturation and acceptance: being fully accepted as part of the range of American citizenry. LGBT elders may not be exactly like you, but there are lots of people who aren’t exactly like you, so let’s get over it, old and young alike.

View a copy of the Public Policy & Aging Report issue “Integrating Lesbian, Gay, Bisexual and Transgender Older Adults into Aging Policy and Practice” here.

Barbara Moran (COM’96) is a science writer in Brookline, Mass. She can be reached through her website. Permission to post this article on ‘The Purple Jacket’ was granted by Barbara Moran.

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The Bow-Tie-Guy Tip of the Day:

Never …just blend in!

Photo Credit: The Purple Jacket

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SunServe and The Purple Jacket: A Perfect Match

I am pleased to announce that ‘The Purple Jacket’ and ‘The Bow-Tie-Guy’ have joined the staff at SunServe Social Services in Fort Lauderdale, Florida  as the coordinator of Senior Services.     SunServe Social Services is the home of the Noble A. McArtor Adult Day Care Center .  Opening in 2004,  the Noble A. McArtor Adult Day Care Center   has been on the frontier for serving the needs of the LGBT senior community in South Florida.

The Noble A. McArtor Adult Day Care Center has always had a special place in my heart as my close friend, Father Richard Orlando, was one of the first participants of the center when it first opened in 2004.     During his time at  Noble A. McArtor Adult Day Care Center, Father Orlando excelled in all facets of his life.  The staff and participants at the center were a major part in providing Father Orlando with a beautiful “SunSet” to his life!

Having been away from Fort Lauderdale for four years and upon returning to Fort Lauderdale in March 2012, I was shocked, surprised and impressed to see the growth of  SunServe Social Services in such a short period of time.   SunServe  has grown into a comprehensive social service agency, offering a number of professional services to the LGBT Community in Fort Lauderdale including:

SunServe Social Services provides high quality, compassionate, and progressive care for all, including those in financial need, minorities, youth, seniors, families, and those with life-challenging physical or emotional conditions.  The growth of SunServe Social Services is a truly remarkable and is a testament to the entire staff.
Forging ahead with this collaboration is a  perfect fit for ‘The Purple Jacket’ and ‘The Bow-Tie-Guy’ as we continue to talk about the real-life issues and needs  of LGBT Aging, Health and Caregiving
SunServe Social Services is rolling out a telephone tree to call our LGBTQ neighbors in Broward County who may be homebound or would like to touch base with someone every day.  If you are in South Florida, I urge you to become active in this program.

You:  Would have to make a commitment to call your client once a day – at a specific time you both find convenient – to check on them, give them an update and share some news.

 You:  Would make a commitment to serve for 6 months at a time.

Yes, you can take a vacation but you will have to let your phone team leader know so another volunteer can cover your client.

Yes, you can go back north for the summer; you might decide to continue your calls from “Up North” or we can ask another volunteer to call for you.

Yes, we can utilize your services for the months that you are here.

Yes, there is a three-hour training that you need to attend on Saturday, May 19th from 10 – 1 PM at SunServe.

Yes, you can have more than one client.

Yes, you will have to keep a brief daily log and report to your telephone team captain once a month on how you are doing, how your client is doing and if any special situations have arisen.

Yes, you can refer friends into the program so they may receive calls.

If you are in Broward County and interested in participating , please call Andrew Forester at 954-764-5150 for a quick phone interview and to sign up for the training on Saturday, May 19 here at the SunServe Office.


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American Society on Aging

I am pleased to share with you my article that was published today with the American Society on Aging. There are five wonderful articles, along with an introduction from Holly Deni who helped collaborate this project;  Finding Pride in Caring: LGBT caregivers answer the call from the community  This link will take you to Holly’s introduction where you can see all the wonderful articles written by LGBT care givers. It is an honor to be associated with these fine people! ENJOY

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It’s More Than a Tree…

Never one to be a horticulturist, I am always intrigued by the variety of beautiful trees we have in this diverse country of ours.  Now that we are back in Florida, I am reminded about the beautiful foliage that Florida has to offer, especially the Palm Trees.  You really don’t get to see many Palm trees in St. Louis.

In Missouri, just like here in Florida, there is an abundance of pine trees.  In fact, we have a pine tree  in our yard where I am constantly picking up the pine cones that fall from the branches.
While picking one of the zillion or so pine cone, I noticed something at the base of the tree that caught my attention…

Intrigued by the green plastic sprouting out of the ground, I asked ‘The Little One’ to explain this phenomenon.  ( I did not know we could grow plastic in the ground and first thought that we might have come across the next great invention and I wanted to be sure we got the Patton on this discovery!)

“Herman planted that tree in 1976, that is the plastic bucket that the tree came in that is coming out of the ground.  Every time I see that tree, I think of Herman!”

WOW…talk about some powerful symbolism!   While Herman has been gone now for over 13 years, Herman’s tree grows tall and strong as a reminder to ‘The Little One” of a long and beautiful relationship.

Richard (a.k.a. ‘The Little One”) and Herman were together for 44 years and moved to Florida in 1976 before it was in vogue to move south.  Like us, there was an age difference between Herman and Richard.  And like us, Richard became Herman’s care giver:  funny how roles change in life when we age?

When Richard  cared for Herman, many of their friends came to help them with their daily task.  Herman often asked Richard…’What would I do without you?”

While caring for your love one or partner should be assumed, that is not always the case; especially for LGBT seniors.  According to SAGE USA  LGBT Seniors 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
The care giving needs for the LGBT senior community are enormous.  While society norms are (slowly) changing, many LGBT senior today are still living in fear, living in solitude, or afraid to reach out for help because of the fear and discrimination that they experienced when they grew up. However with programs like SAGE USA, The National Research Center on LGBT Aging : SunServe Social Service’s Noble A. McArtor Adult Day Care Center just to name a few,  heighten the awareness of this critical issue in our society which will help foster change.
Often times, the LGBT community is portrayed in a negative light which only heightens our fear.  Richard and Herman were together 44  years…YES, 44 YEARS!  
As a former staff member at The Sunshine Cathedral, I had the pleasure to watching life partners celebrate 30, 40, 50 years together.  There are thousands upon thousands of LGBT couples across the world who celebrate long lasting relationships that often go unnoticed. Many of these couples prefer to go unnoticed and that is OK as personal privacy is important and should always be upheld.
While those positive  stories of love and commitment often go left unnoticed in the main stream media,  many  LGBT Seniors who live alone, or as a couple often times have to fend for themselves as they age because of society ‘norms’ because of their fears that they experienced in their youth.     Bullying just does not happen in High School.  How can we break this cycle,  when will we break this cycle of hate and fear?
Being 81 and growing up in Brooklyn and living in Manhattan, “The Little One”  knows a few things about society norms, hate, fear and the such.   He lived through Stonewall and beginning of the AIDS epidemic; he has  experienced discrimination;  he experienced the draft board and the gay issue in the 50’s.  All in all, he would tell you that the LGBT issues today are no different than they were in the 50’s; equality, marriage, children, the whole package.  For him, what is different today is that these issues are now out in the open and people are talking about them.
Now that people are talking about these issues, the next key ingredient is to have the policy makers listen so that we can foster change in our communities and in our society. Communication will foster change, change will foster opportunities for service and care for everyone.      We have to do a better job in getting the word and the need out in a calm and pragmatic way.  Unfortunately,   listening is often an overlooked  communication skill.
As partners we don’t need a piece of paper to secure  our love or commitment for each other; but as a LGBT couple, we  need that piece of paper to get into hospitals to visit our loved one, we need that piece of paper to get access to so many common, taken for granted services  that have a direct effect on our health and well-being.  This list is endless, yet the need is there, especially for those  seniors, (no matter what side of the fence your on) who have no one to care for them.   Could this really be right in America today?
Come to think about it, we do have that piece of paper…it’s in its natural  form as a tree!  

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