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MODULE 7
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The issues of concern to the LGBT community don't end with coming out -- the first time -- and they do not end as we grow older. LGBT people face homophobia in mainstream institutions throughout the life cycle, and in later years we face ageism within the LGBT community and from society in general.
Research comparing LGBT seniors with their straight counterparts has shown some key differences that have profound implications for those in the LGBT communities and for providers serving LGBT seniors. The Brookdale Center on Aging in New York City found that LGBT seniors have significantly diminished support networks when compared to the general senior population. These findings show that:1
This means that when they are compared to seniors in the general population, LGBT seniors are:
As a result, the LGBT community is much more reliant on and has much greater need for professional social services and formal support systems in their old age than seniors in the mainstream. But unfortunately, the studies have shown that LGBT seniors do not access the programs and services they need. In fact,they are five times less likely to access senior services than the general senior population.
Another survey of agencies serving seniors in the US showed that fully 50% of LGBT seniors would not be welcomed at senior centers if their sexual orientation were known.3 And with good reason; the majority of mainstream providers are heterosexist; they assume that all the old people they serve are straight. It's an assumption that affects programming and social service delivery, the language used for intake, for the discussion of relationships, for life reminiscing and many other programming activities, and it serves to marginalize and alienate the 3 million LGBT seniors across the nation.4 So, many LGBT seniors feel they have no choice but to go back into the closet if they want to access mainstream senior services.
Providers do not know enough about LGBT people, especially LGBT People of Color and of transgender experience. And it's only recently that issues confronting people of "intersex" experience become part of LGBT discussion and research.5 Efforts are being made to improve the situation, but until such time as that happens, it's up to us to inform and educate the providers. This may be difficult, but it's the only way change can be effected.
We live in a youth oriented, ageist, heterosexist, and "homophobic" world. Most of our laws, our services, and our entitlements deem that our living and dying happen within the context of the traditional family: mother, father and children; even grandparents aren't regularly included in our definition of family. The old are invisible.
Many states require "family" for enrollment in hospice or respite care, and often an LGBT senior's circle of care providers is left out of the decision making process in terms of medical and end of life issues. It is best to live and die in family and community - and many LGBT seniors have neither.
To be an old LGBT person sometimes means going into the closet as the years go on, especially if one is ill and needs a nursing home or some other form of long term care. Institutional residence is often more necessary if one is not living with a partner and has no immediate family and/or is alienated from family.
Some nursing homes are becoming aware that people over 65 are still sexual - or at least in need of sexual/sensual contact. There is a growing acceptance of this - even for people with Alzheimer's disease, whether they are married or not. Full acceptance of seniors (LGBT and heterosexual) includes acceptance of sexuality - it needs to be honored and provided for in nursing homes and assisted living.
A leading nursing home complex in New York City and other more advanced nursing homes and assisted living facilities have developed "safety rooms," where heterosexual couples, even those with dementia, could go to express their sexuality. Health care professionals were given training to make them sensitive to the continued sexual needs of the frail as they became elderly - or the elderly as they became frailer. Unfortunately, such rooms have been provided for men and women, but not for women and women or men and men.
Why not ask your provider to talk to their State Ombudsman Program about including LGBT issues in their trainings and on their check list. Or, see if they would be willing to enroll as an Ombudsman.
Furthermore, long term care residents in Joint Commission on Accreditation of Health Care Organizations (JCAHO) accredited facilities have specific protection against sexual orientation discrimination. But your friends and relatives need to help monitor this. When there is a lack of compliance they should use the JCAHO complaint hotline: 1-800-994-6610.6
A major issue in the LGBT community is the recognition of partners or, in their absence, of caring communities that provide important support and services. The need for this recognition, though not confined to seniors, takes on additional import as we grow older. There's the likelihood of hospitalization and additional health issues like medical decision making and disposition of remains. In "straight" families this is handled by the "next-of-kin," usually spouses and children, but an LGBT senior in need of care and physical and emotional support faces a serious problem. There are laws that prohibit hospital visitation by anyone other than blood relatives and in many states this means that a gay partner can be shut out of his or her partner's life at the most critical time.
Our current laws were created in a context which assumed the stereotypical family. As a result, LGBT seniors face many challenges when dealing with medical crises and end of life issues.
Changes in New York State Law
At the end of the 2005 session, the New York State Legislature passed a bill that provides domestic partners, both same sex and opposite sex, the ability to make decisions in the disposition of partner remains. Before this bill, it was unclear in New York who had the authority to bury or cremate bodily remains. The legislation creates a simple proxy form and recognizes that a written document expressing the wishes of the deceased always takes highest precedence.
It's important for us to be aware of these changes in the law, as some health care providers may not be aware of them. If you are in a situation where your rights as a partner are challenged you should not hesitate to make the provider aware of the new laws and if they do not respond, consider taking legal action.
Issues that Need to be Addressed
An important step for LGBT seniors to take is the completion of a health care proxy. This is a form that gives someone the authority to make all health care decisions. In the absence of a proxy (and in some cases, even when a proxy is provided), biological family members are often identified as the primary decision makers. (You can download a copy of the New York State Health Care Proxy form from the Department of Health web site.)
In our culture, law, medical and social work schools and theological seminaries don't teach their students about the needs of any old people, except, perhaps the frail elderly. And they have little, if any, training in the needs of the LGBT elderly. Without prepared professionals it becomes the task of LGBT seniors to educate the providers in areas such as well spouse support, grief recovery, and end of life decision making including funeral and burial practices. RAI and others are working to bring this needed education to the professionals, but seniors don't have the time to wait for everyone to becomes educated. Most professionals are not adverse to learning about the issues; they are simply ignorant of them. Therefore, you should feel free to bring your provider copies of this information and direct them to sources which will help them learn.
The mental health care system shares many of the heterosexist assumptions. "Well spouse support" groups and grief recovery groups are usually geared toward "spouses" in the traditional sense - husbands or wives. Well spouse groups that welcome LGBT people are found in the few social service agencies that are LGBT specific. But surviving partners who have not been "out" despite being in a monogamous relationship for 20, 30, 40 or more years may have difficulty finding an understanding group or agency. And very often, if the partner attends the group, the surviving family will use the occasion to express their dislike of the relationship. When a partner dies without a will or specific instructions about disposition of the remains (and sometimes, the property) the situation is exacerbated. We need to make sure the agency or group understands the danger of such a situation and that steps are taken to head off any such confrontation.
Grieving rites usually involve gathering to support the surviving family, but this does not happen when the "survivors" are unknown or unrecognized by the family, the religious institution, or other parts of the community. During the height of the AIDS crisis there was "constructed" family and community in place that may not have been included in grieving rites. This phenomena still holds true for many LGBT seniors.
Today's LGBT seniors have lived through periods of wholesale rejection and condemnation from all segments of society. They have been labeled "illegal" by the State, "immoral" by the religious community, and "mentally ill," by the medical and mental health establishments.
In spite of this marginalization, many of our LGBT seniors were and are social, artistic and political pioneers. They were key in creating a unique and distinct LGBT culture, celebrating the LGBT identity, non-traditional family structures and more varied gender expression. They built LGBT community-based organizations, promoted LGBT cultural expression through writing, music, the performing and visual arts, and organized to reform homophobic laws, institutions and practices, educating the public about our issues.
If you are one of these seniors, you have dealt with homophobia for decades. And you can use the same strategies to deal with "ageism." You can bring your learning experiences to younger generations. Many LGBT seniors have remained "single," but have built support networks of friends, family and past lovers that enrich their lives and provide caregiving assistance. And those who have been in loving relationships for decades despite not having been recognized by laws, are in the forefront of advocacy for changes in laws that recognize domestic partners.
We applaud those LGBT seniors who take an active part in the changes that are being wrought. And we encourage all LGBT people, regardless of age, to become active in the movement to bring about equal care and treatment for LGBT seniors. They have done so much for us; it's time we did much for them. (See the RESOURCES link for organizations and agencies where you can go to offer help.)
SUICIDE PREVENTION
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The information provided by Rainbow Access Initiative, Inc. is for educational purposes only and is not intended to render medical advice or professional services. The information should not be used for diagnosing or treating a health problem or a disease and is not a substitute for professional care. If you have or suspect you may have a health problem, consult your healthcare provider.
Rainbow Access Initiative is a 501(c)3 tax-exempt organization.
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