1. Understanding the Challenges Facing LGBT Older Adults Lauren Fontanarosa, MPH Gay & Grey Coordinator, Friendly House Debbie McCuin, M.A. Long Term Services and Supports Analyst State of Oregon, State Unit on Aging

2. Introductions Introduction of Debbie McCuin Introduction of Lauren Fontanarosa and Gay & Grey ▫A program of Friendly House that works with and for LGBT older adults in the Portland metro area.  Educational outreach  Advocate for LGBT friendly senior housing  Social events  Local and state-level advocacy

3. Terms

4. LGBT ▫L = Lesbian ▫G = Gay ▫B = Bisexual ▫T= Transgender

5. Lesbian, a woman whose primary physical, romantic, and/or emotional attraction is to other women. Gay, a word used to describe anyone, mainly men, who have primary physical, romantic and/or emotional attraction to someone of the same sex.

6. Bisexual, an individual who is physically, romantically, and/or emotionally attracted to both men and women. Transgender, an umbrella term for people whose gender identity and/or gender expression differs from the sex they were assigned at birth.

7. The Unique Challenges LGBT People Face as they Age

8. LGBT history: 1930’s ▫Electric shock therapy is introduced as a “treatment” for homosexuality ▫Gay men are forced to wear a pink triangle in Nazi concentration camps 1940’s ▫U.S. military bars gays and lesbians from serving 1950’s ▫President Eisenhower calls from dismissal of homosexuals from government service ▫Homosexuality is included in the first APA list of mental disorders 1960’s ▫Stonewall happens and begins the gay civil rights movement ▫First support services for transgender people is established ▫NOW comes out against lesbians 1970’s ▫First Pride march happens ▫Homosexuality is declared to no longer be a psychiatric disorder ▫80% of Oregon doctors say they would refuse to treat LGBT people

9. LGBT history continued: 1980’s ▫First reported cases of AIDS ▫Massachusetts Rep. Gerry Studds reveals he is a homosexual on the floor of the House, becoming the first openly Gay member of Congress 1990’s ▫Matthew Shepard’s murder raises awareness of hate crimes ▫DOMA (Defense of Marriage Act) passes Congress and defines marriage as between one man and one woman 2000’s ▫MA becomes first state to allow gays and lesbians to marry ▫HUD issues new regulations prohibiting discrimination based on sexual or gender identity in HUD rentals and public housing 2010’s ▫Don’t Ask Don’t Tell is repealed ▫Supreme Court agrees to hear a challenge to DOMA

10. Barriers to healthy aging Double invisibility Financial barriers Discrimination by care/service providers Social isolation Care giving Housing Historic prejudice

11. Health disparities According to the Aging and Health Report: Higher rates of disability Experience higher rates of mental distress and are more likely to smoke and engage in excessive drinking Higher risk of cardiovascular disease and obesity than heterosexual women, and Older men are more likely to have poor physical health than their heterosexual counterparts.

12. Greater Social Risk Less likely to be partnered or married, which may result in less social support and financial security as they age Gay and bisexual older adult men have significantly fewer children and are significantly more likely to live alone Older adults who live alone are at serious risk of social isolation, which is linked to poor mental and physical health, cognitive impairment, and premature chronic disease and death.

13. Differences in patterns of care High rates of caregiving Friends play a much greater role Higher rates of victimization and potential problems with physical and mental health Lack of access to many of the caregiving supports available since they are often not related by blood or marriage

14. What does this look like? Nearly one-half have a disability and nearly one-third report depression. Almost two-thirds have been victimized three or more times. Thirteen percent have been denied healthcare or received inferior care. More than 20% do not disclose their sexual or gender identity to their physician. Most LGBT older adults (91%) engage in wellness activities. About one-third do not have a will or durable power of attorney for healthcare.

15. Older Americans Act (OAA)

16. Why should we care? ▫OAA priority of serving those with greatest social need ▫Oregon emphasis on inclusion of LGBT population in definition of greatest social need ▫Recognition of AoA’s efforts, including provision of funding, to understand and address the unique needs and concerns of older LGBT adults

17. Why should we care? Acknowledgement of growing population of LGBT elders… facing ongoing challenges  discrimination  health disparities  unique caregiving situations  differing long term care planning needs

18. OAA requirements The OAA requires states to target services to those with the greatest economic and social need.

19. Greatest Social Need The term ‘‘greatest social need’’ means need caused by non-economic factors, which include- physical and mental disabilities language barriers; and cultural, social, or geographical isolation, including isolation caused by racial or ethnic status,

20. Long Term Care Planning

21. Federal definition of marriage Disparities in public benefits programs for spouses versus partners Biological family considerations Specialized estate planning needs Important to have advance directives and other end-of-life documents in order Long Term Care Planning

22. Best Practices

23. Avoid Assumptions ▫Do not assume any person is straight ▫You can’t tell who is gay ▫LGBT people may have different life experiences Inclusive Language ▫Ask people questions in open ended ways  i.e. Who is in your support system, do you have a current partner? What pronoun do you prefer?

24. Best Practices Confidentiality ▫Allow people to “come out” in their own time ▫Do not share sexual identity of client with other staff, unless client has allowed you to Intake Forms ▫Usually send the first message of how inclusive your agency is ▫Allow clients to self-identify, disclose what they are comfortable with, yet not if they are not comfortable.

25. INSTEAD OF:USE: Name Legal Name Preferred Name (if different) Male Female Male Female Transgender (MTF) (FTM) Other Single Married Widowed Divorced Single Married Partnered Domestic Partner Widowed Divorced Other Men’s Room Ladies’ Room Restroom Family Family of choice Family of origin Support Network

26. Best Practices LGBT Social Programming ▫Work LGBT themed events into existing structure of celebrating holidays or cultures ▫Have LGBT books and movies as options Post LGBT Resources and Events Flyers ▫Portland Gay Yellow Pages, Just Out, PQ Monthly ▫Flyers for Gay & Grey events ▫PFLAG flyers Promotional Material ▫Use photos of LGBT couples and individuals ▫Outreach to the LGBT community  PQ Monthly, Just Out, Gay & Grey events

27. Best Practices By knowing someone’s sexual identity you can provide a higher level of care and services ▫It is impossible to treat everyone the same and provide equal services ▫By treating everyone the same LGBT people will feel silenced and unwelcomed ▫By treating everyone the same it ignores the unique challenges LGBT older adults are faced with

28. Best Practices Train staff at all levels Designated a staff person to be a LGBT ambassador ▫Display Ally/Rainbow materials Have formal policy to follow up on complaints between residents or clients ▫This perhaps may be more common, yet often overlooked

29. Resources

30. Training Resources Gay & Grey – Offers 1.5-2.5 hour trainings on the challenges LGBT individuals face as they age. Each training has a panel of LGBT elders. ▫Contact: (503)224-2640 or gayandgrey@friendlyhouseinc.org Lauren Fontanarosa – National Resource Center on LGBT Aging trainer for Oregon. The NRC has 4 and 8 hour curriculums for aging service providers or LGBT organizations. ▫Contact: NRC website: http://www.lgbtagingcenter.org/ or contact Lauren at (503)224-2640 or Lfontanarosa@friendlyhouseinc.orghttp://www.lgbtagingcenter.org/

31. Questions?