Out of the Shadows
Understanding and Meeting the Needs of LGBT Elders
SOURCE: AP/Jacquelyn Martin
Read the report: Improving the Lives of LGBT Older Adults (pdf)
Read the report snapshot (pdf)
Older LGBT Americans have been largely invisible until very recently. Yet they make up a significant and growing share of the LGBT and over 65 populations. LGBT elders are gaining visibility with the aging of LGBT Baby Boomers, who are the first generation of LGBT people to have lived openly gay or transgender lives in large numbers.
These individuals confront all the same challenges of people who age. But they also face unique barriers and inequalities that stem from the effects of social stigmas and prejudice, their reliance on informal “families of choice” for care and support, and inequitable laws and programs that treat LGBT elders unequally. These barriers can prevent LGBT elders from achieving three key elements of successful aging: financial security, good health and health care, and social support and community engagement.
That’s why Services and Advocacy for Gay, Lesbian, Bisexual, & Transgender Elders and the Movement Advancement Project recently released “Improving the Lives of LGBT Older Adults” in partnership with the Center for American Progress, the American Society on Aging, and the National Senior Citizens Law Center, which provides an overview of LGBT elders’ unique needs and the policy and regulatory changes that are needed to adequately address them.
Challenges for LGBT elders
The report outlines three unique circumstances that make successful aging more difficult for LGBT elders than for their heterosexual counterparts:
- The effects of social stigma and prejudice, past and present. Historical prejudice against today’s LGBT elders has disrupted their lives, their connections to their families of origin, their chances at having and raising their own children, and their opportunities to earn a living and save for retirement. This prejudice also impedes full and equal access to important health and community services, programs, and opportunities.
- Reliance on informal “families of choice” for social connections, care, and support. Family members provide about 80 percent of long-term care in the United States, and more than two-thirds of adults who receive long-term care at home depend on family members as their only source of help. Yet LGBT elders are more likely to be single, childless, and estranged from biological family and therefore must often rely on friends and community members as their chosen family. Official policies, laws, and institutional regulations and practices generally prioritize legal and biological family, and in many instances deny caregivers who do not fall into traditional categories the resources and recognition afforded to opposite-sex spouses and biological family members.
- Inequitable laws and programs fail to address—or create extra barriers to—social acceptance, financial security, and better health and well-being for LGBT elders. Safety net programs and laws intended to support and protect older Americans fail to provide equal protection for LGBT elders. This is largely because they either do not acknowledge or do not provide protections for LGBT elders’ partners and families of choice, and because they fail to recognize and address the ongoing stigma and discrimination that result in substandard treatment of LGBT elders.
The challenges identified above diminish LGBT elders’ prospects for successful aging by making it harder to secure financial security; good health and health care; and social and community support.
LGBT elders as a group are poorer and less financially secure than older Americans as a whole. Financial instability comes from a lifetime of discrimination combined with major laws and safety net programs that fail to protect and support LGBT elders in the same way they do heterosexual elders. Data show the grim effects of this unequal treatment—lesbian couples receive an average of 31.5 percent less in Social Security, and gay couples receive 17.8 percent less when compared to heterosexual couples.
Social Security. LGBT elders pay into Social Security just like their heterosexual peers, yet they are not equally eligible for Social Security benefits. The biggest difference in treatment is that committed same-sex couples are denied the substantial spousal and survivor benefits provided to married couples.
Medicaid and long-term care. Medicaid is the largest funder of long-term care in the United States. Medicaid has exemptions for married heterosexual couples to avoid requiring a healthy spouse to sell a shared home or to live in poverty to qualify an ill spouse for long-term care. But these spousal impoverishment protections do not apply to same-sex couples and families of choice.
Tax-qualified retirement plans. There have been some positive changes in the law in recent years, but LGBT elders still lack the same benefits as their heterosexual peers when it comes to the treatment of IRAs and similar plans. For example, surviving heterosexual spouses can leave inherited retirement accounts to grow tax free until they reach age 70 and a half, but “non-spouse” beneficiaries cannot.
Employee pensions and defined-benefit plans. Employer policies regarding the Qualified Joint and Survivor Annuity and Qualified Pre-retirement Survivor Annuity deprive same-sex couples of needed financial protections for a surviving partner or chosen family member, though these protections are available for heterosexual spouses.
Retiree health insurance benefits. Federal tax law currently allows an employer to provide health insurance to the heterosexual spouse of an employee or retired employee as a tax-free benefit, but for same-sex couples, a partner’s insurance benefits are treated as taxable income.
Estate taxes and inheritance laws. The federal government allows a surviving heterosexual spouse to inherit all of the couple’s assets without incurring any tax penalty, but federal and state laws require same-sex partners to pay inheritance taxes on some estates. LGBT elders in most cases must put in place a series of specific and often expensive legal arrangements to try to ensure that financial decision making and inheritance will pass to a partner or member of a family of choice.
Veterans’ benefits. The U.S. Department of Veterans Affairs provides a variety of benefits to veterans’ heterosexual spouses, including pensions paid to the spouse of a service member killed in combat, medical care, and home loan guarantees. These benefits are not available to a same-sex partner.
Legal recognition of same-sex relationships at both the state and federal level would address many of the inequities in government safety net programs for LGBT Americans. Yet government should also examine broader approaches given the uncertain timeline associated with this approach, coupled with the fact that it still would not help the vast majority of single LGBT elders.
Congress could address many inequities at the federal level by adding and defining a category of person who is not a spouse (such as a permanent partner) who would receive equal treatment to a spouse under various federal laws and safety net programs for older people. The full-length report outlines broad state-level recommendations to advance equality on Medicaid rules, pension and domestic partnership benefits, estate and inheritance taxes, and more. Many of the state-level fixes are similar to the federal recommendation of establishing a “permanent partner” category to applicable state laws.
Health and health care become increasingly important issues for people as they age. But LGBT elders often find it more difficult than others to receive the health care.
LGBT elders’ health disparities are overlooked and ignored. Governments and service providers rarely track, and are largely unaware of, LGBT elders’ health disparities. For example, LGBT elders are more likely to delay getting needed care, and they have higher rates of chronic certain physical and mental conditions.
There is limited government and social support for families of choice. LGBT elders rely on family-of-choice caregivers, who generally do not receive the same legal or social recognition as biological family caregivers.
Health care environments often are inhospitable to LGBT elders. Many professional caregivers are not accepting of, or trained to work with, LGBT elders. These providers may be hostile, discriminatory, or simply unaware that LGBT elders exist.
Nursing homes often fail to protect LGBT elders. Nursing home rules, together with prejudice and hostile treatment on the part of staff and fellow patients, can create unwelcoming environments for elders who are unable to advocate for themselves.
Visitation policies and medical decision-making laws often exclude families of choice. LGBT elders’ partners or other loved ones may be shut out of medical decision making or denied visitation unless they have complex and often expensive legal arrangements in place.
There is no one catch-all approach for solving LGBT elders’ health inequities given the sheer size of the U.S. health care system and the complex network of state and federal laws that regulate it. Helping LGBT and other elders achieve good health and health care requires strategies ranging from training and education for health care providers to state and local advocacy such as passing nondiscrimination laws that include protections for LGBT elders, and changing state laws to more clearly recognize partners and families of choice for care giving and medical decision making.
Social support and community engagement
Social isolation is higher among older LGBT adults than in the general population of elders despite a high level of resilience and strong connections to families of choice. LGBT elders are more likely to live alone and more likely to feel or actually be unwelcome in many health care, social service, and community settings. Research shows the harmful effects of this type of social isolation and denial of services and support, including higher depression, poverty, rehospitalization, delayed care-seeking, poor nutrition and premature mortality. Successful aging for LGBT elders depends on reducing their social isolation and increasing access to the services that are available to other older people.
LGBT elders lack support from, and feel unwelcome in, mainstream aging programs. LGBT people often feel unwelcome at senior centers, volunteer centers, or places of worship. Few such agencies engage in outreach to LGBT elders, nor are they prepared to address incidents of discrimination toward LGBT elders by staff and older people.
LGBT elders lack support from, and feel unwelcome in, the broader LGBT community. Several authors have commented that ageism is particularly strong within gay male communities. Researchers have also found that many older LGBT people feel disconnected from or unwelcome by younger generations of LGBT people. LGBT advocates and organizations are becoming more intentional about reaching out to, involving, and harnessing LGBT elders’ talents, but there is still a great deal of work to be done to build bridges within the LGBT community.
LGBT elders lack sufficient opportunities to contribute and volunteer. Many LGBT older people are, or have the potential to be, powerful advocates for change. Becoming active provides great value to the community at large, and can reduce social isolation and provide a sense of purpose. Adults who volunteer regularly have better physical and mental health and a lower risk of mortality. Yet older adults as a whole lack sufficient opportunities for community engagement, and LGBT elders often feel unwelcome in, or are overlooked as potential volunteers for, existing volunteer programs. Elder advocacy opportunities are extremely limited.
Housing discrimination adds to the challenges LGBT elders face in connecting to their communities. LGBT elders may be denied housing, including residency in mainstream retirement communities, based on their sexual orientation and gender identity and expression. This discrimination may separate LGBT elders from loved friends or partners, or push them into homelessness. LGBT elders may also feel the need to re-enter or stay in the closet in order to obtain or maintain housing.
Helping LGBT elders secure social support and community engagement requires action on many fronts. The Older Americans Act must be revised to specifically recognize and address the needs of needs of LGBT older people when it goes up for reauthorization in 2011. Mainstream aging services providers need to provide training to staff in cultural competency, while LGBT advocates should offer more programming directed at LGBT elders as well as more opportunities for them to become involved in advocacy and service provision. State and federal government should also strengthen laws to prevent discrimination in housing based on sexual orientation.
A growing number of openly LGBT elders will soon present new challenges and opportunities to the way our nation cares for and serves its older population. Now is the time to make changes to laws, community services and attitudes, and health care practices to help elders improve their financial security, access culturally competent health care, and remain active and fully engaged members of their communities. All Americans deserve the chance to age with dignity, and solutions that help LGBT elders do so will help all Americans who are aging or face inequality.
Read the report snapshot (pdf)
Michael Adams is the Executive Director of Services & Advocacy for GLBT Elders and Jeff Krehely is Director of the LGBT Research and Communications Project at the Center for American Progress.
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