Gay and Gray: What You Need to Know About Working with LGBT Elders & Caregivers

Lisa Krinsky, LICSW of the LGBT Aging Project and Betsey Crimmins, Senior Attorney with Greater Boston Legal Services’ Elder Law Unit presented at the October CRC Info Session.

The mission of the LGBT Aging Project is “(t)o ensure that lesbian, gay, bisexual and transgender elders have equal access to life-prolonging benefits, protections, services and institutions that their heterosexual neighbors take for granted.” The need for the program arose from the realization that LGBT issues generally just aren’t on the radar for most elder service providers. When asked, most think they don’t serve this population, supporting the theory that when they need care, many LGBT elders feel the need “go back into the closet”. In addition to providing direct support to LGBT elders, the program works to raise awareness among elder-service providers and provide support for them to become inclusive of all elders through in-depth training and consultation.

Support Groups

The LGBT Aging Project noticed that there is a dearth of support groups for LGBT elders. It is important to have population-specific groups because people who are LGBT may not be welcome in other groups and/or may not have the energy at times of crisis to worry about determining if they are safe in a group. Also in mainstream groups some of the most salient issues LGBT people face wouldn’t be shared by other group members, obviously limiting the normalization and sharing that are the key benefits of support groups.

LGBT Caregiver Support Groups- This is a free monthly group that welcomes new members to talk about the impact of providing care for a partner, parent, sibling, spouse or friend. Come for stress relief, resources and understanding. Someone in the dyad needs to be 60 or over (though this may be flexible on a case-by-case basis). Unlike in the heterosexual population, the same proportion of men and women are caregivers. The group meets the first Monday of the month, 6pm – 7:30 pm in Jamaica Plain, MA. Contact group facilitator Joanne Peskowitz at 617.271.4182 for details. Sponsored by the LGBT Aging Project and the Caregiver Alliance of Suffolk County. More information at: www.lgbtagingproject.org.  

Bereavement groups- these groups are open to bereaved LGBT folks of any age. “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). This initiative consists of six free LGBT Bereavement Groups each in different parts of the state.   Each group will run for six consecutive weeks and will be led by a licensed clinical social worker who specializes in bereavement issues in the LGBT Community. The free group is open to any lesbian, gay, bisexual or transgender individuals who have experienced the loss of a loved one (family member, friend, partner/spouse). To learn about upcoming LGBT Bereavement Groups in your area: Contact Bob Linscott (617) 522-1292. More information at: www.lgbtagingproject.org.  

One of the things they are learning from these groups is that many gay men who survived the early years of the AIDS epidemic are finding themselves re-traumatized as they age and are beginning to lose loved-ones again.

Open Door Program

The LGBT Aging Project’s “Open Door” program offers in-depth, multi-stage training with institutions that want to become LGBT friendly. After an initial awareness raising session the program works with agency administration to look at institutional and organizational barriers to becoming a fully welcoming and inclusive organization. They help with reviewing policies and procedures and in appropriate messaging, to get the word out to the LGBT community.

Ms. Krinsky shared the information she typically presents in an introductory presentation to elder-service providers. Using the historical events that help shape the experience of two elders of different generations, we can better understand the differing approaches of these generations. “Anna” was born in 1920 and “Sarah” was born in 1950. More about Sarah later. In Anna’s childhood and young adult years the concept of being gay or lesbian was something that wasn’t discussed, or, if it was at all, it might have been a whispered reference to a distant relative who “wasn’t right” and was in a mental institution. Discrimination in employment and housing were legal and the rule rather than the exception. Anna and her partner would have needed to rent a two-bedroom apartment at a distance from their jobs and still live with the constant fear of losing their jobs and their home not to mention the likelihood of jail, institutionalization and/or violence if anyone found out the true nature of their relationship. The Stonewall riots, considered the birth of the gay-rights movement were in 1969- Anna was 49. Homosexuality was listed as a mental disorder in the DSM until 1973- when Anna was 53. Gay marriage became legal in Massachusetts in 2004- when Anna was 84.

This history of discrimination leaves many LGBT elders with a well-founded distrust of mainstream institutions that many heterosexuals assume are available to help anyone. One of Ms. Krinsky’s slides effectively illustrates the social marginalization this group experienced in their relationship with institutions (and obviously still do though to a lesser extent:

This history commonly leads to a coping strategy of lying low, or becoming invisible. The positive side of this strategy is strong sense of self-reliance and that “home” is particularly valued as being a safe haven. But it also means that when others might turn to institutions for help, there may be a deep distrust in this population that is difficult to overcome.

Our sample younger elder “Sarah”, 59, on the other hand, was born in 1950. She was 19 when Stonewall occurred, 23 when homosexuality was removed as a mental disorder, and a still relatively young 54 when marriage was legalized in Mass. She and the other “baby boomers” are expected to bring a very different outlook and set of expectations to their interactions with elder service providers in the coming years. They have changed every institution they have come in contact with and there is no reason to expect otherwise in the future.

Current Issues

Current data also highlight that LGBT elders are less likely to have the traditional informal supports that heterosexual elders (and elder-service institutions) tend to count on.

 

 

LGBT Elders

General Elder Population

Live Alone

Up to 75%

33%

No Children

90%

20%

Ages as a single person

80%

40%

Cannot identify an emergency contact

20%

2%

-Brookdale Center/SAGE 1999

HIV/AIDS and Aging

-Centers for Disease Control & Prevention, 2008

Issues In Institutional Care

How does an institution who typically places roommates together by gender deal with a transgender elder? Frequently they deal with the issue by putting the elder in a single room. But is this financially feasible for the facility if the resident’s stay is paid by Medicaid. Ms. Krinsky knows of at least one case where the resident was in a single room and eventually had spent-down assets and was occupying a single room. The patient was then hospitalized longer than the Medicaid bed-hold. Once ready for discharge the hospital couldn’t find a facility willing to take the patient. Adequate staff training on medical issues for the transgender elder is also an issue.

For more information: Lisa Krinsky, LICSW, Director, LGBT Aging Project lkrinsky@lgbtagingproject.org, 617-477-6607 or www.lgbtagingproject.org.

GBLS Elder Law Unit

Betsey Crimmins spoke about the LGBT Elder Law project that is part of the Elder Law Unit at GBLS. Due to the federal Defense of Marriage Act (DOMA) with same-sex marriage in Massachusetts came a host of complex legal issues. DOMA prohibits these married couples from being treated as each other’s spouses for the purpose of federal benefits, including Medicaid (MassHealth in MA). The LGBT Elder Law program was created to respond to the complex legal questions related to this complexity.

This program was a key advocate for the MassHealth Equality law which was signed in to law in July 2008. Under this law MassHealth uses state funds where necessary to ensure that same-sex married couples have the same responsibilities and benefits under MassHealth as heterosexual married couples. This offers “community spouse” protections against impoverishment and the need to sell the house if one spouse is institutionalized. One of the arguments that allowed passage of this bill is that balance between rights and responsibilities. In some cases counting a spouse’s income or assets will render an applicant ineligible for MassHealth who would have been eligible as an individual.

For more information or to refer: www.gbls.org, 617-371-1234, TDD: 617-371-1228.  

-Thanks to Lisa Krinsky and Betsey Crimmins for their engaging and enlightening presentation and their help with this article.

Stonewall Riots (from Wikipedia, retrieved 10/26/09)- Police raids on gay bars were routine in the 1960s, but officers quickly lost control of the situation at the Stonewall Inn, and attracted a crowd that was incited to riot. Tensions between New York City police and gay residents of Greenwich Village erupted into more protests the next evening, and again several nights later. Within weeks, Village residents quickly organized into activist groups to concentrate efforts on establishing places for gays and lesbians to be open about their sexual orientation without fear of being arrested….Within six months, two gay activist organizations were formed in New York, concentrating on confrontational tactics, and three newspapers were established to promote rights for gays and lesbians. Within a few years, gay rights organizations were founded across the U.S. and the world.

 

10/09