The Aging LGBT Community

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The Aging LGBT Community
Presented by LGBT Boomers and
BeyondCoalition For Arizona State University
Southwest Interdisciplinary Research
Center(SIRC)
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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

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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

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LGBT Boomers and BeyondCoalition The Beginnings

• Scott Hawthornthwaite
• Director of Caregiver Services
• Area Agency on Aging

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History

• 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

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Monthly Social/Educational Series at One Voice
LGBT Community Center

• Movies
• Pride
• Caring for yourself
• Housing Options
• Community Resources

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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
http//lgbtboomersandbeyond.wordpress.com/
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LGBT Aging in AmericaFact and Myths

• PresenterRev. Adero C E Allison, PhD
  Transitions Adults Plus
• http//TAplus.com

PresenterChris Boutwell One Voice Community
Center http//1VCC.org
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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)

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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)

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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)

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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
  alone.
• 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)

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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)

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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
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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)

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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.
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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
  family.
• 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)

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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 ,
2009)
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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
  restraints.
• (Geyer, G., 2011)

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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
  heterosexuals.
• Older adultsthose age 50 and olderare not at
  risk for HIV or AIDS.
• (Southern Poverty Law Center, 2011 )
• (LGBT Aging Center, 2011)

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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
  activity.

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Resources

• Outing Age Public Policy Issues Affecting Gay
  Lesbian Bisexual and Transgender Elders by Sean
  Cahill, Ken South and Jane Spade
  http//www.thetaskforce.org/reports_and_research/o
  uting_age_2010
• 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.
  org/downloads/resources_and.../find_the_dollars.pd
  f
• Caring for caregivers The issuesand
  interventionsare different for racial and
  ethnic-minority caregivers. By Rebecca A. Clay
  February 2009, Vol 40, No. 2 http//www.apa.org/mo
  nitor/2009/02/caregivers.aspx
• Gay and Lesbian Retirement Communities Gays and
  lesbians over 50 find friendship, community and
  mutual support, By Sharon O'Brien -
  http//seniorliving.about.com/od/housingoptions/a/
  gay_housing.htm
• Population Resources Center Providing the
  Demographic Dimension of Public Policy
  http//www.prcdc.org/300million/The_Aging_of_Ameri
  ca/

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Resources

• THE COST OF MARRIAGE INEQUALITY TO GAY, LESBIAN
  AND BISEXUAL SENIORS A Human Rights Campaign
  Foundation Report January 29, 2004
  http//www.hrc.org/documents/cost_of_marriage.pdf
  
• Senior-care providers face more gay, lesbian,
  bisexual and transgender clients, report
  indicates from Pioneer Press December 22, 2010
  http//www.aarp.org/relationships/caregiving/news-
  12-2010/senior_care_providers_face_more_gay_lesbia
  n_bisexual_and_transgender.html
• 10 Anti-Gay Myths Debunked By Evelyn Schlatter
  and Robert Steinback, Southern Poverty Law Center
  http//www.splcenter.org/get-informed/intelligence
  -report/browse-all-issues/2010/winter/10-myths
• LGBT Aging Center http//lgbtagingcenter.org/resou
  rces/resource.cfm?r322

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Lesbian, Gay, Bisexual Transgender Issues and
Family Caregiving

• David W. Coon, Ph.D.
• College of Nursing Health Innovation
• Arizona State University

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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
  history

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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)

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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.
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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.
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Moving from Awareness toIncreasing Cultural
Competence

• Within these sociocultural contexts providers
  need to
• explore the physical, psychological and social
  changes
• 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

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Moving from Awareness toIncreasing Cultural
Competence

• 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)

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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
  process?

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Identifying Obstacles to LGBT Service Utilization

• Institutional/Organizational Barriers
  (Availability/Accessibility).
• Community Level
• (ageism cg burnout respect for level of
  outness).
• Policy Level
• Lack of domestic partner benefits
• Lack of anti-discrimination policies protecting
  employment, public housing and social services.

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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.

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Overcoming Obstacles to LGBT Service Utilization

• Organizational/Systems Level
• Zero Tolerance for Discrimination.
• Improve availability/accessibility (info
  referral).
• Safe Place Symbols.
• Community Advisory Board/Partners.

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Overcoming Obstacles to LGBT Service Utilization

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

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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
  benefits.

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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)

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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.
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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.
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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.
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Emerging Promising Practices

• Information and Referral.
• Published material.
• Education Workshops Forums.
• Support Groups Counseling.
• Online Information Support.
• Skills training.

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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. www.ngltf.org
• 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
  Group.

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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
  www.caregiver.org

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Some Readings

• Family Care Giver Alliance (2011) Special
  concern of LGBT caregivers. Available free
  online at www.caregiver.org.
• Fredriksen-Goldsen, K. I., Muraco, A. (2010).
  Aging and sexual orientation A 25-year review
  of the literature. Research on Aging, 32,
  372-413.
• 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.

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Community Programs and Resources in Maricopa
County
LGBT Boomers and BeyondCoalition
46
Social Prime Timers
For More Information Visit http//phxprimetimers.
wordpress.com/
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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

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Other Arizona LGBT Resources
Tucson Wingspan www.wingspan.org Prescott
Pride Center www.prescottpridecenter.com Northla
nd Cares www.northlandcares.org Parents
Friends of Lesbians and Gays (PFLAG) www.pflag.org
Nationwide with 9 AZ locations Bullhead City,
Lake Powell, Payson, Phoenix, Yuma, Tucson,
Winslow, Sierra Vista, Flagstaff
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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.

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PresenterBrett Petersen, MSWDuetwww.Duetaz.or
g
Working with Caregivers
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Caregiver Statistics

• One in four U. S. households involved in care
  giving
• 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)

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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
  caregiving
• 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
  caregiver
• (LGBT Movement Advancement Project and Services
  and Advocacy for Gay, Lesbian, Bisexual and
  Transgender Elders, 2010)

53
Sources

• Caregiving in the US Executive Summary conducted
  by The National Alliance for Caregiving in
  collaboration with AARP, 2005, www.caregiving.org
• 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, www.lgbtmap.org

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Hospice of the ValleyPresenterBillie Myres,
LPC, Bereavement Counselor
LGBT Bereavement Support
55
LGBT Bereavement Support

• History
• Open, on-going group
• Closed, six week groups
• Who attends

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LGBT Bereavement Support

• Why they attend
• Stories
• Challenges

57
602 530-6900, www.hov.org Jennifer Klingberg,
RN, BSN Community Liaison, jklingberg_at_hov.orgJoa
n Zecherle, jzecherle_at_hov.org
Hospice of the Valley Contact Information
58
Discussion/Questions

• For a copy of this PowerPoint presentation
• Visit our Website
• http//lgbtboomersandbeyond.wordpress.com/