[Jess]

I'm not sure if another LGBT and aging thread has been started, so I decided to place this here in hopes to bring attention back to the issue of aging in our communities.

It is a wonderful and insightful read:



Amazing Keynote Speech on LGBTQ Elders and Aging from Robert Espinoza of SAGE
August 3rd, 2011 at 4:04 pm (Uncategorized)

Editor’s Note: The following keynote addressed was delivered on July 26, 2011 at the opening luncheon of the TransFaith in Color 2011 Conference in Charlotte, North Carolina. The conference was hosted by the Freedom Center for Social Justice.

The Age of LGBT Aging

BY ROBERT ESPINOZA

It is estimated that every six seconds, someone in this country will turn 50, and every eight seconds, someone will turn 65. In fact, if the statisticians are correct, this clock-like aging of our country will mean that the number of older people in the U.S. will more than double over the next two decades to more than 80 million elders. It is unprecedented, referred to by some as “the graying of America,” a phenomenon largely explained by the retirement of a very large Baby Boomer generation.

But for those of us who work in the aging field with an eye toward social justice, it is only one frame on a much broader aging narrative. We are also witnessing the aging of transgender, lesbian, gay and bisexual older people in large numbers. And we are also seeing the first generation of people to age with HIV/AIDS—due in part to the success of highly active anti-retroviral therapies introduced in the mid-1990s. Finally, our country continues to become increasingly more racially and ethnically diverse, enriched and sustained by the contributions of communities of color and immigrants from all parts of the world.

What this means is that over the next few decades, our communities who have been historically underserved, marginalized and often politically targeted will together represent the majority of older people in this country. And with it—leave no doubt—will come an increased resistance from our opponents. We are seeing it right now—as we meet at this conference—in the hostile Congressional conversations on the debt ceiling and our national deficit, in the ways in which our country’s strongest safety net programs from Medicaid to Medicare to Social Security are now under increased attack.

The graying of America, then, must not be understood solely as a demographic phenomenon. It must be understood as a paradigm shift that will test how our country deals with our most marginalized people. It’s on this issue that I would like to pose three questions to inform this conversation.

First, is our country’s aging network—the broad system of aging providers, health and social service professionals, community-based organizations, churches and houses of worship, and direct care workers—prepared and resourced to deal with our growth in numbers?

Second, are government leaders grappling with the right questions? Or worse, are they targeting the very system that’s meant to protect us as we age at the exact moment in which our communities transition into the majority?

And, third, have we created the necessary political infrastructure, which includes communities of faith, to imagine a healthy aging reality for our elders, and for ourselves? Is it sustainable? And will it tackle one of the most devastating economic recessions in recent history? Will it challenge the most vicious, political opponents, or policy experiments, of this era?

Poet Adrienne Rich wrote: It’s exhilarating to be alive in a time of awakening consciousness; it can also be confusing, disorienting, and painful.

* * *

I oversee the national advocacy efforts for SAGE, Services and Advocacy for Gay, Lesbian, Bisexual and Transgender Elders, the country’s largest and oldest organization dedicated to improving the lives of LGBT older adults. These questions underscore the work that we do across the country every day.

In Texas, an older gay man is moved against his will by his children all the way to St. Louis, separated from his partner of 22 years, and filed anonymously in a nursing facility so that his partner can never locate him. Across the country, transgender elders report harassment by hospital staff and by nursing home staff—denied answers to the most basic of requests. In central Louisiana, a 45-year-old man and his partner—both HIV-positive—serve as the sole caregivers of an 84-year-old gay man who lives an hour away, and who came out in his 60s, only to watch his entire family up and leave. In California, one of SAGE’s national Latino partner organizations reports countless incidents of area agencies on aging refusing services to Spanish-speaking elders and then reporting them for deportation. And in New York City, an older woman’s partner passes away, and because she lacks the proper paperwork as a domestic partner, and has no other tenant protections, she loses their shared home and becomes homeless overnight.

Yet while each of these stories is unique in the lives they have affected, they are not out of the ordinary. We find that LGBT older adults are more likely to be single, without children and many are estranged from biological family members. If 80 percent of long-term care in this country is offered by biological family, it means that many of our elders live isolated and rely on friends, caregivers and eventually the formal aging system. Yet elders often report going back into “the closet” at that point for fear of discrimination—and many who don’t reenter the closet (or who are unable to reenter the closet because they were never in it), report rampant verbal harassment, abuse and discrimination by aging and health professionals.

A lifetime of discrimination will add up in our bodies and in our minds as we age, and the effects are measured. LGBT people—and especially LGBT people of color—experience high rates of depression, suicidal thoughts, and alcohol abuse, all of which magnify as we get older. Yet LGBT elders are more likely to delay care for fear of encountering discrimination, and are less likely to be screened appropriately by medical providers who do not understand them as gay men, as lesbians, as transgender people, or who assume older people have no sexualities, as reported by experts in the HIV field.

And if a history of structural racism has arranged our country into cities and regions so that communities of color are more likely to be concentrated in areas with fewer resources, including health and aging services, and if undocumented immigrants are increasingly denied these services, then it means that the health care options for LGBT elders of color are fewer—and the health outcomes are worse. The existing research shows this over and over: the worst health outcomes reported in our communities are often experienced by poor and low-income transgender people of color.

SAGE’s growing body of work with transgender elders around the country reveals the subtext behind these outcomes. Transgender elders routinely report incompetence, negligence, prejudice and discrimination in both health care and aging settings by staff and by their fellow residents. As documented in this year’s groundbreaking transgender discrimination report led by the National Center for Transgender Equality and the National Gay and Lesbian Task Force, this can mean that a transgender person often experiences longer wait times, even physical assault, while trying to access basic medical care. Someone who fears discrimination might delay visiting a doctor, which can mean that illness goes undetected and gradually intensifies. Or it means that the prohibitive costs of health care, and the general lack of insurance coverage or underinsurance, means than many transgender elders—many poor and low-income people of all ages—have no health care options, no primary care doctors, and are more likely to rely on emergency room for health care, usually when crisis hits.

We also know that aging providers rarely offer cultural competence training and do little outreach to transgender clients. Transgender elders report incidents of staff refusing to call them by their preferred pronouns and report a general fear of being discovered as transgender and the abuse that might follow. With smaller support systems, an incident of discrimination will likely go unheard and be left unaddressed, with no one to advocate on our behalf. This places many transgender elders at risk of elder abuse, including financial exploitation.

If our health system were to begin adequately addressing the unique health needs of transgender elders, they would unfortunately have little research on which to base their practices. Transgender people—especially elders and people of color—are rarely studied for their realities, their unique health and psychosocial needs, or the types of health interventions that might work to improve health and a general quality of life. Data collection efforts in both the public and private sectors rarely include questions related to gender identify and expression (and when they do, the subgroup samples on older people are thin). To date, there exists no large-scale study on the health needs of transgender elders. We know almost nothing about the long-term effects of hormone therapy or transition-related surgery, especially at a later life, when surgery is riskier, hormone levels usually drop, and many elders take multiple medications.

This broad disregard for transgender aging issues resembles the area of HIV/AIDS, which disproportionately affects transgender people and elders. Two weeks ago, SAGE met with various policy leaders in Washington, DC to discuss the general lack of support for older adults with HIV, many of whom are men who have sex with men, transgender, people of color, and struggling with poverty. Likewise: there is insufficient research on the physical effects of living and aging with HIV and highly-active anti-retroviral therapies; there have been no national studies on older adults with HIV; few if any HIV prevention marketing programs ever target older people; and HIV and aging is virtually absent from major legislation or strategies affecting this population, from the Older Americans Act, which is the largest provider of older adult services, to the Ryan White Care Act, which is the largest funder of HIV/AIDS services, to the recently released National HIV/AIDS Strategy under the Obama administration. You would never guess that in a few years, one in two people with HIV will be 50 or older; or that older adults are more likely to be dually diagnosed with HIV and AIDS, meaning that they have often been living with it for years, as the illness has progressed in their bodies; or that infections are on the rise among older people, some of whom come out later in life and report feeling immune to infection. “Silence equals deaths,” said the ACT UP slogan for in the early AIDS movement in the 1980s—and the silence on this aging issue is deafening.

What, then, must be done? What is our responsibility? Where do we even begin?

Break inserted to be continued below