1. SOCIAL WORK PRACTICE AND COMPETENCY WITH LESBIAN, GAY, BISEXUAL, AND TRANSGENDER OLDER ADULTS Kristina Hash, LICSW, PhD West Virginia University

2. Topics  Key concepts and definitions  Events and policies  Strengths and resilience  The families of older LGBTs  Health and mental health issues  Unique issues for transgender elders  LGBT caregiving and bereavement  Special populations of older LGBTs  Competencies and models of practice

3. Key Concepts and Definitions  Sexual orientation  Gender identity  Gender expression  Transgender

4. Events and Policies  Negative Events  Legislation, laws, professional views (1930s+)  McCarthy Era (1950s)  AIDS epidemic (1980s)  Don’t Ask, Don’t Tell (DADT) & Defense of Marriage Act (DOMA) (1990s)  State actions vs same-sex marriage (1990s+)

5. Events and Policies  Positive Events  Beginnings of gay bars (1930s+)  Kinsey Report (1953)  Beginnings of advocacy societies (1950s-60s)  Stonewall Rebellion (1969)  Marriage and employment legislation (1990s+)  SCOTUS ruling for same-sex marriage (2015)

6. Strength and Resilience  Early experience of loss  Early experience of stigma  Strong social support networks

7. Families of Older LGBTs  The families of older LGBTs are very diverse including same-sex partners and spouses, former partners, former opposite sex partners, children, grandchildren, friends, and family of origin  The strong support networks built by LGBTs throughout their lives is often called “family of choice”

8. Health and Mental Health Issues  LGBTs experience higher rates of:  Disability and obesity  HIV  Depression  Loneliness  Violence  Substance abuse  Suicide

9. Issues for Transgender Elders  Transgender elders face additional challenges, including:  More harassment and violence  Access to hormone therapies and gender reassignment procedures  Lack of knowledge of trans-issues by health care and other professionals

10. LGBT Caregivers and Bereavement  All caregivers must deal with physical and emotional strains as well as conflicts between the caregiving role and others roles (employee, spouse, etc.)  LGBT caregivers have had the additional strain of institutional and social discrimination  LGBT persons may often experience “disenfranchised grief” and have traditionally been excluded from legal rights and protections when a same-sex partner dies

11. Special Populations  “LGBT aging is diversity”  Many ethic minorities face additional challenges in aging including lower levels of disclosure and social support and greater homophobia  Older lesbians may be less likely to live alone and have larger support networks but have lower incomes than gay men  Older LGBTs in rural areas are more isolated from social opportunities and specialized services

12. Competencies and Models of Practice  Practice models and competencies exist to guide practice with older LGBTs  Competent and effective practice with this population begins with an understanding of normative aging issues as well as unique challenges faced by this population and the awareness of the strengths that they have built throughout their lifetimes