1. Cultural Competency Issues in the LGBT Community and LGBT Elders.
The life course perspective shows that people age as they have lived. Therefore, those involved
in the field of aging should ”be concerned with the entire course of life, because the outcomes in old
age—both for individuals and cohorts—are substantially influenced by the investments made in
earlier life (kingson, Hirshorn, &Corman, 1986 as cited in Croman & Kingson, 1996). The
increasing diversity of the older population has brought about an awareness of how crucial cultural
competence will be in order for people who work with elders to successfully and efficiently provide
the services and healthcare our elders deserve. “Cultural competency refers to the ability of health
care providers to interact sensitively with members of different cultural groups. Such care generally
involves not only an acceptance of and respect for difference, but also a degree of understating of
community norms, vulnerabilities and practices (Healthy People, 2010). Health care providers, legal
advisors, social workers, housing facilities their staff can all affect the service of their clients. With
competency training, clients and patients can create a welcoming and respectful client.
This paper will look at the issues that are inherent to competency training for the Lesbian Gay
Bisexual and Transgender (LGBT) community. LGBT culture is of special importance because the
LGBT community collectively suffers from a lack of simple human rights. The community itself is as
diverse as it’s members, whose one common thread may only be the stigma and decimation they
have faced (Healthy People, 2010). This means that the vulnerabilities of LGBT people are similar
to other minority groups as they bring “less financial means and education, and greater health risks”
(Croman & Kingston, 1996). The services our country has put in place to protect its elders are
often not applicable to LGBT people, due to decimation and legal barriers.
Social workers are among those who can help elders cope with this marginalization (Orel,
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2. 2004), however a heightened sensitivity toward the legacy of decimation is necessary in order to
gain a client’s trust. A recent study which cross­analyzed data on social worker’s beliefs and
attitudes with their actual behaviors, which revealed a high rate of homophobia. (Crisp, 2008) This
means that as part of cultural competence training, one must first work out their own internalized
homophobia. This in turn, can shed light on the profound effect of homophobia on LGBT people,
that they themselves had to overcome their own internalized homophobia, This can lead to deeper
understanding of the meaning of homophobia and a greater respect for LGBT elders.
This paper will begin by looking at some of the defining characteristics of the LGBT community.
This includes population numbers, distribution, diversity, discrimination and its effects. Then an
overview of the potential vulnerabilities that LGBT elders face will be analyzed. These are elder
abuse, healthcare access and risks for illnesses, poverty rates and financial burdens, and finally
housing options, and the risk of isolation.
The number of LGBT people is an estimation derived mostly from four different sources. They
are The US Census 2000, National exit polls, Youth surveys conducted in some states, and surveys
conducted by community advocacy and service organizations. The estimates range widely across
surveys, though the majority of the literature agrees that the LGBT cohort is between 4­10% of the
US population. Experts have used these numbers to project that 1.4 to 3.8 million LGBT
Americans will reach retirement age in 2011, and that 3.6 to 7.2 million will be 65 and older in 2030
(Grant, 2009). The US census data is limited to lesbians and gays in same sex partner relationships,
which does not give any reference to the amount of single gays and lesbians, bisexuals or
transgender. As a general idea of the geographical distribution of lesbian and gay couples, the US
Census showed that 98% of counties in the US had at least one gay couple. The lesbian and gay
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3. partners, who identified as such, were most densely located in the same states as heterosexual
couples (California, Florida, and New York). Fifteen percent of couples lived in rural areas,
particularly in the mid­north, west, and south of the country. Those who lived in metropolitan areas
fell into two groups. Those who were white showed a tendency to live in urban and suburban
enclaves, coined “gayborhoods” whereas Black and Latino same sex couples tended to live within
their racial lines (Grant J., 2009).
This brings up the important fact that the LGBT community is as diverse as the US population at
large (Hunter college study). In order to serve LGBT elders a global view of determinant factors is
required. These are genetic, environmental factors, gender, ethnicity, race, religion, places where
one has lived, relationships they’ve had, jobs or professions they’ve had, level of education, financial
influences, marriage, children, hobbies, and skills, and their sexual identity. All of these variables
contribute to the trajectory of lives and people’s perception of themselves (healthy people, 2010).
For some LGBT people, the “environmental press” of their minority status may have been more or
less challenging due to all the other factors in their lives. Thus the biological, psychological and social
components will determine a person’s behavior in their social environment. When talking and
connecting with clients who are gay, it is important to keep in mind, those other components of their
life may be just as much of importance as their sexual identity and the LGBT culture. However, the
defining trait of the LGBT culture, especially for elders and those who are approaching their older
years, stigma and discrimination was a challenge to overcome.
All persons born or naturalized in the United States, and subject to the jurisdiction
thereof, are citizens of the United States and of the state wherein they reside. No state
shall make or enforce any law, which shall abridge the privileges or immunities of citizens
of the United States; nor shall any state deprive any person of life, liberty, or property,
without due process of law; nor deny to any person within its jurisdiction the equal
protection of the law. (The United States Constitution)
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4. Minority stress has been explained by xenophobia, which is the aversion to something different or
strange. However, despite this primitive tendency, the human rights movements, appealed to the
intelligent members of our society and eventually where protected by law. Sexual identity is not a
cognitive visual event, but rather a difference in sexual preference, and inherently more primitive. This
may explain the confusion, hatred and visceral effects that the LGBT community has been exposed to
throughout history. Even today, after 40 long years of gay civil rights, the LGBT community is hated at
worst, and forgotten by at best.
Therefore, the story of every homosexual or transgender person begins with internalized homophobia
and the way in which they handle it. The extent to which homophobia is embedded in the thread of our
society has driven those who came out to socially surround themselves with other LGBT people who
they can depend on and feel comfort with. These social networks are often referred to as “families of
choice”. A sense of fellowship amongst members of the LGBT community is due to shared challenges
and adaptive skill sets, which helped them to face homophobia. These communities and families are also
not all the same age and not all necessarily LGBT people (Orel, 2004). “Gay culture” which is seen by
many Americans as a culture based upon sex, is actually a culture like any other. This is poignantly
defined by the inclusive definition that follows “Culture is not restricted to racial or ethnic identification or
heritage; instead, culture is the customs, beliefs, values, knowledge, and skills that guide a people’s
behavior along shared paths” (Linton R, 1947).
As in all cultures, historical events often define the environment and values of the time period. Historical
events in the lives of the LGBT elders include World War II, the McCarthy witch­hunts, the civil rights
movements, the feminist movement, and the sexual revolution of the 60s. The years before 1969 are
known as “preliberation” years for LGBT people (Orel N., 2004). The advent of the gay liberation
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5. (also called the “gay civil rights movement”) was “The Stonewall Rebellion”. This is regarded as the
igniting event of the modern LGBT civil rights movement. The Stonewall Inn is a bar in Greenwich
Village, Manhattan the patrons of which were LGBT people. This made it a common target for police
raids, brutality and arrests. On the night of June 9th, 1969 the patrons fought back. “Buffered by the
current civil rights movements” (Grant 2004) they spontaneously revolted fighting back with broken
bottles, bar chairs, fists, and whatever they could. This fueled a week of riots.
The oldest of the baby boomers, are in the younger cohort of the pre­liberation LGBT Americans who
share their entrance into a world where being gay or lesbian was rarely heard of and never referred to.
Coming of age in the 1950s meant facing harsh discrimination. They were thought of as sick, deranged
and severely mentally ill. The logic was that only someone who is severely mentally ill would choose a
life of homosexuality. It many LGBT people were subjected to harsh medical intervention such as
shock therapy, and psychological therapy geared toward curing them of their disease. They were
discriminated against, hated, and subject to violence. There may have been displays of feigned pity, but
nonetheless, it was considered unconscionable to allow them to be members of society. The majority
chose to hide their identities so not to suffer such profound consequences. Many hated they, were
isolated, and indoctrinated to believe it was wrong to have sexual attraction toward someone of the
same sex. Those who allowed themselves to be with same sex partners often hid their relationship at all
costs. They lived in fear of the being caught or revealed. The few who stood up for themselves, did so
at the risk of their lives (Cooke­Daniels, 1997)
A common defense mechanism of many LGBT elders was denial. They often did not even recognize
they were lesbians or gay males, even those in relationships might not have thought of themselves as gay
or lesbian. They thought they just preferred women, to men, or vice­versa. Some considered their
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6. partner to be their roommate, even if they engaged in sexual activities.
"We identify simply as two women living together in a
primary relationship," said one 75­year­old who had
been partnered for 41 years. Another elder said, "I
never wanted to identify with a lesbian group. I just like
being with women." (Cooke­Daniels, 1997)
For most of these elders who lived portion of their lives “out”, the frailty and uncertainties that come
with old age, can force them back in the closet. The stressors of ageing can tax their ego strength. For
elders who lived openly as an LGB person, it took enormous self­reserve and coping skills to overcome
their internalized homophobia. Many were disowned by their families. By coming out they were able to
meet other LGBTs and form a community (families of choice) in which they lived comfortably with their
self­identity. These communities became known as being “LGBT affirmative”. LGBT affirming services
imply a sensitivy to the needs of LGBT people, and a comfortable place where they feel included in the
environment and not have to face inequality, or heterosexism, which is degrading and can lead to
depression and mental health problems (MetLife, 2006)
It is not a surprise that the little research that exists has shown that years of systemic discrimination and
heterosexism can affect the mental health of an LGBT individual. This can manifest in depression,
anxiety disorders, substance abuse, isolation and even suicide. Mental health also puts a person at harm
for health risks due to the results of risky behaviors and self­neglect. However, it has also been noted
that the coping skills that were acquired in the process of coming out and deconstructing internalized
homophobia, lead to a resiliency that could be transferred in dealing with other groups, which suffer
from prejudice, like elders must deal with the challenge of facing ageism. (Orel, 2004)
Another factor that can protect LGBT elders is the skill to develop and maintain emotional attachments
to a large network of friends with a communal sense of social connectedness. Those with a social
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7. network have a lessened perception of homophobia, and a greater sense of internal well­being (Orel
2004). A recent study examined the effect of LGBT individuals with “double or multiple jeopardy”
risks. Multiple minority risks can have an additive negative effect on psychological well­being. The
increase of minority stress is thought to put mental health “at jeopardy”. The researches compared both
the quality of social surroundings and inner comfort level compared with different levels of depression.
The findings showed that the quality of the social supports were more indicative of well­being than the
number of minority “isms” they faced. Additionally, this study also reported the idea of resiliency as
being something one could transfer across different situations of oppression (Kertzner et al, 2009)
While there are risks for LGBT people, there is also a sense of inherent strength and independence to
those who are more comfortable with their sexuality. Almost 40 percent of LGBT people in a recent
study believe that being lesbian, gay, bisexual or transgender has helped them prepare for aging. Thirty
six percent said the experience taught them greater self­reliance.
Research shows that each group struggles with different stressors, group defining events and coping
skills. For example, while Stonewall may be important to male gay post­liberation elders, the feminist
movement may be more important to lesbians to bolster their self affirmation and group identity.
Bisexuals have to deal with the added stigmatization within the LGBT community and transgender have
had the most stigmatization of the group. Only in the last 10­15 years have this group been given any
attention and increased freedom. While studies of gays and lesbians have been conducted over the last
40 years, very few have been done on bisexuals, and even fewer have been done on the transgender
population. Transgenders are the least studied group facing the most hardships, financially,
psychologically and socially. (Grant, 2009). It is shown that feminism and it’s ideology buffers lesbians
from the psychological effects of both sexism, and ageism (Olsen 2004, Grant, 2009). Conversely, gay
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8. males may experience a greater sense of identity loss as they age, due to the importance of youth and
beauty in the gay male society. (Kertzner et al., 2009, Grant, 2009, Adams, 2009)
HEALTHCARE
For LGBT people, social stigma and systemic discrimination have led to decades of inadequate access
to LGBT­affirmative and culturally competent healthcare. This has significant negative impacts on the
overall health of LGBT individuals. LGBT people suffer disproportionately from stigma, stress, and
violence, which is compounded by lack of access to healthcare. Due to widespread employment
discrimination and lack of coverage for same­sex partners, LGBT people are more likely to be without
prior insurance coverage. This can keep them from receiving coverage on the basis of pre­existing
conditions. Those without coverage often cannot afford healthcare. Those who participate in HMOs
are limited to “in­network” physicians, which creates a smaller pool of physicians, and often less ability
to find LGBT affirming care. Lack of coverage, lack of LGBT awareness on the part of health care
practitioners, lack of trust and fear of disclosure all lead to a high risk of unhealthy behavior and neglect
of preventative care ultimately leading to an increase in disease and mortality.
The Healthy People Initiative is a decennial plan funded by the government to prevent illness, disability
and mortality among Americans. The plan consists of a number of focus points with tangible and
quantified objectives that are expected to be met within the decade. The Healthy People 2010 Initiative
included the LGBT community in the objectives of several focus areas. The Companion Document to
Healthy People 2010 for LGBT Health is a 450 page reference guide to educate clinicians and other
health care providers of the particular risks and health disparities in the LGBT population.
Unfortunately, the data collection methods did not obtain data on LGBT people among the objectives in
which they were included. Historically, health data collection efforts have not included LGBT
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9. populations or gathered information regarding the specific healthcare needs of LGBT people.
Consequently, all new or updated national forms or data collection tools must be inclusive of diverse
sexual orientations and gender identities. For example, forms contain language that can define a person’s
sexual identity or gender identity, and the technology of collection must be updated in order to read and
categorize new forms that include questions that weren’t previously asked. Healthy People 2020 is up
for open recommendation until December 31s. Hopefully it will not include the LGBT population among
it’s focus and prioritize efforts to ensure reliable data that can be used to promote LGBT health, and
identify concurrent risk factors with other indicators of health variance.
Many of the issues that disproportionately affect sexual and gender minorities, such as substance abuse,
obesity, and tobacco use which are among the leading health indicators designated by Healthy People
2010. Particular health risk factors that are currently known to the medical community are cancer,
mental health, substance abuse, HIV/AIDS and Hepatitis A B and C. Lesbians are at a greater risk for
breast cancer than any other subset of women (lgbthealth.net), and have a higher incidence of obesity
and alcohol abuse. Gay men are at a high risk for anal cancer, which is thought to be spread by the
human papilloma virus. Gay men are also at risk for prostate, colon and testicular cancers.
Preventative care is crucial for all these risk factors. Coming out to a healthcare provider is
recommended by advocacy groups and has been shown to lead to greater satisfaction in visits with
physicians (Orel, 2004). Without an effort to make the predominantly heteronormative healthcare
community competent and compassionate to the health risks of LGBT people, they are at risk for
potentially life­threatening illness.
Transgender people are at the greatest risk of discrimination in healthcare. Insurance companies refuse
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10. coverage for “transgender­related services” and deny coverage for any medical expenses that could be
interpreted as relating to “sex reassignment” (Grant, 2009). This means that female­to­male transsexual
people often are not covered for gynecological care, and male­to­female individuals may be denied
coverage for routine prostate exams, which are vital measures of preventative care for their original sex.
In California, a report on transgender discrimination, showed 10% being denied primary health care,
30% delaying healthcare due to discrimination from doctors, and 35% recounted having to tell their
doctor about transgender people in order to receive competent care.
POVERTY
Poverty is a risk that has been noted as a truism for the LGBT community by advocacy groups
and activists. This could be due to the social stressors and unequal policies suffered by LGBT people.
Lack of protection from workplace discrimination, lack of family support, or conflict with families
leading to estrangement after coming out, lack of insurance, and lack of equivalent marriage rights are all
reasons to think that LGBT people suffer poverty more than their hetero­counterparts. A recent report
by The Williams Institute at the UCLA School of Law titled “Poverty in the Lesbian Gay and Bisexual
Community” was the first to analyze data on poverty in LGB people. Three surveys provided the data
for the findings: Census 2000, the 2002 National Survey of Family Growth and the 2003 & 2005
Califormai Health interview Surveys. They were not able to include transgenders in the study because
they were not included in the sources.
The main findings showed that poverty was at least as common or more common in LGB people than in
heterosexual people. The most significant differences in poverty levels where seen for lesbians, who are
at greater risk for poverty than heterosexual women (24% vs. 19%), and lesbian couples and families
are much more likely to be poor than heterosexual couples and families (9.4% vs. 6.7%). Lesbian
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11. couples over the age of 65 where at a significantly greater risk than gay male couples and heterosexual
married couples, with 9.1% living below the poverty line as opposed to 4.9 percent gay couples, and
4.6 percent of heterosexual couples, essentially making them twice as likely to be poor.
The researchers controlled for certain characteristics that showed to increase the risk of poverty in
order to isolate “the sexual orientation effect”. These were being non­white or Hispanic, being
unemployed, not having a college degree, being younger than 50,and having children. This analysis
showed lesbians couples to be significantly more likely to be poor than heterosexuals with the same
characteristics. While gay male couples showed a lower risk of poverty than their heterosexual
counterparts before controlling for these factors, the adjusted rates showed them to be 1 percentage
point more likely than their heterosexual counterparts. The researchers thought this reflected that gay
male couples have characteristics that put them at lower risk than heterosexual couples, “with lower
rates of childrearing, a greater likelihood of being white, higher education levels, and of course, being
male” (Albeida et al. 2008). Other risks for poverty within the LGB community which showed a much
greater risk for poverty included being African American and living in rural areas. So it seems, from
these findings that being male and gay is a risk for poverty but being a lesbian is the greatest risk,
reflecting the concomitant effect of gender and homosexuality on vulnerability to poverty.
Transgendered people were not included in this analysis, however in another study by The Williams
institute showed that 22­64% of transgendered people surveyed earned less than $25,000 a year. In
California, a study on transgender people showed a twice the risk of unemployment and that 1 in 5
reported having been homeless since they “first identified as transgender”.
VIOLENCE
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12. The National Coalition of Antiviolence (NCAP) is considered be LGBT activists,
lobbyists, and advocacy groups to be the most indicative source for the number of hate crimes
committed against LGBT people in the US. The reports come from individuals, as opposed to law
enforcement agencies. This is thought to lessen the high rate of underreporting. According to NCAVP,
“bias and hate violence can range from verbal harassment, phone or e­mail harassment, property
damage, threats of assault, actual assault or “bashing,” rape, and murder”. Almost every lesbian, gay
man, transgender individual, or bisexual person has experienced some form of hate violence, knows, or
knows of someone who has been impacted by violence. According to NCAVP, a total of 2,430
hate­crimes against LGBT people in the United States were documented in 2007, a 24% increase over
2006. The FBI report also showed an 11% increase in crimes against LGBT people. This trend is
alarming for LGBT people.
Another source of Violence that affects LGBT people is domestic violence. According to NCAVP,
3,319 incidents of LGBT domestic partner violence were reported in 2007. The age of domestic
violence victims is the least­known variable in NCAVP statistics. Of the 2,146 callers whose age was
known, 15% were ages 50 or older: 12% were ages 50—59; and 3% were 60+.
Domestic violence is known to occur in same sex relationships, and is compounded by the legal fact that
many states do not legally define domestic violence when it’s not between a man and a woman. Also,
ageism can ignite internal homophobia, which is often the reason domestic violence occurs between
male partners. The batterer projects his own homophobia onto the victim, which is often not reported
especially if a partner is a care giver. Same sex partners are also not protected from shared assets in
the case of a divorce. This financial situation can force a spouse or partner to remain abused so as not
to lose all their money, which is often the case when the abuser signs everything in their name in order to
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13. imprison their partner in the relationship. When a caregiver abuses an elder, it is often due to
homophobia. In institutional settings the fear of being outed is often used as a threat to silence the
victim. The Adult Protection services note that for every one report, there are five incidences that go
unreported victims of elder and vulnerable adult abuse. Self­neglect is the most common category of
substantiated reports, followed by caregiver abuse and financial abuse. Females are more likely than
males to be abused. The oldest old are also most likely to be abused.
Finances
The greatest issues to be addressed on a Federal level are the Medicare, Medicaid, Tax and End of
Life issues, which are written only from a heterosexual perspective. This causes huge hassles and
disparities that the LGBT community must overcome to achieve the same ends their heterosexual
counterparts do with the ease of laws already in place. Particularly unique to these elders are that the
domestic partnerships are not recognized under the Medicaid and Medicare Health care systems, and
transgenders are not covered for screenings they need for their original sex (i.e. cervical cancer, and
prostate cancer screenings). Those in the Transgender community also suffer the worst from abuse,
neglect and complete naïveté on the part of the health care community at large.
Domestic partnerships and other legal unions create a thicket of bureaucracy one must hack through
to get the desired results. For example, they are not entitled to a spouse's Social Security income if it is
greater than their own, never mind survivor benefits that a heterosexual spouse is entitled when their
partner dies. Medicaid's spousal refusal does not apply to same sex marriages, leaving them no
protection if their partner must go into a long term care facility. Tax laws that permit the survivor of a
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14. same sex marriage some tax shelter when withdrawing pension funds are unequal, as heterosexual
partners can rollover 401Ks without paying taxes in an emergency. The Federal Omnibus Budget
Reconciliation Act is designed to allow "qualified beneficiaries" to continue to receive their employer’s
coverage, but does not cover domestic partnerships. (Aging Well, Vol. 1 No. 3 p.36). Antiquated
laws do not address simple human rights. LGBT members can still be fired from the workplace without
cause. Even family visitation rights, sharing a nursing home room, and protection from homophobia still
remain issues.
There are ways around these inequities, but they take a lot of research, preparation and money. The
Elder Law Project was introduced by the National Center for Lesbian Rights in 1999 (www.ncla.org).
They published a report called "The Survivor Project" as a guide for LGBT elders and their caregivers
to understand what legal issues they will face as they age. The guide lays out the biases in the Medicare,
Medicaid and the tax laws and other financial inequities the LGBT elders will face when it comes to
Long­term Care, and End­ of life issues. Though very comprehensive, the guide must be accompanied
with professional legal advice. The Services for GLBT Elders headquarters in New York, has a lawyer
on staff to work with their senior community in order to explain the preparation that it takes to choose
end­of­life issues.
Housing and Social Isolation
Housing is an issue for all elders. Different options for housing for Elders include Aging in place,
Homecare, Assisted living, Naturally Occurring Retirement Communities (NORCs) and Nursing Homes.
The majority of adults hope to age at home, coined “ageing in Place” where they can maintain their sense
of identity, connection with their family, community, social networks, and the comfortable setting of home.
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15. Ageing begins a process of successive losses, and the nature of these losses and the perception of them,
are the challenges that one navigates which will shape how they experience old age. The physical changes
in an aging body are one of the losses of ageing. A lack of mobility will eventually make it harder for older
people to perform their daily functions, such as getting food, getting dressed, navigating stairs, lifting heavy
things, bathing, getting in out of bed, and performing household chores. . One study reported that 34% of
older adults in New York City had “physical disabilities that affected walking, climbing stairs, reaching,
lifting, or carrying; 23% had conditions that restricted their ability to go outside the home, shop, or visit the
doctor.” Renovations within the home can help with some of theses issues but eventually some home care
assistance is needed. Informal caregivers are family and friends who assist an older adult with the tasks
that they need to keep them at home and maintain a sense of independence and security. For those who
are alone as elders, “formal care” such as home aids and homecare workers can help an elder age, though
great care must be taken in screening home health care workers to make sure that the “fit” will be
beneficial for both.
Living alone is known to put elders at a higher risk for isolation. The more physical and mobility issues
they face can lead to less outings and connection with their social environment. As noted earlier in this
paper, social connectedness was twice as likely to determine a happiness. Another factor that can lead
to isolation internalized ageism. This can be feeling worthless, without purpose, and having nothing to
contribute to society. Internalized ageism is a risk for depression, isolation, neglect and suicide (Grant
2009).
Since LGBT elders are twice as likely to not have children (MetLife 2006), there are less available
caregivers to help them age. They also have a great sense of independence, and an unwillingness to
depend on others. For those who faced familial estrangement coupled with a homophobic society,
tenacity and independence where the core skills that enabled them to live a self affirming lifestyle.
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16. Unfortunately, those coping skills can work against them in age, as the need to ask for help is necessary
to stay engaged in community and gain access to healthcare. In areas without LGBT affirming services
for seniors, there is reluctance to use senior centers or go to nursing homes or senior housing. There is
the inherent fear of discrimination and need for secrecy, but they also feel there is little in common with
those talking about grandchildren, and spouses (Grant 2009)
In a discussion with Alex Kent, the project director at SAGE’s New York senior center, she said
none of her clients were “out” in other senior centers. They collaborate together about AIDS
awareness and around Gay Pride week, so the other centers know they have LGB clients, but
none of them admit to being gay or lesbian when they are not at the SAGE center.
For this reason SAGE has an outreach program called the “Friendly Visitor’s program to visit isolated
seniors who are homebound. The program is one of SAGE’s proudest and successful services. While
LGBT community housing has begun to emerge across the country, in retirement facilities and assisted
living centers, Michael Adams, SAGE’s Executive director say that the reality is that none of “our”
seniors are going to be a part of those communities. This is due to the financial challenges and poverty
rates of the seniors who most need to be in senior housing. There is a need for more affordable housing
that is LGB affirmative and nursing homes that are trained in LGBT competency.
The Department of Housing and Urban Development (HUD) recently announced they will explicitly
prohibit discrimination of LGBT elders in Affordable housing for seniors. They also plan to track
discrimination in order to get a sense of the rate at which LGBT people face discrimination. This will
hopefully incentive a housing development for LGBT seniors with units available for low income seniors.
Another promising option for LGBT seniors are Naturally Occurring Retirement Communities
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17. (NORCs) in which with community services to enable older adults to age in place with the infrastructure
in place to help with vesting physicians, getting groceries and shopping, and maintenance of the home.
While community members privately fund some NORCs, others are federally of state funded. The
Harlem NORC project run by SAGE is an innovative solution to accommodate LGBT people of black
and Latino decent. They have coupled with a large number of community partners that include
churches, LGBT groups, a hospital, and many private businesses that can provide service to members in
the Harlem NORC.
Innovations such as SAGEs Harlem NORC and similar advocacy and services groups in cities like LA,
Boston, San Diego and Boulder are massive strides toward creating an LGBT competent environment
as the community level (Kimmel, 2001). In California, the Equal Californian Elders Act is an example of
cultural competency on the state level. It pledges to treat all LGBT elders with respect and enforces
cultural competency training t all services that deal with LGBT elders. They also track discrimination
and encourage reporting (Grant, 2009). Finally, The Matthew Sheppard Act and the announcement of
HUD are "macro level" (Kimmel, 2001) changes which will effect the lives and public awareness of
LGBT needs. Most important to LGBT elders is the recent announcement that the Health and Human
Service Department has plans for the fist Federal Service Center for LGBT elders. It aims to be a
resource to all service providers in the country and to ensure the encouragement and provisions for
cultural competency training for the service professionals working the LGBT community, the community.
In summary, cultural competence is the degree to which one can steep in the factors that will effect their
aging process, and also consists of different variables and diversity within a culture. The LGT
community faces a number of risks, but there is change on all levels that can work toward ensuring
culturally competent care. Today’s announcement from the Senate that the healthcare bill has been
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18. passed, has significance to LGBT elders because under the current bill, Insurance companies cannot
withhold coverage for pre­existing illness, and there is more flexibility in choice of doctors. In the last
few months, there have been a number of exciting announcements in the LGBT community, which
inspires confidence that change can happen quickly and across different states. That being said, there is
still much to be done for LGBT elders. As a student of social work, the prospect of witnessing social
change for an oppressed population is an exciting time to be in. Maybe the tenacity of the boomer
generation and their demand for their rights and needs might be the catalyst to amend the civil rights act
to include sexual orientation and gender identity.
Albelda, R., et al. (2009). Poverty in the Lesbian, Gay and Bisexual Community. Los Angeles: The
Williams Institute. Retrieved from www.law.ucla.edu/williamsinstitute/pdf/LGBPovertyReport.pdf
Crisp, C. (2006). The Gay Affirmative Practice Scale (GAP): A New Measure for Assessing Cultural
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