• Michael Casterlow

Concerns for LGBT Baby Boomers

Mike Casterlow, Esquire

Almost 40 million people in the United States are age 65 or older, and with the Baby Boomer generation approaching retirement age, that number is expected to increase up to 19 percent of the total population by 2030. According to the AARP, over 1 million Americans, age 65 and older, identify as LGBTQ. With this in mind, long-term healthcare plans are things that the LGBTQ community, especially Baby Boomers should be thinking about.

In many ways Baby Boomers who identify as part of the LGBTQ community are pioneers within the community. They are survivors of the AIDS crisis that eradicated a significant percentage of the community. They help initiate the movement for gay rights and paved the way for freedoms that the LGBTQ community can enjoy today. They are also some of the first within the community to experience the harsh realities of approaching retirement age. Health care and aging will be a challenge for all Boomers — nobody has saved or invested near enough to cover the costs — but LGBTQ boomers face a few extra challenges. These may include gay-specific issues such as homophobia in nursing homes or health care providers who just outright refuse to offer them their services. And as a community that still has more single people than coupled, we are more vulnerable to increased costs of long-term care incurred by single and/or childless seniors.

Also a concern for many is the long-term effect of HIV treatment. Once an assumed death sentence, HIV has become much more of a chronic illness. That said, current treatments are still terribly hard on the body, strict diligence is absolutely necessary, and a cure remains elusive. How years of these treatments will change the quality of retirements for people living with HIV has yet to be seen.

Long-term care is defined as the assistance or supervision that a person who is physically or cognitively impaired needs to get through the day. With few exceptions, no federal or state program will pay for custodial assistance over an extended period of time. Quite often, and traditionally, much of this care may be given by children or family members. With so many in the LGBT community less likely to be partnered or parents, they are at greater risk of not having family relations in place to help with this care.

Dr. Jennifer L. Fast, Licensed Clinical Psychologist (Texas & Illinois)

Now is a good time to be thinking about, and talking with, people in your life who you would trust with your financial and medical affairs. It is also important to make your wishes known of the type of living environment you would want should you not be able to care for yourself independently. These things may feel as if they are a long way off, but life takes us all by surprise on occasion.

Many older adults transition to senior living, assisted living, or skilled nursing homes after 65. Assisted living and skilled nursing homes are not all created equal as I have seen in my role as a clinical psychologist. I currently work for a company that provides mental and behavioral health care in skilled nursing facilities. Some are better funded, better equipped, and better staffed than others. Each has its own culture and many struggle to meet all of the unique needs of their patients. It is a tough job, but a rewarding one as well. As a mental health profession and ally of the LGBTQ community, one area that I find lacking is awareness and appreciation for the needs of LGBTQ elders.

Perhaps it has to do with the medical model where biological facts matter more than psychosocial factors. It may be that staff are trying to serve so many folks that they don’t take time to ask the right questions. Or it could be outright discrimination. I tend to think it is all of these and more. But whatever the reason, LGBTQ elders are rarely ever asked about their identity, their wishes for being identified or not identified publicly, or able to discuss their chosen family.

Older adults entering skilled nursing homes are in need of compassionate medical care. We know that discrimination can have a devastating impact on the well-being of a person. LGBTQ stigmatization, especially from healthcare providers, negatively impacts mental health for LGBTQ individuals, and can increase risk of suicide. LGBTQ elders who are discriminated against also can have longer recovery times from serious illnesses such as heart attacks, strokes, cancer, and falls.

So, when the time comes for supportive care, be sure to ask the following questions:

(1) How does the facility address instances of bias? (2) How does the facility discuss sexuality in a safe and confidential manner? (3) In what ways do staff invite disclosure of chosen family members?

I suggest also that you pay attention to staff language. If you are transgender and present congruently with your gender, does staff use your correct pronoun and name? Do they assign you to a room with a person of the same gender? If you are gay or lesbian, and married, does staff address your partner as wife/husband? If you are partnered, does staff acknowledge and communicate with them as a loved one involved with and responsible for your care?

As my blog co-author has so eloquently pointed out this Pride month, there is much to consider as you make plans for life after 65. Having a plan in place and knowing what questions to ask will help to ensure that if, or when, you need extra care, you will be in the right hands.