Eldercare Voices: Understanding the Unique Health Needs and Vulnerabilities of LGBT Older Adults
legal mistreatment, many LGBT older adults deal with a complex array of social, emotional and physical health needs, including elevated rates of social isolation, depression, suicidal ideation, HIV/AIDS, chronic illness and premature mortality.
LGBT older adults, when compared to their non-LGBT counterparts, are disproportionately likely to be single, childless and living alone. These factors are largely consequences of past legal restrictions to marriage and adoption, as well as exclusionary societal definitions of family. Painfully contributing to this isolation is the fact that many LGBT older adults have also become estranged from their biological family members over the course of their lives.
According to the Movement Advancement Project, 80 percent of caregiving in the United States is provided by family members. LGBT elders aging without such a familial support network are therefore disproportionately likely to have to rely on formal systems of care. Yet, these systems of care are in many ways unprepared to serve the unique and complex needs of LGBT older adults.
There are also financial challenges that result in disproportionate hardship for this population. Decades of institutional discrimination have severely cut short the lifetime earning potential of a large segment of the LGBT community. Data from UCLA’s Williams Institute suggest that 24 percent of lesbians and 15 percent of gay and bisexual men are poor, compared to 19 percent and 13 percent of heterosexual women and men, respectively. A 2014 report from SAGE (Services and Advocacy for GLBT Elders) found that LGBT older adults were far more concerned than non-LGBT elders about their financial security and ability to retire.
Transgender communities, in particular, face these economic hardships and the financial insecurity that hinders successful aging. Lifetime experiences with discrimination in housing, education and employment are even more pronounced for transgender people than for LGB people. The 2010 National Transgender Discrimination Survey found that trans individuals were nearly four times more likely to have a household income of less than $10,000 per year compared to the general population.
These economic and health disparities leave many LGBT elders dependent on social services and entitlement programs like Medicaid, Medicare and Social Security, making the political debates swirling around these policies at the present of particular relevance to LGBT older adults and those who serve them.
The future of the Affordable Care Act (ACA) will deeply impact LGBT communities – particularly more vulnerable subsets of the community including LGBT people of color, transgender individuals and older adults. The ACA was monumental in starting to close the disparities in health insurance coverage within LGBT communities. It was the first federal law to prohibit discrimination against LGBT people in the health system. Section 1557 of the ACA also issued explicit protections for transgender individuals, barring insurers from refusing coverage or charging more for a plan based on a person’s gender identity. The current political uncertainty surrounding the ACA leaves millions of people at risk of losing their insurance coverage, opens the possibility of LGBT people being legally discriminated against and worsens the health disparities that affect LGBT communities.
The Senate’s proposed ACA repeal bill would cut Medicaid spending by nearly $800 billion over the next 10 years. These cuts will disproportionately impact low-income older adults, including LGBT elders, who depend on Medicaid funding for long-term care and other essential health services. Adding to the dangers of the proposed cuts are demographics. With the aging of the Baby Boomer generation, the size of the LGBT older adult population is expected to double by 2030. This is a time when we need to be improving the ability of the aging services network to effectively address the unique needs of this growing population. Cutting benefits, undoing non-discrimination protections and making it harder for LGBT older adults to access services will instead worsen the existing health care and financial disparities that already harm the community.
David Griffith is the Director of Programs & Outreach for the LGBT Elder Initiative, a Philadelphia-based non-profit dedicated to helping lesbian, gay, bisexual, and transgender older adults to age successfully. He received his Master of Science in Social Policy (MSSP) and Master of Social Work (MSW) from the University of Pennsylvania’s School of Social Policy & Practice. To learn more about the LGBT Elder Initiative, visit www.lgbtelderinitiative.org.