By Dr. Marcy Adelman–
Four years ago, this March, the San Francisco LGBT Aging Policy Task Force concluded its 18-month tenure by submitting its final report, LGBT Aging at the Golden Gate: San Francisco Policy Issues and Recommendations, to the Board of Supervisors. The LGBT task force had been charged with studying and identifying systemic barriers to living well and to make recommendations for enhancing quality of life and reducing health disparities and inequities for LGBT older adults.
The task force’s report was unanimously adopted by the Board of Supervisors in April 2014. Four years later, I am happy to report that all but two of the task force’s thirteen recommendations have been implemented, or are in process of implementation.
The task force was able to achieve successful outcomes because of four key factors:
First, the task force intentionally increased the likelihood of achieving favorable outcomes by focusing on bold policy changes and innovative programing that were highly feasible and would have the greatest impact. The LGBT Senior Care Facilities Bill of Rights and the LGBT Data Collection Ordinance are policy changes that best reflect this focus. The development and implementation of an LGBT dementia capable care training program and an isolations prevention peer support program are examples of feasible, innovative and much needed programing.
Second, the successful outcome of the task force’s recommendations can also be attributed to the leadership of then Supervisor Scott Wiener, who responded to requests from LGBT aging advocates by introducing legislation to establish the time limited task force, sponsored and authored task force recommended legislation, and supported funding for task force identified programs. To succeed, LGBT aging issues and concerns greatly benefit from a champion at City Hall.
A third factor in the task force’s success in the implementation of their recommendations is its partnership with the Department of Aging and Adult Services (DAAS). San Francisco has a department of aging that is committed to the principles of diversity and equity. DAAS committed resources and assistance that were essential to the task force’s ability to commission and conduct four research projects and then followed through with funding for new, or increased, programing based on the strength of these studies and the task force’s study of best practices in deliberating and making recommendations.
And finally, the task force members themselves were a passionate, dedicated group of community advocates with diverse areas of expertise in LGBT aging from health and social services to housing and legal issues to HIV and transgender aging issues and more. Each member understood what a unique opportunity the task force was to make a difference in all of our lives and we were determined, no matter what, to do our very best. It was a privilege and an honor to serve and to serve with these dedicated people.
The success of the task force does not mean, however, that there isn’t more work to be done. There are still two recommendations that have yet to gain traction. They are a work in progress. Supervisor Wiener is now a Senator and is no longer on the Board of Supervisors. The two remaining recommendations would benefit from a champion at City Hall.
The existing continuum of senior care is too slow in responding to the needs of LGBT older adults. LGBT older adults are still underrepresented in housing and health and social services and remain invisible and devalued in too many places in the LGBT community itself. The work continues, but because of mandated data collection, we will be better prepared to identify what our needs and concerns are and how best to employ our resources. The task force’s success is not a fix, but it is another step—and an important step—on the road to all people being able to thrive and grow regardless of age, race, ethnicity, income level, sexual orientation, gender identity or ability.
LGBT Aging Policy Task Force: Problems and Solutions
Below is an update on each of the issues identified by the task force.
1) Recommendation: Improve understanding of service needs and service utilization in the LGBT community by collecting data on sexual orientation and gender identity whenever other voluntary demographic data is collected.
Solution: The LGBT Data Collection Ordinance, mandating data collection by five city departments, was passed in July 2016. A progress report will be released this fall. Full compliance is scheduled for the summer of 2019.
2) Recommendation: Improve inclusion in services and improve service providers’ ability to work effectively with LGBT older people by expanding existing cultural competency training.
Solution: Funding was made available to expand provider training.
3) Recommendation: Improve LGBT community awareness of existing community-based services and city resources for a wide range of social services and health care.
Solution: An Aging and Disability Resource Center was opened in the LGBT community. An LGBT Care Navigation and Isolation prevention program was developed and implemented.
4) Recommendation: Increase care planning and care coordination by developing and implementing an LGBT older person case management and peer specialist program.
Solution: Funding was provided for Case Management program.
5) Recommendation: Increase supportive services that address the emotional, behavioral, health and social isolation challenges by developing and implementing an LGBT older adult peer counselling program and an LGBT peer support volunteer program.
Solution: A prevention program is now up and running.
6) Recommendation: Increase LGBT older adults’ utilization of existing Alzheimer’s and dementia care services by developing and conducting LGBT/dementia competent training for service providers and older adult serving organizations to be more effective in serving the LGBT community and create and conduct an LGBT community targeted education and awareness campaign.
Solution: Alzheimer’s Association of Northern California and Nevada has partnered with LGBT older adult serving non-profits to develop and conduct training and an awareness campaign.
7) Recommendation: Increase financial literacy by developing and implementing a financial literacy training targeting LGBT older adults.
Solution: Training was developed by the Department of Treasury and the Office of Financial Empowerment.
8) Recommendation: Improve eviction and homeless prevention protections for LGBT older adults by increased funding to existing programs with flexible subsidy pools.
Solution: Funding was increased in 2015.
9) Recommendation: Increase availability of affordable housing welcoming to LGBT older adults by prioritizing developments that target the LGBT community and improve access to affordable housing by providing LGBT focused housing counseling programs.
Solution: Funding was increased to the existing LGBT focused housing counseling program.
10) Recommendation: Improve legal protections and resources for LGBT older adults in long term care facilities by passing legislation that protects clients with clear guidelines and offers support for enforcement.
Solution: The LGBT Senior Care Facilities Bill of Rights was unanimously approved by the Board of Supervisors in March of 2015.
11) Recommendation: Promote LGBT life planning legal clinics targeted to LGBT older adults to ensure future life wishes are followed.
Solution: Implementation and funding are in progress.
Recommendations Waiting Implementation
1) Improve unsafe and unhealthy conditions in SROs through improved policies and enhanced work on habitability.
2) Improve safety of LGBT older adults in city shelters by providing LGBT targeted shelter services and implementing culture competency training for shelter staff.
Marcy Adelman, Ph.D., a clinical psychologist in private practice, is co-founder of the non-profit organization Openhouse. She is also a leading advocate and educator in LGBT affirming dementia care and a member of the Advisory Council to the Aging and Adult Services Commission.
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