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Friday, July 15, 2011

The Gay Golden Years

By Tim Louis Macaluso -

Pittsford residents Marvin Ritzenthaler, left, and Steven Jarose.
When Bud, an elderly gay man who lives in a Rochester-area residential community for seniors, posted news clippings outside his door regarding same-sex marriage, the reaction he got from other residents was not overwhelmingly positive.
"Some of the pictures were taken down," he says. "Once someone pinned note paper covering over a picture."
It was a little intimidating, Bud says. It's also an example of a culture that can be deeply entrenched in some traditional nursing and assisted-living homes: prejudice that can have a profound emotional impact on elderly members of the LGBT community.
Though Bud, who recently celebrated his 84th birthday, is out, he's still cautious. He lives alone and he asked that his last name not be printed.
"I've always been me," he says. "But I've been careful not to out myself to the wrong people."
Bud is certainly not the first gay man to move into a senior-living community. But he is part of a population of seniors that is gradually becoming more visible both nationally and locally.
Gay culture is sometimes criticized for its exaggerated emphasis on youth, but there is growing awareness about older members of the LGBT community - people who have reached their mid-60's, and are living into their 70's, 80's, and 90's. What do we know about them? What are their concerns? Are senior-living communities and nursing homes becoming more accepting of their gay clients? And how do they treat gay couples?
After New York passed same-sex marriage legislation last month, Bud found a message posted outside his door. Someone wrote a note saying, "Congratulations on gay marriage. I'm so proud to live in a state that's leaning toward equality."
"That really put a smile on my face," he says.
But Bud's experience of gradual acceptance, though a good sign, is not shared by all LGBT seniors. In some respects, LGBT seniors face the same issues and daily trials that many seniors face: less mobility, limited incomes, and managing illnesses.
But LGBT seniors often confront those issues along with the injustices and abuses that accompany discrimination. And elderly LGBT people frequently find themselves in a strange and unexpected predicament: while they have lived through the liberating gay-rights movement, they often discover that they stand to lose some of those freedoms in what are supposed to be their golden years.
"Many elderly LGBT people were not out through most of their lives, and they learned the importance of hiding," says Scott Fearing, program director for the Gay Alliance of the Genesee Valley. "Some [LGBT seniors] tend to go back into the closet," he says.
Unlike LGBT youth today, who are used to seeing gay characters positively portrayed on television and in film, LGBT seniors remember a time when it wasn't safe to be out.
In the early 20th century, homosexuality was viewed as something beyond scandalous, and could result in the loss of a job or housing. Given the history of discrimination toward LGBT people, it's understandable why many LGBT seniors are reluctant about being out.
Part of it, too, may be due to an increased sense of vulnerability that sometimes comes with aging, Fearing says.
Hiding may also help explain why it is sometimes difficult to find solid data concerning LGBT seniors. According to "Outing Age 2010," a publication by the National Gay and Lesbian Task Force, most of the research until recently has focused on elderly gay males. Much less research has been done on lesbians, and relatively little research has focused on bisexual and transgender seniors. This can present problems in health care, Fearing says. Little is known, for example, about the long-term use of hormones among transgender seniors, he says, or how the hormones will interact with other medications.
Researchers estimate that there are between two million and seven million elderly LGBT people living in the US today. And studies indicate that living in social and economic marginalization extracts a toll from LGBT seniors. Compared to their heterosexual peers, LGBT seniors are at greater risk of isolation, poverty, and homelessness.
The majority of LGBT seniors live alone, while their heterosexual peers are much more likely to live with their children or a caretaking family member. And research shows that seniors who live alone are at much greater risk of serious injuries, depression, and alcohol abuse.
And contrary to the stereotype that often portrays gays as financially secure with plenty of disposable income, research indicates that a significant percentage of LGBT seniors face financial difficulties in their later years.
Services and Advocacy for GLBT Elders in New York City reported that about 35 percent of its clients in 2009 were Medicaid eligible with annual pretax incomes below $10,000. The situation is especially troubling for transgender seniors. Though they are typically more educated than the general population, transgender seniors are twice as likely to live below the poverty line, according to the California-based Transgender Law Center.
While many LGBT seniors slip back into the closet, others struggle to remain out: they dread transitioning into a nursing home or assisted living community, says Brian Hurlburt of Rainbow SAGE of the Genesee Valley. Many LGBT seniors have wrestled for years with being honest about their sexual orientation, Hurlburt says, and they don't want to go back in time.
"They really fear that they can't be who they are during these years," Hurlburt says.
For instance, they might be afraid to share close living quarters with heterosexual seniors who, for personal or religious reasons, still look at LGBT people through a 1950's lens.
"Fear of having to go back into the closet is overwhelming for them," Hurlburt says. "Some just can't do it."
Rainbow SAGE, the local chapter of the national SAGE organization, is one of several local groups working to alleviate these fears. The group holds social activities such as pot lucks, picnics, and holiday celebrations.
But SAGE is also active in advocacy and cultural competency training. Members speak to health-care workers, caregivers, and nursing and assisted-living workers who are in daily contact with LGBT seniors.
"The big word everyone wants to hear is ‘acceptance,'" says Saundra Ehman, SAGE member and a long-time Rochester advocate for LGBT seniors. "We're pigeon-holed. When you say the words ‘gay' and ‘lesbian,' many straight people immediately focus on the person's sexuality. That's just a small part of what we're talking about. We're talking about making the person comfortable being themselves. They deserve that."
Ehman says she remembers hearing a nurse in one home refer to an elderly gay man as "just an old queer." She says the incident was so disturbing that she couldn't forget it.
"That kind of abuse is why people are afraid," she says. "And this is what we're trying to change."
LGBT seniors who need to enter a nursing home want to be assured that they are going to be treated with respect, Hurlburt says. When LGBT couples aren't allowed to share a room, it only increases the sense of isolation for both people, he says.
But there are signs that cultural sensitivity training may be working.
"We're always trying to make sure that we're culturally aware and sensitive to all segments of the [senior] community," says Mary Kanerva, Catholic Family Center's director of aging adult services.
The organization's mission is to help people remain independent for as long as possible, she says.
"I think it's very important that we alleviate the fears," she says. "We really try to meet every person where they are."
And in some regions of the country - California, Arizona, and Florida, for example - there are a few "affinity" retirement communities, designed with the LGBT client in mind. The 10-acre Fountaingrove Lodge in Santa Rosa, California bills itself as the first gay continuing-care retirement community in the country.
Though progress is being made, society still has a long way to go before meeting the needs of LGBT seniors, says local attorney Jennifer Gravitz. And much of the problem, she says, is linked to institutionalized homophobia and discrimination.
As well-meaning as the medical, legal, and social-work communities are, she says, the problems are deeply entrenched.
Institutionalized homophobia creates its own unique form of suppression on LGBT seniors, Gravitz says, and it tends to impact them at the worst possible time - when they are living on limited incomes, coping with a chronic illness, or when a partner needs long-term care.
"First, we have to consider the mindset of people who are in their 60's, 70's, and 80's," she says. "They may not be aware of their choices, or they are fearful if they share who they are, they'll be further marginalized, punished, or denied services that they truly need."
The institutionalized challenges LGBT seniors face range from laws affecting inheritance to benefits. LGBT couples have no automatic right to inherit from a partner or spouse. They face higher taxation on an inheritance on deferred benefits, such as an IRA or pension. And surviving LGBT partners are not always eligible to receive deferred benefits.
"There are many benefits still today that domestic partners cannot receive, the military's being one of them," Gravitz says. "The preclusion of being able to receive Social Security from a deceased partner is another."
Gravitz is also troubled by an actuarial issue, particularly as it relates to financial and long-term planning. Most of the planning models are designed for heterosexual couples where it is well known statistically that women tend to outlive their husbands by about seven years.
"But what happens to those models when you have a family of two men?" she says.
Statistically, the two could become critically ill and pass away within a few years of each other. A family of two women, however, could each live, according to statistics, for years with disabling illnesses. What's the unique impact on each of those families, she says, when the planning models used are not typically designed with their needs in mind?
But the biggest discriminatory hurdle most LGBT seniors face has to do with Medicaid. While a short list of states have legalized same-sex marriage, the Defense of Marriage Act still prevails. The federal legislation signed into law in 1996 by former President Bill Clinton defines marriage as an act between one man and one woman, and it has direct influence over Medicaid rules.
Medicaid was designed to care for the truly poor, Gravitz says, who require the chronic care of a nursing home. A heterosexual couple can spend down or transfer assets to, for example, help the wife qualify to enter a nursing home. But the husband is allowed to keep the house and all of its equity, which can amount to thousands of dollars. The law does not impoverish the husband or the heterosexual "community spouse" in order to make sure the patient or wife receives the care she needs.
But domestic partners or legally married LGBT couples aren't recognized by Medicaid law.
"They are legal strangers to one another," Gravitz says. "It means that the house that they purchased decades ago and is paid off now has to be divided in half. And the community partner, the person not going into the nursing home, now has to buy back his or her own house."
Joint accounts are presumed to be the assets of the person requiring Medicaid, unless the community partner can prove ownership of half of the money, she says.
"That's just how the Medicaid rules are written," Gravitz says. "Unlike the community heterosexual spouse who is permitted to keep a certain amount of income, savings, and a car, all of that has to be liquidated. And the gay or lesbian community partner gets nothing. We've accomplished the opposite of what Congress intended for the heterosexual spouses."
This means the LGBT senior and community partner, who may be emotionally and physically frail, too, could now be made destitute so the ill partner will qualify for Medicaid and accepted into a nursing home.
"I can think of nothing more cruel or inhumane," Gravitz says.

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