Cultural Awareness LGBT Aging Doug Carl Georgia Department of Human Services Division of Aging Services March 22, 2013 Georgia Department of Human Services

Vision, Mission and Core Values Stronger Families for a Stronger Georgia. Mission Strengthen Georgia by providing Individuals and Families access to services that promote self-sufficiency, independence, and protect Georgia's vulnerable children and adults. Core Values Provide access to resources that offer support and empower Georgians and their families. Deliver services professionally and treat all clients with dignity and respect. Manage business operations effectively and efficiently by aligning resources across the agency. Promote accountability, transparency and quality in all services we deliver and programs we administer. Develop our employees at all levels of the agency.

What is LGBT? Lesbian - a woman whose primary physical, romantic and/or emotional attraction is to other women. Gay - a word to describe anyone, mainly men, who have primary physical, romantic and/or emotional attraction to someone of the same sex. Bisexual - a person 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.

Creating Safe and Inclusive Services for LGBT Older Adults LGBT older adults are at higher risk of social isolation – more likely to be single, without children, estranged from biological family A 2011 federally-funded health study of more than 2,500 LGBT elders—The Aging and Health Report: Disparities and Resilience among LGBT Older Adults, found significant disparities in areas including physical and mental distress, disability, victimization, and lack of access to supportive aging and health services. Moreover, the stigma and discrimination that many LGBT older people have experienced across the lifespan continues into their later years; many reside in settings where LGBT discrimination and bias are both routine and legal. While there have been great changes and progress to society attitudes about LGBT, gotta remember that today LGBT elder’s personalities and coping strategies were forged when survival required hiding and keeping quiet.

3.5% of Georgia residents self-identify as LGBT (Williams Institute) Who’s Out There? An estimated 9 million Americans -- or nearly 4 percent of the total population -- say they identify as lesbian, gay, bisexual or transgender (Williams Institute) 3.5% of Georgia residents self-identify as LGBT (Williams Institute) By 2030, one in five Americans will be 65 or older – roughly 4 million of these will be LGBT LGBT older adults have created ways to keep themselves safe and hidden – many were married to hide People who live the majority of life in SOCIAL DISAPPROVAL have gotten good at scanning their environment and people in order to protect themselves.

LGBT Elders face unique challenges to successful aging Cumulative effects of a lifetime of stigma Need to rely upon “families of choice” for care and support Unequal treatment under laws and programs for older adults

A Lifetime of Stigma Has lived most of his/her life closeted Disrupted lives due to coming out Severed connections to families of origin Fewer, less secure opportunities to make a living and save for retirement

Early Attitudes about LGBT (1940) Courts rule New York State and Liquor Authority can legally close down bars that serve to same-sex couples (1943) U.S. military bans gays and lesbians from serving in the Armed Forces It is revealed that Holocaust victims include Gay, Lesbian, and Transgender 1950’s (1950) U.S. Senate approves a broad sweeping investigation of homosexuals in national government (1952) Immigrants are banned from U.S. is they are known to be homosexual (1952) American Psychiatric Association includes homosexuality under “sociopathic personality disturbance” in its first official list of mental disorders (1953) President Eisenhower orders dismissal of all federal employees found to be homosexual (1956) Florida Legislature establishes the Johns Committee to People are shaped by their life experiences, the people around them, and events of the world.   We are influenced by our religion, race, culture, socioeconomic status, and one’s sexual orientation. It’s important to understand ones history to allow your work with the person/client more effective Today’s LGBT elderly grew up with fear of mental illness and criminal offense – tell milestone story

Families of Choice Families and social networks are critical to successful aging Social isolation is linked to higher morbidity, mortality, infection, depression, addiction, and cognitive decline 80% of long-term care in the U.S. is provided by a family member and are the only in-home caregivers for more than two-thirds of adults LGBT older adults (older gay men particularly) are significantly less likely than their heterosexual counterparts to be in partnered relationships and/or have children Source: AARP Public Policy Institute, 2002; Family Caregiver Alliance, 2001

Inequalities Under the Law Laws and Government programs designed to provide safety nets around marriage, but exclude LGBT couples – DOMA Social Security benefits including: the spousal retirement benefit; the spousal disability benefit; the lump-sum death benefit; and the survivor benefit. While we understand that LGBT people come in every race, ethnicity, religion, political and environmental region – there are many ways LGBT are told “YOU ARE NOT LIKE US”

Inequalities Under the Law Medicaid Long-Term Care Same-sex couples not eligible for Spousal Impoverishment Lack of Employment Protection No Federal Protection – Employment Non-Discrimination Act No State Protection – Fair Employment Practices Act Federal Family Medical Leave to care for the employee’s spouse, child, or parent who has a serious health condition Employment Non-Discrimination Act (introduced in every Congressional session since ’94 except the 109th) Only 21 States have Sexual Orientation included in employment non-discrimination laws In Georgia we have the Fair Employment Practices Act – a State bill that will insure all state employees are protected from discrimination based on sexual orientation and gender identity. There are 70 co-sponsors of the bill. Last session there were two hearings , but the committee failed to vote on the measure before cross over day. It will be reintroduced in 2013.

Inequalities Under the Law Lack of inclusion in Government funded Aging services LGBT Elder Americans Act

Other Forms Discrimination LGBT and HIV-positive seniors are facing discrimination related to their sexual orientation, gender identity, or HIV status including: staff and residents at senior centers denial of housing denial of the ability for same-sex couples to share a room in an assisted living facility or nursing home disrespect of gender identity including while incapacitated These signs can also be subtle and often invisible to people who “DO” fit the norms: Marketing techniques Language used Community Events   Many still not comfortable letting others know of their sexual orientation – AHA HIGHRISE!

Assumptions that Exclude LGBT Older Adults Assumption that all older adults (seniors) are heterosexual Service providers often assume they can identify an LGBT person By not asking, providers believe they’re organization is not discriminating History of legal and medical discrimination and prejudice has left many older LGBT elders distrustful and fearful of the health and social services.   Many in the Aging network see no need to talk about LGBT issues cause what someone does in the bedroom is none of our business By not talking about it – many agencies feel they are avoiding discrimination – don’t want to make anyone uncomfortable But this leaves many older adults feeling like they must hide who they are in order to access services Our culture desexualizes older people and tends to only think of LGBT in sexual terms

Cultural Responsiveness The Need for Cultural Competency Cultural Awareness Cultural Humility Cultural Responsiveness

Ready to Serve? The Aging Network & LGB and T Older Adults . A 2010 nationwide survey of 320 area and state units on aging 50% of the agencies completed the study 45 states in all regions of the country participated

Study Findings More that 1/3 of agencies had offered or funded some type of LGB aging training to staff – and 4 out of 5 agencies were willing to offer training Trained agencies were more likely to offer targeted LGBT services and outreach Agencies with trained staff were three more likely to have received a request to assist a transgender person and twice as likely to have received and LGB request for help

Study Findings Staff training was key in building understanding and addressing the unique needs of LGBT older adults

The State’s Role in Promoting Inclusiveness System’s Integration Grant 1. Provide the LGBT Awareness to State agencies and Aging service providers throughout the State 2. Conducting Training throughout the State’s Aging Network 3. Identify LGBT welcoming/friendly service providers within the State’s Aging Service Network

So that knowledge gets better with age.

Resources www.lgbtagingcenter.org http://leadingagega.org www.sageatl.org