The number of Americans over the age of 65 is estimated to more than double by year 2060. As our healthcare system adapts to an aging population, it must incorporate the perspectives of older LGBT Americans to address specific needs.

Last month, AARP released a report of nearly 2,000 older LGBT-identified Americans following a 2017 survey on health, community, and social determinants. The study sample was derived from a research panel of 85,000+ LGBT individuals developed over a 20-year period to support LGBT research initiatives. Although the panel skews to more educated and socially engaged elders, the study identified a number of concerns in healthcare for older LGBT Americans.

Long-Term Care Concerns

Individuals were asked about concerns surrounding their or their partner’s future long-term care needs. In all categories—Neglect, Abuse, Refused or Limited Service Access, Harassment, and Identity Suppression—gender expansive elders expressed the greatest concern about future long-term care (gender expansive (*GE) here meaning transgender or non-binary individuals). In nearly every minority sexual orientation and gender identity group, over half of the participants expressed at least moderate future long-term care concerns.

Concerns about long-term care as an LGBT community member are great, particularly for gender expansive individuals. A majority cite concerns about neglect, abuse, being refused access to services or harassment. The most LGBT-specific impact is to be forced to hide one’s identity which is a concern for about half of LGB respondents and for 70% of gender expansive respondents.

Family Support

Family support in individual health and wellness is critical, and health systems are increasingly integrating family-centered care and engagement. However, LGBT survey participants, especially transgender and non-binary elders, did not readily see their family members as parts of their social support networks. In working with LGBT populations, it is important to acknowledge and adapt to an expanded definition of “family” as the primary source of social support. LGBT family care models should consider friend and neighborhood networks as potential social support substitutes for more traditional biological or nuclear family units.

The vast majority of LGBT participants (92%) feel that they have some social support network. Of interest is the high level of both LGBT and straight friends that make up that network. While family is important, the percentages are unfortunately low compared to the friends network, especially for the gender expansive community. Also noteworthy is the relatively limited support by religious communities. Of interest is the higher level of support from online communities for gender expansive community members, the social support connection between the bisexual and gender expansive communities, and the higher connection with neighbors by lesbians.

Access to Services

Access to LGBT specific and affirming spaces was limited for survey participants, especially those living in small communities. Nearly half of all respondents from small communities said that they did not have access to any LGBT organizations where they live. Outside of big cities, LGBT elders had very limited access to specific senior services and health centers. With high rates of access to community centers, social organizations, bars and faith centers outside of small communities, there is reason to consider alternative locations for LGBT senior wellness services and programing.

LGBT community members living in small cities, small towns and rural areas have the most limited access overall to LGBT- affirming services. Four in ten LGBT respondents in small communities are without access to any LGBT specific community services where they live. Access to LGBT senior services is particularly low in communities of all sizes and especially outside big cities.

Primary Care Provider Relationships

Although many survey participants said they were out to their primary care providers, bisexual individuals disproportionately reported withholding their sexual orientation from their provider and feeling reluctant to discuss some issues for fear of being judged. However, of all participants who had a primary care provider, almost none reported having difficult or negative experiences with their provider.

The majority of LGBT respondents in this survey are “out” to their physician, but bisexual men and women are significantly less likely to say their primary care physician knows their sexual orientation.

Summary and Future Action 

Of the near 2,000 survey respondents, many reported a number of affirming support systems in their lives and communities. However, there were identified, specific concerns for long-term care plans for gender expansive elders, as well as provider barriers for bisexual patients. Additionally, access to LGBT services in smaller, more rural communities was reported to be greatly limited. With the number of Americans over the age of 65 projected to more than double by year 2060, these needs should be met with community development and capacity building efforts alongside evidence-based interventions and service provision models specifically tailored to older LGBT Americans.

Providers of long-term care services and supports can initiate specific outreach activities to make the LGBT community feel more comfortable including training, hiring LGBT staff, investing in advertising to communicate LGBT-friendliness, and displaying LGBT-welcoming signs in facilities and online. Any of these actions help create LGBT-safe spaces within the long term care industry and would be roundly welcomed by the LGBT community.

Report and Images Source
Houghton, Angela. Maintaining Dignity: Understanding and Responding to the Challenges Facing Older LGBT Americans. Washington, DC: AARP Research, March 2018.