By Grace Li, M.H.A.–
When Openhouse and On Lok began working together on the concept of an adult day program for the LGBTQ+ community, in 2018, our goal and hope was to help LGBTQ+ seniors who were aging in isolation access services and supports in order to remain living in their community.
We all share the goal of aging in the place we call home, surrounded by the people we love, in a community where we feel a sense of belonging. Aging in place is especially important for LGBTQ+ seniors, who are more likely to be at risk for nursing home placement due to lack of family support, health disparities, and other risk factors, and to face discrimination and mistreatment in long-term care facilities.
The fear of ending up in an institution, away from their chosen family and community, is common among LGBTQ+ older adults who have experienced the trauma of discrimination and exclusion in their lifetime. According to a 2011 study by the National Senior Citizens Law Center, 78 percent of LGBTQ+ people surveyed felt it would be unsafe for an LGBTQ+ senior to be “out” in a care facility, and 80 percent believed staff and other residents would discriminate against an LGBTQ+ elder who was out of the closet.
Openhouse and On Lok had the expertise and deep desire to deliver services to help these seniors age in place. On Lok has over five decades of experience pioneering programs to maintain seniors living in their homes for as long as possible. Openhouse has a history of providing housing, services, and community programs to LGBTQ+ seniors. However, as we engaged with the community to learn more about their unique needs, we realized that accessing aging services, even in LBGTQ+-friendly San Francisco, was of itself a challenge for this population. In the groundbreaking Needs Assessment of LGBTQ+ Senior Health in San Francisco—published by University of Nevada, Las Vegas, Assistant Professor of Public Health Dr. Jason Flatt when he was an Associate Professor at the UCSF Institute for Health and Aging and released by Openhouse and On Lok—data showed that LGBTQ+ seniors are four times less likely to access aging services than other populations. One in five respondents felt unsafe or unwelcome in care settings; others reported difficulty accessing transportation to services and programs that did not reflect the LGBTQ+ experience.
To overcome the deep mistrust of LGBQ+ seniors, we knew we had to create a space and a program that really spoke to the needs and concerns of the LGBTQ+ senior community in all of its glorious diversity. In partnership with Openhouse, we envisioned a safe and inclusive space where community members could connect with their peers, enjoy activities that recognized and celebrated their identity, eat a nutritious hot meal together, and receive affordable and compassionate care to support their health and wellness.
The Vision Becomes a Reality
Since it launched in December 2021, Openhouse + On Lok Community Day Services has been using the strength, expertise, and credibility of our organizations to bring to the community a program you don’t see anywhere else in the nation. Openhouse + On Lok Community Day Services is the first licensed day program in the nation co-designed with and for the LGBTQ+ community. And it is a true partnership between Openhouse and On Lok.
Located on the second floor of a brand-new facility built by Openhouse at 75 Laguna Street in San Francisco, the day center houses a large and light-filled activity room with state-of-the-art equipment, a kitchen, library, and gender-neutral bathrooms with showers. It shares an outdoor courtyard with the residents of the Openhouse community at 55 Laguna, with picnic tables and natural shade. In this welcoming and life-affirming space, LGBTQ+ seniors can engage with their community and benefit from meals, wellness and personal care services, transportation, and social activities. The program is offered with a sliding scale discount to make it affordable to all.
Seniors who were once averse to engage with clinical settings because of historical trauma now enjoy support services and social connections at Openhouse + On Lok Community Day Services. When the community began to affectionately call it Club 75, we knew that our participants care about their center, and feel as if they belong there. Community members are always sharing with us the positive impact of Club 75 on their lives. Our most recent success stories go straight to the heart of our mission and our vision for this program.
We were able to help Sharon with social activities and care for her wife, Barbara, whose memory is starting to decline, so she can remain living at home and socially connected with her chosen community. Other programs they tried where either unresponsive, too expensive, or just did not feel right. But at Club 75, Barbara has found critical care support and community, in a safe environment she trusts. Sharon has started attending an Openhouse support group for caregivers, which has become an important outlet from the stress and grief of caregiving.
Another participant, Maryanne, is grateful for the opportunity to break out of years of isolation and enjoy lunch, walks, board games, and conversations with her queer peers. Because of a disability, she used to feel that her world was shrinking, and she was becoming invisible. Most of her friends have moved or were lost during the AIDS epidemic and COVID-19. But today she feels seen and embraced by her community at Club 75.
And after two years of sheltering in place, Miss Patti Ann, a transgender woman living with disability, is thrilled to spend her days at Club 75. Like many transgender seniors, she had no one to rely on for support and social interaction. Here she has found a fun group of people who care about her, and life-affirming activities she can enjoy as her authentic self. She appreciates cooking classes and an exercise program she can do while seated in her chair. With safe transportation now available, she has come out of her shell and is discovering the city with her new friends.
A Program Informed by the LGBTQ+ Experience
Club 75 staff bring their own first-hand experience of discrimination and marginalization to break down barriers and ensure the program is applicable, relevant, and impactful in meeting the needs of LGBTQ+ seniors. Staff members identify with the queer community they serve and revere their elders. They are specially trained to care for adults who have experienced trauma or have mental health challenges, or who are living with Alzheimer’s or other dementias.
Our programming is robust and intentional, filling the day with activities tailored to the individual needs of participants. Seniors are engaged in San Francisco’s culture, with outings to music performances, cultural events, gallery, and museums—the kind of activities they enjoyed when they were younger and now cannot access on their own.
If needed, members and their caregivers are referred to additional health and social services through Openhouse and On Lok to provide them with a continuum of care as their needs change. The center is now a certified alternative care setting (ACS) for the Program of All-Inclusive Care for the Elderly (PACE), the full-service healthcare program pioneered by On Lok to empower seniors with long-term care needs to live at home for as long as possible. Alternative care settings offer PACE participants more geographically convenient access to some of the services they receive, such as preventative care and meals. On Lok has a history of supporting vulnerable populations by creating alternative care settings with partners in the community. For the city’s LGBTQ+ seniors who choose to enroll in On Lok PACE, it will also include the choice to attend Club 75.
Ephraim Getahun, Director of Strategic Partnerships & Training at Openhouse, is leading outreach deep in the community to identify seniors who would most benefit from the program. Hospitals and skilled nursing facilities are learning about us and reaching out when they discharge people as they are transitioning back to the home. Many want to embed Openhouse + On Lok Community Day Services in their care planning.
Our dream is for the program to grow and lift the lives of all LGBTQ+ seniors in need, and for our partnership with Openhouse to continue to flourish. We are deeply grateful to all the people who have worked so hard to make our bold vision of creating a safe and inclusive space for LGBTQ+ elders a reality: Karyn Skultety and Marcy Adelman, with whom we began our amazing journey, and Openhouse Executive Director Kathleen Sullivan for her leadership and guidance going forward. Together, we can ensure that LGBTQ+ seniors have the services to age as their authentic selves in the community they love.
For additional information about Club 75, contact Openhouse + On Lok Community Day Services at 415-292-8302 or email communitydayservices@onlok.org
With more than three decades in healthcare and 22 years at On Lok, Grace Li’s experience spans a wide range of healthcare settings. She has worked in hospitals and managed physician practices, in private and academic settings, and in assisted living facilities and healthcare consulting. She holds a Master of Health Administration from the University of North Carolina, Chapel Hill, and a Bachelor of Arts in Economics from the University of Florida.
Aging in Community Special Section Part Two by Dr. Marcy Adelman
Published on May 18, 2023
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