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    The Longevity Wave: Meeting Future Needs

    agingladyThere are 3 million LGBT seniors, and that number is expected to dou­ble by 2030. People over 65 years of age are the fastest growing segment of both LGBT and non-LGBT popula­tions, especially seniors over the age of 85. Is the existing senior-serving infrastructure prepared to meet the needs of this exponential growth in our senior population? Yes, but only if government, foundations and philanthropy step up to the plate by investing in additional affordable senior housing, services and programs that will help all of us, LGBT and non-LGBT, live longer healthier more vital lives.

    Although many of us can take steps to remain healthy and independent as we age, most will experience de­clining physical and sensory abilities, and some will suffer from a decline in cognitive functioning. It is estimated that half of all people over the age of 65 will need some type of assistance with activities such as bathing, dress­ing, house cleaning, cooking, trans­portation and managing money. This assistance can help a person recover from a recent hospitalization or medi­cal incident, or provide the on-going capacity for self-care that is lost be­cause of a chronic illness or disabling condition. The focal point of this care is the home.

    Housing is the lynchpin of health and well being for people of all ages. Af­fordable housing, when combined with supportive services, allows peo­ple to stay in their homes and to re­ceive needed care to live as indepen­dently and as long as possible in their communities. Conversely, care in a nursing home is four times more ex­pensive than receiving care at home, and the disruption to a person’s life, relationships and well being is incal­culable. The lack of affordable hous­ing is not just a San Francisco crisis but is also a national one. It isn’t a surprise then that safe, affordable housing is cited as the #1 priority of LGBT seniors across the country.

    Essential to the housing crisis is the problem of supply and demand. There is not enough affordable housing, es­pecially in the country’s larger cit­ies, for low-income seniors, disabled people, veterans, middle income and working families and people living with HIV/AIDS. The lack of an adequate hous­ing supply causes housing costs to escalate. The more money that goes to pay for rising rents or mortgages means less money for the essentials of life, such as food, transportation and medicine.

    LGBT older adults and seniors face unique challenges to staying in their homes. Five are listed below:

    1- High levels of financial insecuri­ty after a lifetime of discrimination that has negatively impacted gov­ernment benefits, income and sav­ings. Studies report that lesbians, LGBT seniors of color, trans elders and longterm AIDS survivors ex­perience higher levels of poverty than heterosexual seniors.

    2- High rates of discrimination in housing and in senior service set­tings. It has been well documented that LGBT seniors experience dis­crimination by providers in their homes, in nursing homes, assisted living facilities and when buying or renting a home. When forced to move from their homes for health or financial reasons, it is challeng­ing for LGBT seniors to find other safe and affordable housing.

    3- Fear of discrimination, of not be­ing treated with dignity and respect by service providers and senior housing residents is a barrier to ac­cessing senior services or applying for affordable senior housing.

    4- Lack of protection from dis­crimination in housing. In March of this year, San Francisco passed the LGBT Senior Long Term Care Facilities Bill of Rights, the first or­dinance of its kind, which makes it illegal to discriminate against pa­tients in nursing homes and assist­ed living facilities based on sexual orientation, gender identity, gender expression or HIV status. Hopeful­ly other cities and counties will fol­low with similar ordinances. More protections are also needed at the national and state level.

    5- Limited support networks result in fewer resources in financial and emotional assistance. The major­ity of non-LGBT people rely on spouses and adult children to pro­vide the care and support that they need to age in their homes and in their communities. Family caregiv­ers lovingly provide the care that is needed either directly themselves, and/or assist with the financing of professional in-home services. Two out of three older people who re­ceive care at home receive all their care from family caregivers.

    Unlike, heterosexual seniors, LGBT seniors and LGBT boomers are four times less likely to be parents and twice as likely to be single and living alone. LGBT older adults and seniors rely on close friends, rather than fam­ily, for support. But our informal sup­port networks can become frayed and limited over time as our dear friends are typically similar in age and may not be available to provide the care that we need.

    At some point, we will need to rely on home health care services in or­der to stay in our homes and to avoid placement in a skilled nursing facility or assisted living. I recently visited a friend in his late 70’s who is recover­ing at home from back surgery. He said, “I knew about all of this. After all, we have talked about this sort of thing eventually happening—needing to hire someone to help. But I nev­er really understood how complex, difficult and expensive it all is. I am still easily exhausted by rehab and from focusing on the things I have to do to get well. I have little energy left to work out schedules, the coming and going of the aids and adapting to hav­ing them here in my home. If I didn’t have friends to help with the logistics, I would be in real trouble.”

    The good news is that there is a small, but expanding, network of LGBT ag­ing and LGBT senior competent ser­vices in place to assist people to con­tinue to live at home and to thrive in community. Three innovative organi­zations in San Francisco are the San Francisco Village, the Next Village and Openhouse. Both Village organizations are mainstream, LGBT welcom­ing, non-profit, membership-driven organizations that help members as requested, coordinate volunteers, and also provide health, wellness and so­cial programs. Openhouse, a non­profit LGBT agency, helps seniors re­main in their homes and community by providing support groups, a friend­ly home visitors program, health and wellness programs, free medical con­sultations, housing counseling, hous­ing itself, community events, LGBT senior cultural competency training for senior service providers and agen­cies, and information and referral about other services and resources.

    In New York City, SAGE provides so­cial activities and programs as well as national advocacy work. It is home to the National LGBT Resource Center. The Los Angeles LGBT Center—Se­nior LGBT Services provides afford­able housing counseling and a wide range of services and programs. In Chicago, the Center on Halsted pro­vides an array of senior services and programs and, in partnership with Heartland Alliance, offers LGBT friendly senior apartments. However, most large cities lack LGBT friendly services related to the housing or ser­vices that seniors need.

    The development of low-income LGBT senior welcoming housing projects with supportive services is taking place around the country: Los Angeles; Chicago; Washington, D.C.; Phila­delphia; Minneapolis; Sacramento; Cleveland and San Francisco. The project by San Francisco’s Open­house is unique in offering services and resources not only for their hous­ing residents, but also serving as a hub for LGBT seniors citywide as well.

    We can expect that half of the es­timated 6 million LGBT seniors in 2030 will need some kind of assis­tance, and that people will continue to prefer aging in their homes and in their communities. We can best pre­pare for this longevity wave by doing the following:

    -Assure that more federal, state and local support leads to increases in the supply of affordable housing with services for all seniors, as well as the development of more LGBT-friendly senior housing with services

    -Reward innovative housing pro­grams that create more housing op­tions

    -Increase funding for LGBT senior cultural competency training to make all senior services and senior housing more LGBT competent and friendly

    -Target funding that encourages and supports partnerships and collabora­tions between mainstream for-profit senior providers and LGBT senior non-profits

    -More funding is needed for  capacity building  for  the existing LGBT aging infrastructure if we are  to ensure a smart and effective response that will keep pace with the growing senior population.

    This is a time of great opportunity, if we have the courage and vision to meet the future head on.

    Marcy Adelman, Ph.D., a clinical psycholo­gist in private practice, is co-founder of the non-profit organization Openhouse and was a leading member of the San Francisco LGBT Aging Policy Task Force.