There 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.