The singular needs of LGBT seniors
It can be as simple as guiding someone to a toilet instead of a urinal, or pausing to consider which pronoun to use when addressing a dementia patient or the person’s partner.
Growing awareness of gender identities and sexual orientations is prompting policy changes in law enforcement, medical care and the military. Now, in the Bay Area, advocates hope it will also change how professional caregivers for the elderly interact with LGBT seniors, particularly those with dementia.
The city of San Francisco, through its
Arnel Valle conducts a dance movement program for clients at an On Lok senior center. Valle, who coordinates activities for On Lok, says he has learned about the traumas many LGBT seniors have faced.
Department of Aging and Adult Services, is funding a $400,000 effort to train hundreds of workers at companies and public agencies on how to better communicate with aging LGBT adults. Primarily aimed at home care aides and staffers at senior centers, it is also offered to organizations that interact with seniors regularly, like Meals on Wheels and public transit employees.
About 12 percent of seniors age 60 and above in San Francisco — roughly 19,200 people — identify as lesbian, gay, bisexual or transgender, according to estimates from the city’s Human Services Agency.
The demographic faces challenges specific to its generation and gender identity and sexual orientation, aging policy experts say.
LGBT seniors are more likely to live alone, and only 15 percent have children, often the de facto caregivers for aging adults; and many worry that disclosing their sexual orientation or gender identity to caregivers or peers in a care facility may lead to discrimination, said Edie Yau of the Alzheimer’s Association of Northern California, which is leading the training with Openhouse, the San Francisco advocacy group for LGBT seniors. Some who have dementia regress to a previous period in their life, before they came out or transitioned, making conversations with family and care aides confusing and frustrating.
“It was very eye-opening,” said Arnel Valle, who coordinates activities for seniors at On Lok Lifeways, a San Francisco long-term care provider for the elderly with four locations in the city and three elsewhere in the Bay Area. Valle is one of several On Lok employees who have taken the LGBT dementia training in recent months.
Valle says the workshop made him more aware of the trauma LGBT seniors in his care may have endured earlier in their lives.
“It brought me back to San Francisco in the ’80s and ’90s,” Valle said. “They survived the AIDS crisis; they survived alienation from family, being legally fired because there were no (workplace antidiscrimination) protections, housing discrimination.”
Valle recently began leaving out copies of the Bay Area Reporter, a free newspaper for the LGBT community, at the senior center, alongside copies of other free publications like Chinese and Korean language newspapers and SF Weekly.
Yau, of the Alzheimer’s Association, advises caregivers to be careful
“Often, listening to a client and how they refer to themselves is really important.” Edie Yau, Alzheimer’s Association of Northern California
about the language they use.
“Today the younger generation has reclaimed the word ‘queer,’ but if you’re talking to an 80year-old, they may not be accepting of that word, given it was pejorative for them,” Yau said. “Many of us steer away from using ‘homosexual,’ but some older people grew up referring to themselves as such. Often, listening to a client and how they refer to themselves is really important.”
On July 1, a new state law will take effect requiring programs funded by some state health and aging agencies — like CalFresh and some Meals on Wheels programs — to collect data on the gender identity and sexual orientation of people who use their services. It’s voluntary to disclose such information, which is collected along with other demographic information. The data are aggregated and anonymized, and are used to help identify gaps in care for aging LGBT adults in the health and social services system.
There are limited data on whether LGBT seniors face greater risk of developing cognitive impairment and dementia than seniors in the general population. But early research indicates they may — in part due to stressors earlier in their life, like alienation from family and friends and discrimination at work, school or housing.
“They are an age group that was traditionally more conservative,” said Jason Flatt, a UCSF assistant professor who researches health and aging in the LGBT population. “There is a fear of having to go back into the closet or not being able to express yourself openly, or worrying there will be negative consequences . ... There is a fear of, ‘Will I be able to be myself ?’ ‘Will they treat me with respect?’ ”