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Published By Ben Solomon on June 12, 2018

Understanding the Unique Needs of LGBT Elders

In a University of Washington study, researchers concluded that 2.7 million people age 50 and older identify as lesbian, gay, bisexual or transgender, and that the number is expected to double by 2060. As someone who has been working as a senior home care service provider since 2004, Ben Solomon asked, “Why are LGBT older adults often described as an isolated and underserved community?”

Solomon, owner of Right at Home Pierce County, Washington, reached out to and spoke with Steven King, Assistant Director of Clinical Services of Linden Grove Communities, and Pat McIntyre, President of Tacoma Older LGBT, in July 2016 to learn more about the unique care needs of the LGBT community. Both King and McIntyre are members of the Northwest LGBT Senior Care Providers Network.

*The information below is extracted and edited from a recording of the interview.

Why You Shouldn’t Use the Word “Queer” Around LGBT Elders

Solomon: What does “LGBT” mean?

King: “LGBT” is an acronym that stands for “lesbian, gay, bisexual and transgender.” “Q” was added most recently and stands for “questioning” and/or “queer.”

McIntyre: The “Q” word is a scary word to a lot of older people because it’s a word that has been built with hate. The younger LGBT folks have reclaimed that word and embraced it. But it’s probably a word you do not want to use around older LGBT adults.

LGBT History in America

Solomon: When we focus on understanding the unique care needs of older LGBT folks, it’s important to understand their needs from a historical perspective, which shaped how they see the world.

McIntyre: One of the questions that people have is, “Why are people hiding? Why are they isolated?” There were years of government sanction and discrimination. Back in the 1920s, police were raiding gay bars. In the 1930s, there were between 10,000 and 15,000 LGBT folks who were killed in Nazi concentration camps. In the 1940s, gays and lesbians were banned from serving in the military—this was a complete ban, not just a “don’t ask, don’t tell” policy. In the 1950s, the American Psychiatric Association added homosexuality as a mental illness. During the same time, (Sen. Joseph) McCarthy wasn’t just hunting communists, they were hunting what they called “sexual perverts.”

Just hearing that name (“queer”) kind of put a scare in anybody who was LGBT.

In the 1960s, things were starting to change. We heard about Christine Jorgensen, who was one of the first persons who went through a transitioning, as a transgender, from a man to a woman. In the late 1960s, we also saw the Stonewall riots, which was a predecessor of Gay Pride. The Stonewall riots happened at the Stonewall Inn (in the Greenwich Village neighborhood of Manhattan, New York City); people (patrons of the bar) had had enough of all the police harassment, so they stood up. The fighting went on for two or three days; police came and hauled people off to jail. The following year, they had the first Gay Pride event. In the 1970s, the American Psychiatric Association took homosexuality off of their list of mental illnesses.

But gender identity is at times still considered gender dysphoria. When I do training, I try to help people understand that the “L,” “G” and “B” of “LGBT” is sexual orientation—meaning who you love or who you care about. The “T” part is who you think you are or who you believe you are—that’s when we see people going from male to female, or from female to male.

Then there were hate crimes from the 1970s to the 1990s, where Harvey Milk, Brandon Teena and Matthew Shepard were killed. But the 2000s were huge. We saw the removal of “don’t ask, don’t tell” and parts of the Defense of Marriage Act repealed. But people who were born in the 1920s are still around; they had experienced all of that.

LGBT Aging Challenges

Solomon: That gave us some historical perspective on why people may be reticent to opening themselves to strangers. Then there’s also family dynamics to consider.

King: The University of Washington conducted a nationwide survey. Findings showed that there’s a very high risk for seniors within the LGBT community to be even more isolated and depressed than heterosexual people, as LGBT seniors have a lack of family support.

Some may have been rejected by their families, and others may still be living in the closet. Some LGBT people may have finally come out in their senior years but have not yet developed a support system of friends within the LGBT community. In addition to that, they may not have any children or a surviving partner to act as the primary caregiver. Isolation and depression, therefore, affect the older LGBT community deeply.

LGBT Sensitivity and Cultural Competency Training for Senior Service Providers

Solomon: As senior service providers, what can we do to help?

King: Make sure all of the caregivers and staff are adequately trained to provide care with sensitivity to LGBT elders. As we have seen more and more transgender seniors through the healthcare system at both skilled rehabilitation facilities and assisted living communities, it’s becoming more prevalent for us to address their needs and sensitivity. The cultural differences can be barriers.

Service providers should also make it clear with signage so LGBT people know that the providers have completed the sensitivity training and advocate for equal rights of the LGBT population in a care setting.

Solomon: What about the specifics of the training? How can we make others feel inclusive and receptive to support?

McIntyre: A lot of people believe that they can tell who is gay and lesbian, but you can’t.

King: It’s all assumption.

McIntyre: At the intake stage, people are asked to fill out forms and answer questions such as, “What is your sexual orientation?” But life has gotten a little more complicated than trying to figure out what an individual prefers. For example, pronouns are huge. Listen to people and how they refer to themselves, especially with the transgender community. When Caitlyn Jenner was first interviewed, he was still using the “he” pronoun; now, she is using the “she” pronoun. Listen to others, they’ll give you those tips.

King: It’s important to not assume or question. Over time, listen to those pronouns, engage in conversations, and you may put together an idea of who this person is. By then it might be more comfortable for them to hear the questions: “Are you gay?” or “Are you transgender?” or “What do you identify as?” But if you ask those questions when you first meet someone, you may come off as being nosy.

Oftentimes, it’s a bit more challenging in the transgender population to really identify if they are fully transitioned, had gender reassignment surgery or not. But everyone is just as beautiful as the next.

McIntyre: That’s interesting. Some people would ask; “Have you had all the surgeries?” But that’s not important. Unless you are a doctor and there is a direct impact on the care, you shouldn’t be asking those questions.

In our training, we show a documentary called “Gen Silent.” It follows six people around for a year; one of them was a transgender woman. There was a scene in which she was taken to the hospital because she had a heart attack or a stroke. They really did ask her, “Has she had all the surgeries?” Which had nothing to do with taking care of her.

King: How she feels as a person, what she identifies with and the reason why she is in the healthcare system—we have to look at those things because we have to know the appropriate placement. Technically, male is still defined as male in the anatomy even though the person may identify as a woman.

McIntyre: If someone (with a male anatomy) comes in and definitely identifies as a woman, that’s where it becomes very difficult from an administrator’s perspective. We are trying to get through some of those barriers.

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