1. LGBT Aging What You Need to Know to Advance Emotional Wellbeing for Lesbian, Gay, Bisexual and Transgender Older Adults & Caregivers MASSHOUSING Conference April 10, 2013 Lisa Krinsky, LICSW 1 © 2011 LGBT Aging Project / Third Sector New England

2. Elder Services: LGBT Issues not on their radar screen LGBT Community: Elder Issues not on their radar screen. Result: LGBT Older Adults are overlooked 2 History of the LGBT Aging Project © 2011 LGBT Aging Project / Third Sector New England

3. To ensure that lesbian, gay, bisexual and transgender older adults and caregivers have equal access to the life-prolonging benefits, protections, services and institutions that their heterosexual neighbors take for granted so that they can grow older with the dignity and respect they deserve. 3 Our Mission © 2011 LGBT Aging Project / Third Sector New England

4. Our goal is not to develop a separate service network for LGBT older adults but to be catalysts of change to make the existing system inclusive of all older adults and caregivers. 4 Equal not Separate © 2011 LGBT Aging Project / Third Sector New England

5.  Lesbian: Women attracted to women  Gay: Men attracted to men; also an umbrella term to describe both gay men and women  Bisexual: Individuals who are attracted to both men and women  Transgender: Individuals whose gender identity or gender expression is not congruent with their biological sex 5 Terminology © 2011 LGBT Aging Project / Third Sector New England

6. How Many Older LGBTs? 2010: estimated 1-3million 2030: estimated 3-6 million 2000 Census: 600,000 self identified  1 out of 4 same sex couples has a partner over 55  1 out of 10 has a partner over 65 Outing Age 2001  2010 Census: 650,000 self identified 6 © 2011 LGBT Aging Project / Third Sector New England

7. Elder Issues Healthcare Housing Medication Costs Social Network: Family, Friends Income Retirement / Work Social / Recreational Activities LGBT Elder Issues Healthcare Housing Medication Costs Social Network: Family, Friends Income Retirement / Work Social / Recreational Activities 7 What’s So Different? © 2011 LGBT Aging Project / Third Sector New England

8. Comparison: LGBT vs. General Population 8 © 2011 LGBT Aging Project / Third Sector New England

9. LGBT Older Adults: Key Aging and Health Findings 2011 2500 LGBTs 50-95 year old in eleven communities across the country Nearly 50% have a disability; nearly 33% report depression Most (91%) engage in wellness activities Nearly 90% feel good about belonging to their communities Almost 2/3 have been victimized 3 or more times 13% have been denied healthcare or received inferior care 21% do not disclose their sexual orientation or gender identity to their physician 1/3 do not have a will or durable power of attorney for healthcare 25% have children; 15% have grandchildren 44% are employed The Aging and Health Report: Disparities and Resilience in Lesbian, Gay, Bisexual and Transgender Older Adults, 2011 9 © 2011 LGBT Aging Project / Third Sector New England

10. Anna Sarah Born: 1920 1950 McCarthy Trials (1954 )34 4 Stonewall (1969)49 19 APA/DSM (1973)53 23 Elaine Nobel Elected (1975 )55 25 Reagan Mentions AIDS (1987)67 37 “Ellen” Comes Out on TV (1997)77 47 Gay Marriage is Legal in MA (2004) 84 54 Don’t Ask Don’t Tell Repealed (2011) 91 61 10 © 2011 LGBT Aging Project / Third Sector New England

11. Challenges: Distrust of Mainstream Institutions A history of discrimination leaves many LGBT older adults with a general distrust of mainstream institutions that many heterosexuals assume are in place to help them. 11 Housing: Eviction Religious: Excommunicated or excluded Medical: Psychiatric Disorder / illness Law Enforcement: Police Brutality Military: Dishonorable Discharge Social Services: Denied Family: Estrangement or disowned © 2011 LGBT Aging Project / Third Sector New England

12. Consequences of Distrust in Mainstream Institutions Greatest coping strategy: Becoming Invisible Strong self-reliance Limited circle of support “Home” is important safe-haven 12 © 2011 LGBT Aging Project / Third Sector New England

13. Mental Health Pathology of Identity: You are Sick and Need a Cure 1973 DSM Revision: Homosexuality no longer a Mental Disorder. Change in Policy; Change in Practice? Gender Identity Disorder: DSM Clinicians as gatekeepers to hormone/reassignment treatment 2013 DSM Revision: GID no longer a Mental Disorder. Gender Dysphoria: emotional distress from "a marked incongruence between one's experienced/expressed gender and assigned gender." 13 © 2011 LGBT Aging Project / Third Sector New England

14. Mental Health Higher Incidence of Mental Health Issues for LGBTs across the lifespan ▫Suicide Attempts ▫Anxiety ▫Depression ▫Substance Abuse Balsam, K.F. Et al (2005) in Outing Age 2010 Differences in mental health outcomes disappeared when controlling for poor social support and coping skills Safren & Heimberg (1999) in Outing Age 2010 14 © 2011 LGBT Aging Project / Third Sector New England

15. HIV/AIDS and Aging HIV over 50 15% of new diagnoses - fastest growing segment of adult population Centers for Disease Control & Prevention, 2005 By 2015: 50% of all HIV cases will be those 50+ US Senate Special Committee on Aging, 2005 Development of caregiving systems and networks – model for aging/disability 15 © 2011 LGBT Aging Project / Third Sector New England

16. Challenges: Financial and Legal Defense of Marriage Act (DOMA) of 1996 defines marriage as one man and one woman –a definition used in all federal programs Economic Security: Gay and lesbian couples, after a lifetime of work and forced contribution, do not get Social Security spousal or survivor benefits Health Care Decision Making: Definition of Family (blood or “legal” marriage) 16 © 2011 LGBT Aging Project / Third Sector New England

17. Mass Health Equality Law “…no person who is recognized as a spouse under the laws of the commonwealth shall be denied benefits that are otherwise available under this chapter due to… federal non recognition of spouses of the same sex.” Signed into law, July 31, 2008 17 © 2011 LGBT Aging Project / Third Sector New England

18. LGBT Baby Boomers as Caregivers  Same proportion of men & women provide care (unlike heterosexual population)  75% expect to be caregivers Spouse or partner Parent Families of choice (Out and Aging: The Met Life Study Lesbian and Gay Boomers, 2006)  Much LGBT caregiving is horizontal not vertical 18 © 2011 LGBT Aging Project / Third Sector New England

19. LGBT Baby Boomers as Caregivers General LGBT Population Population women men/women 90% birth/marriage 35% partner/spouse 16% parent 9% other relative 10% non relative 32% friend 7% non relative/neighbor The Aging and Health Report: Disparities and Resilience in Lesbian, Gay, Bisexual and Transgender Older Adults, 2011 19 LGBT Caregiver Support Group: Safe space for unique experience © 2011 LGBT Aging Project / Third Sector New England

20. Challenges: Bereavement and Loss “Gay widowhood is a completely unique societal situation marked by disenfranchised grief and an utter lack of support systems.” Shernoff, Gay Widowhood: Life After the Death of a Partner, 1998 LGBT Bereavement Group Statewide; 6-8 weeks; general loss or partner loss Current and Previous Losses; Broader range of losses Suicide mentioned in every group 20 © 2011 LGBT Aging Project / Third Sector New England

21. Individual Practice  Challenge Heterosexist assumptions  Normalize inclusion  Consider gender-neutral language and labels  (spouse or partner vs husband or wife)  Expand definition of family and friends  Prepare for possible backlash 21 © 2011 LGBT Aging Project / Third Sector New England

22. Language of the times:  Homosexual vs. Gay/Lesbian vs. Queer  Friend, lover, partner, husband/wife  Euphemisms -- friend, roommate, cousin  Open ended questions – who else lives in your home? Who do you consider your family?  Affirming environment w/o naming Individual Practice 22 © 2011 LGBT Aging Project / Third Sector New England

23.  Create inclusive and supportive service delivery systems.  Enhance professional capacity and cultural competency  Strengthen the collaboration between mainstream providers and the networks that serve the LGBT population. 23 Organizational Change: © 2011 LGBT Aging Project / Third Sector New England

24. Open Door Task Force  ODTF: Institution/Organization Sustainable Impact  ODTF: Policy and Practice Comprehensive Skills  ODTF: Conveying your Message  Community Connections 24 © 2011 LGBT Aging Project / Third Sector New England

25. LGBT Symbols The Human Rights Campaign logo is one of the most recognizable symbols of the LGBT community. It has become synonymous with the fight for equal rights for LGBT Americans. The Pink Triangle was one of the Nazi concentration camp badges intended as a badge of shame; the pink triangle has been reclaimed as an international symbol of gay pride and the gay rights movement. The Rainbow Flag was popularized as a symbol of LGBT pride and diversity by San Francisco artist Gilbert Baker in 1978. The different colors symbolize diversity in the LGBT community. 25 © 2011 LGBT Aging Project / Third Sector New England

26. LGBT Baby Boomers: Activist Generation  LGBT - Visibility and Acceptance  Aging – Redefining How We Grow Old Final Thoughts 26 © 2011 LGBT Aging Project / Third Sector New England

27. For More Information: Lisa Krinsky, LICSW Director, LGBT Aging Project lkrinsky@lgbtagingproject.org (617) 477.6607 www.lgbtagingproject.org 27 © 2011 LGBT Aging Project / Third Sector New England