Lesbian, gay, bisexual and transgender older adults are pioneers who bravely pushed open the doors to coming out. It is unconscionable that many of these leaders of social justice are forced to retreat into the closet as they age. The troubling reality is that the U.S. lacks a complete understanding of the LGBT senior community and is particularly unprepared for the needs of LGBT older adults at the intersection of multiple disadvantaged populations, such as LGBT seniors who are people of color, disabled, living with HIV/AIDS, undocumented immigrants or socioeconomically marginalized.
Many LGBT seniors fear that the health-care system is judgmental and have experienced discriminatory care or lack access to culturally competent aging services. To address this crisis, the U.S. must adopt a new perspective that emphasizes health, rather than just health care. All sectors of society must come together with a renewed sense of social responsibility that focuses on social determinants of health -- a holistic view of everyday factors that impact the health, economic and social well-being of LGBT seniors.
Ending "Don't Ask, Don't Tell" Health-Care Environment
Eliminating LGBT health disparities and providing more personal and equitable care to LGBT populations depends on overcoming a primary obstacle: Many LGBT patients are uncomfortable discussing sexual orientation or gender identity with health-care providers, and many providers need training on these discussions. Consequently, LGBT patients often forgo prevention screenings or seek care late in their illnesses or diseases, and clinicians lack information that helps in making a diagnosis and recommending treatment.
Research has found that more than one fifth of LGBT older adults have not disclosed sexual orientation or gender identity to their primary physician. Almost 20 percent of LGB seniors and more than 50 percent of transgender seniors fear that they will be treated differently, and almost 35 percent of LGB seniors and more than 60 percent of transgender seniors have encountered a health-care provider who was unaware of their health needs. These factors contribute to LGBT adults (24 percent) being more likely than heterosexuals (18 percent) to receive services in emergency rooms.
The Institute of Medicine's landmark report "The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding" found that incorporating LGBT data into electronic health records and federally funded surveys is essential to addressing health disparities. The report also calls for more research in LGBT demographics, health-care inequities, interventions, transgender needs and social determinants.
Addressing Social Determinants of LGBT Senior Health
Medical care influences only about 10 percent of health status. The truly powerful determinants are genetics, behaviors and social circumstances. For many LGBT seniors, numerous factors complicate the path to health security, such as low likelihood of biological family assistance during health crises, lack of health insurance or same-sex partner retiree benefits, low incomes and high rates of poverty, geographic locations without LGBT-welcoming support systems, and social isolation for those who are single, live alone or do not have children. Addressing these determinants is critical to finding sustainable solutions for responding to LGBT older adults' health needs.
The difficult truth is that the U.S. spends more per capita on health care than other nations yet has worse outcomes. The U.S. needs to adopt the approaches of countries that spend less money and get better results because they spend money on the right things at the right time. U.S. health-care funds must be directed upstream on social services programs that promote wellness instead of downstream on high-cost disease after it develops. A national survey of Area Agencies on Aging and State Units on Aging revealed the challenge: Only 7.8 percent offer services targeting LGBT seniors, and more than half believe it is unnecessary to establish separate LGBT aging services.
Promising Solutions
Fortunately, innovative public-private partnerships are establishing models of progress, including: (1) 55 Laguna Street, San Francisco's first, and the nation's largest, low-income LGBT-welcoming senior housing community that also will provide expanded services to LGBT older adults from across the city; (2) New York City's SAGE Center, the nation's first LGBT senior center providing comprehensive programs relating to arts and culture, fitness, food and nutrition, health and wellness, and lifelong education; and (3) Triangle Square in Los Angeles, the nation's first affordable, LGBT-welcoming senior housing facility and community center that creates a hub of social services, classes and recreational activities supporting the needs of the city's LGBT older adults.
These are inspiring examples of upstream approaches to addressing the health needs of the LGBT senior community. They represent advancement of social justice for the LGBT community, yet we have more to do. We have what it takes: skills, knowledge, caring, determination and, most importantly, a passion for doing the right thing. Now is the time for all members of society to come together to help prevent LGBT older adults from aging back into the closet.