January/February 2016 Issue

LGBT Elder Housing — Opening Doors Without Finding Closets
By Sue Coyle, MSW
Social Work Today
Vol. 16 No. 1 P. 20

LGBT older adults struggle to find welcoming, affordable elder housing.

In June 2015, the U.S. Supreme Court ruled in favor of same-sex marriage, stating that all couples, regardless of sexuality or gender makeup, have the right to marry. It was one step forward in what has been and continues to be a long fight for equality. In the months that have followed, there have been setbacks, but also additional historic steps forward, as advocacy continues.

But even with the increased awareness and drive for equality, challenges remain. Some are evident—making headlines or the evening news—others are less so, particularly those pertaining to the individuals that society tends not to see—older adults.

"Older adults are invisible in society," says Catherine Thurston, LCSW, senior director of programs at SAGE (Services & Advocacy for Gay, Lesbian, Bisexual & Transgender Elders). "Even with the changes [in the LGBT community], older adults are often not the first voices heard."

One such issue is housing. Elders looking for affordable, LGBT-welcoming housing, be it a 55+ community, an assisted living home, or a nursing home, often find more challenges than opportunities.

"I have spoken to LGBT residents in care facilities who told me they had to go back into the closet because their residence is not gay friendly," says Sharon Raphael, PhD, researcher/gatekeeper for Old Lesbians Organizing for Change, a national advocacy organization run for and by lesbians aged 60 and over. "[In these facilities], heterosexual assumptions reign loud and clear."

Getting In
One of the first obstacles LGBT elders face is locating a facility or community that will fairly and willingly accept them. "In more than two-thirds of the country, there is no law prohibiting discrimination on the basis of sexual orientation or gender identity," says Karen L. Loewy, senior attorney and seniors program strategist at Lambda Legal, a national organization advocating for the civil rights of all LGBT individuals.

There are, she notes, sex discrimination prohibitions. However, these prohibitions do not explicitly include discrimination toward the members of the LGBT community. A broad interpretation is needed to grant LGBT older adults protection under these prohibitions, and there is currently no guarantee. Thus, continually, housing communities and facilities discriminate against out elders.

How that discrimination plays out may vary. "Sometimes, it can be that the same-sex couple is being told there are no apartments available when a different-sex couple is told there are three. It can be charging different rent. It can be harassment within the housing community," offers Loewy.

It can also be silence—an unwillingness to admit acceptance or discrimination. "I remember calling a certain aged independent care residence in Long Beach to ask if they were gay friendly," Raphael says. At that time, she was assisting in the creation of a gay-friendly resource guide to Long Beach, CA. "Two persons I talked to on the phone refused to answer the question. They said they were not allowed to say."

Affordability
Even once an individual or couple locates a facility that will welcome them (or at least admit them), the problem of affordability arises. "There's a misperception that gay and lesbian older people are wealthy," Thurston says. "The majority of people we work with at SAGE are living with limited means."

"There are a bunch of affordable housing options," she continues, "but they're costly to build. Chicago, Philadelphia, Minnesota, and Los Angeles all have affordable housing for LGBT older adults."

Raphael adds that these affordable options take on a variety of forms. "Triangle Square Housing in Los Angeles is now run by the Gay Center in Los Angeles, and they have expanded housing services to include intergenerational housing. In Florida, there is housing in Sarasota, and [there is] housing in North Carolina. In Apache Junction [Arizona] there are at least two RV parks that house older lesbians. Both parks have been around for at least 20 years."

In San Francisco, there is Openhouse. "Marcy Adelman, who wrote Long Time Passing: Lives of Older Lesbians and has done psychological research on the topic of lesbian aging, cofounded Openhouse with her now-deceased partner," Raphael explains. "The good thing about Marcy's vision was that she included in-depth support services along with the housing services."

It is the hope of all organizations and advocates that even more affordable options develop throughout the country. SAGE recently launched an LGBT elder housing initiative that includes not only the building of LGBT elder housing but also the sharing of their model so that these communities can exist in all communities.

But they don't exist yet. And not all LGBT elders want to live in LGBT communities. "There is probably the same amount of people who want to live in an LGBT environment when they get older as don't," Thurston says of her experiences at SAGE. "Fifty percent don't want to be in an LGBT-only community; they want to be in an LGBT-affirming community. A community that will honor them, support them, but not be all gay."

One such community exists through So Others Might Eat (SOME), a Washington, DC, organization that, among a bevy of other services, provides in-home and housing services to low-income older adults. "We try to be as LGBT friendly as we can," says Julie Maggioncalda, LICSW, senior director of senior services at SOME. Maggioncalda says the organization looks at everything from the intake paperwork to the bathroom designations to ensure no discrimination occurs.

Treatment Within
Should LGBT older adults find housing they can afford and that will accept them, they still face challenges from within. As Raphael noted, many older adults feel forced back into the closet because of the treatment they receive in residence.

One of the most common forms of discrimination to occur is ignorance. "The primary way discrimination against LGBT persons occurs in care settings is by assuming that everyone in the facility is straight or not gay," Raphael says. "This leads to other omissions. If the LGBT person has a spouse or partner, that person may get ignored or not included as someone who is part of the caregiving team or support system of person in care.

"When that assumption occurs, it may push the LGBT person in care further in the closet, as an atmosphere is created that appears to cater to only the needs of straight, married couples or biological kin of the resident, excluding someone who may appear only as a visiting stranger or friend."

Thurston agrees. "We've seen repeatedly at SAGE cases of people who have hidden their true identities, who have talked about their partners as their friends or sisters or neighbors," she says. "They are not able to live their true lives at a time in their life when they are supposed to be able to be authentically who they are."

When the individual is out, the discrimination can take many more forms. For example, in an independent living community, a same-sex couple may be harassed by their neighbors. "There are procedures for filing complaints," Loewy says, "but the board may fail to respond to the gay couple's complaint."

She adds, "In assisted living communities and nursing homes, there is a health care component. People have reported feeling shunned and not receiving appropriate care."

Raphael has heard similar reports. "I had an intern working in a nursing home who told me the staff refused to bathe a lesbian resident just because the label elicited such a negative reaction.

"This was quite a few years ago in Los Angeles, but it would not surprise me to hear this kind of prejudice still exists among staff where caregivers have little or no education about LGBT issues."

Raphael also remembers a gay man speaking of ill treatment he received. "He was not fed properly," she says. "I am not sure if it was homophobia or just that it was a bad place. But he had to actually go and pick apples to eat off the trees in the backyard in order to eat at times. This is why it is so important for family and friends to visit loved ones who have been placed in any type of facility."

Solutions
How, then, can such discrimination be combatted? One solution has already been mentioned: building/creating LGBT communities. "We have two projects in New York City in the pipeline for LGBT elder housing," Thurston says. "While they're still in the early stages, we are really confident that we'll see movement in the coming months. It's critical that we build something and build it soon."

But, she cautions, building can't be the only option. "We are never going to be able to build our way into a solution. It really is a dual approach: build housing when we can, and train existing housing providers around the country." And that training must encompass all aspects of housing, care, and cultural competency, while starting with the basics.

"A lot of what we do is to help people understand what the 'L', the 'G', the 'B', the 'T' stand for. Literally, you need to know what the words mean," Thurston states. You also need to know when to use them.

For example, Social Work Today asked Thurston why SAGE uses LGBT as opposed to LGBTQ or LGBTQI. Thurston's response: "Historically, SAGE has not used the 'Q' or the 'I', but the 'Q' specifically, because for many older people, queer is not a term that they associate with strength. Younger people took the 'Q' and flipped it on its head. But for many older people, queer represents being harassed, teased. Queer has a different connotation for older people." She does add that as time continues and the younger generations become the older generations, the 'Q' may be more widely used among LGBT older adult advocacy organizations.

Therefore, it's not only important to understand the words but also how the meanings can differ depending on age and experience.

"The experience of an 85-year-old in an elder community is different from a 55-year-old," Loewy describes. "Generational experiences make folks of some older generations really, really reluctant to out themselves, to seek assistance. They may have incredible distrust of health care providers.

"Right now we are seeing some of the first wave of LGBT people in specific settings. We are at a critical moment in time. The more communities are aware of and familiar with LGBT people, the more that discrimination can subside or lessen," she says.

Thurston agrees. "We have to help people understand what it was like to be gay in 1940, 1950, etc.," she urges.

Beyond the basics, trainings should also help teach professionals how to approach LGBT elders and help them feel welcome. "We have to help staff say, 'Is that your partner?' or, 'I noticed that Jane comes to visit you every day,'" Thurston advises. "We have to open the door to help people talk about themselves as an older LGBT person."

However, Raphael cautions, being LGBT-culturally competent and allowing individuals to truly be themselves does not mean forcing an older adult to be more open than they're comfortable. "I do not think care providers should try to bring closeted or hesitant nonidentifying LGBT adults out of the closet," she says. "That would be a mistake, especially if the provider is not gay or out themselves." It is less about forcing individuals to be out and more about creating an environment that enables them to be included.

SOME does just that and reinforces that environment by providing departmental trainings and CEU-based trainings. "All of the clinical directors meet regularly," Maggioncalda adds, "in an effort to support each program [in being LGBT welcoming]."

Who to Train
These trainings should be offered to—put simply—everyone. "SAGE does trainings in which the audiences are housing providers, the site staff, site managers, and any additional service providers," Thurston describes. "We train in long term care, assisted living communities, and senior centers, from the administration to the direct service providers."

The staff isn't the only group to train. Residents would benefit from being informed as well. According to Thurston, SAGE is working on a training procedure for residents. "It's especially complicated when you're talking about nursing home residents," Thurston says. "Even when the staff and nurses and administration are totally trained and fluent, a resident who has very different feelings can make it a very difficult experience."

Conversely, a resident who has very accepting opinions can help create a welcoming atmosphere. "My experiences in visiting assisted living residences is that a significant number of the people there have gay relatives—sons, daughters, grandchildren, etc.—and usually these people have positive perceptions about LGBT people in general," Raphael says. "Perhaps these positive perceptors could help share in these seminars and help the others who might have homophobic ideas move away from their negative sense of the issue."

The Future
Moving forward, it's important that advocacy continues. For Loewy, that means working within the laws to change the laws. "There are two things happening," she says. "One is that we are continuing to represent clients who have experienced discrimination in housing and making sure that the existing sex discrimination prohibitions are interpreted broadly enough to address the needs of LGBT older adults.

"At the same time, there's legislation being worked on in congress to add LGBT and gender identity to the sex discrimination prohibitions," Loewy says. "That is not only letting me sue more people, but it sends an incredibly strong discrimination notice."

For social workers, Loewy continues, advocacy means looking at the bigger picture. "I think there's a way in which particularly overburdened caseworkers are all about solving the immediate issue. But there's a role that I think social workers can play in being an advocate," she explains.

"When they are getting the message that their clients are being discriminated against, they can play a tremendous role in advocating with the staff and making sure there are nondiscrimination policies in place. [They can do this] in a culturally competent way that doesn't try to erase or diminish in any way the person who is LGBT," Loewy says.

When advocating and effecting change, Maggioncalda encourages, social workers shouldn't feel as if they have to reinvent the wheel in terms of procedure and policy. "Find research or an article, take it to your supervisor, and say you've really been thinking about it.

"You don't have to be the one who came up with it," she says. "You just have to be the one to do it."

And amidst it all, hold on to hope. Thurston does.

"My goal is that there be no wrong door for an LGBT older adult," she says. "I don't think SAGE is going to lose its relevance any time soon, but I do think there's a chance there will one day be no wrong door. I couldn't do this job every day if I didn't think that would be the case."

— Sue Coyle, MSW, is a social worker and freelance writer in the Philadelphia area.