Tip Sheets

Resources for reporting on the health care needs of older LGBT adults

By Eileen Beal 

Three things have come together to throw a spotlight on the health care needs and challenges of older adults identifying as lesbian, gay, bisexual, or transgender:

First, is the aging of America. Today, 13 percent of the population is over 65; by 2030 that figure is projected to increase to 20 percent.

Second, is the impact of the Obama administration’s championing of older adults’ and the LGBT community’s civil rights. This HHS report is the go-to roadmap for “advance[ing] the equality, health, and well-being of lesbian, gay, bisexual and transgender (LGBT) individuals, families, and communities.” Also, the National Institute of Minority Health and Health Disparities has been tasked with “[d]eveloping a robust and diverse research agenda in LGBT health” that includes research as well as training programs.

Third, the LGBT community’s advocacy on behalf of its older members.

That means there’s more demand than ever before to better cover the health and care needs of what until recently had been a “marginalized minority.”

Numbers count

According to the U.S. Census Bureau’s Population Clock, almost 325,000,000 people are living in the United States today. Since LGBT is a new census cohort, data are in flux, as this recent report indicates. Depending upon the source, those identifying as lesbian, gay, bisexual, or transgender adults are estimated to comprise between 3 percent and 4 percent of the U.S. adult population. That statistic jumps to 11 percent of the adult population when considering both sexual behavior and attraction.

Differing realities

According to these two reports, Improving the Lives of LGBT Older Adults and SAGEUSA’s Health & Health Care, when it comes to the LGBT community, LGBT baby boomers are the first generation to have had the opportunity to live openly gay or transgender lives.

Some research classifies those who identify as bisexual a little differently. This MetLife report notes, “bisexuals have significantly different experiences than do lesbians, gay men, or transgender people … and are far less likely to say that being LGBT [is] an important part of their identity.” This analysis also indicates that the LGBT “community” may be more a strength-in-numbers advocacy position than a rock-solid reality. However, this conclusion also depends on the source of the data and analysis.

The above reports and presenters at a recent conference I attended on the “unique health and social needs” of LGBT older adults, also points out other realities:

  • The familial, social, financial and, by extrapolation, health status and access to health care of LGBT people currently portrayed in the popular media, does not reflect the reality of a large number of the LGBT older adults. Indeed, a significant percentage of LGBT older adults – who have dealt with career-related bias and discrimination all their lives – are struggling to make ends meet.

  • Urban, educated and financially well-off older members of the LGBT community may be able to depend on their families for the help, emotional support and care as they age. However, rural, less educated, and poor people often determine that they must go back into the closet in order to obtain the care they need.

  • While the 67-year-old wealthy and media-savvy Caitlyn Jenner is the transgender community’s current poster gal, her “reality” (and life-long access to top-tier health care) is not that of the majority of older transgender people. Nor that of younger ones either, according to this recent Human Rights Campaign report.

A common history

There is historical prejudice against today’s LGBT elders, according to a report from the LGBT Movement Advancement Project. “It has disrupted their lives, their connections to their families of origin, their propensity to have and raise their children, and their opportunities to earn a living and save for retirement.”

The report notes that the current generation of LGBT elders lived through a time when they were thought to have a psychiatric disorder (until revision of the Diagnostic and Statistical Manual in 1973); were considered criminals (until the last sodomy laws were struck down in 2003); and were deemed a security risk or moral threat by the U.S. military (until the “Don’t Ask, Don’t Tell” policy was repealed in 2010). Being LGBT still is considered anti-family and immoral by many religious groups.

This prejudice – a major social determinant of health  – has led to:

  • Significant health disparities: According to this study from the LGBT Aging Center, a large number of older LGBT people are dealing with chronic health conditions.

  • Distrust of health care providers: A Family Caregiver Alliance analysis finds that 20 percent of older LGBT individuals and 44 percent of older transgender people feel their patient-practitioner relationship is, or would be, adversely affected if providers know their sexual or gender orientation.

  • Perceived or real cultural insensitivity of the health care system: The lack of cultural competence – including bias, discrimination, and denial of services – experienced by many older LGBT adults (especially in rural areas), has been well documented in both the mainstream media and scholarly journals.

  • Significant mental health disparities: Research shows that the LGBT community, especially the community’s older members, are disproportionately affected by mental health issues. More than half of LGBT people surveyed said that a doctor told them that they have depression and 39 percent have seriously thought about suicide, according to SAGE USA.

  • Scarcity of knowledgeable medical care providers: The GLMA (formerly the Gay and Lesbian Medical Association) has been providing culturally and clinically appropriate care to and for the LGBT community since 1981. It also is a leader in advocacy efforts to address the bias and discrimination experienced by LGBT individuals. However, its members, their care practices (especially related to needs and care of transgender people) and advocacy efforts tend to be clustered in urban areas. Meanwhile, the need for the kind of care and services they specialized or sub-specialized in is national.

However, as more health care practitioners and service providers receive enhanced training, as HHS continues promoting and requiring cultural competency, and LGBT-advocacy organizations and mainstream health care organizations continue lobbying for health care equity, the number of culturally and clinically competent health care providers is projected to expand to better meet demand.

Scarcity of long-term caregivers

According to the National Gay and Lesbian Task Force Policy Institute, traditional caregivers – “blood-tie” relatives – too often are not available for long-term caregiving because “older LGBT people frequently are disconnected from their families of origin ...[so] are at high risk of finding themselves without care when they need it.” Instead, many LGBT older adults have developed social networks and “families of choice” – partners, friends, neighbors and others – who are caring for them as they age. While “family of choice” members can provide significant physical, emotional and financial support, unless proper legal documents exist, these caregivers lack the legal right to make health care decisions. Establishing these legal rights too often doesn’t happen due to the expense of fears of being “outed.”

Scarcity of data

Data collected on the health status and health care needs of the LBGT community has significantly increased knowledge about the community’s needs, the nature of the health disparities that LGBT people face across the age span, and understanding of the unique health and social issues older LGBT people do or will eventually face. Stronger advocacy and a friendlier policy climate have improved the situation.

The majority of the solutions to providing appropriate, culturally sensitive health care for LGBT elders are or will be “intersectional and definitional,” according to SAGE CEO Michael Adams, who gave the closing remarks at the conference. That means they will not just focus on cultural competency, access, policy and funding, but on building credibility and partnerships that increase resources and awareness, too.

Not only will this holistic approach directly or indirectly address the health care issues, barriers, and disparities that older LBGT adults now face, but will benefit the entire LGBT community.

Potential story ideas

  • How do the health care needs of LGBT older adults differ from non-LGBT older adults? Or do they?

  • A significant percentage of LGBT older adults are dealing with depression. What are the cultural and societal reasons for their depression?

  • How has your community (as opposed to just the health care community) acknowledged and dealt with the barriers to health care many older LGBT adults face?

  • Many low-income or other mission-driven clinics have been accepting and treating members of the LGBT community for decades. What are their experiences? Has their patient load increased, and how? Would they be willing to connect you with a patient to profile?

  • What are remedies and solutions to the LGBT community’s perceived and actual experiences of bias, discrimination and denial of access to health care?

  • What innovative partnerships exist in your community to provide better care to older LGBT residents?

  • Medicare lifted its long-standing ban on gender reassignment surgery in 2014. Has your community seen a rise in the number of older adults seeking gender reassignment surgery? Has Medicare’s decision to expand coverage to include gender reassignment surgery affected benefits offered by local insurers?

  • The LGBT community recently was designated as a “marginalized minority community.” Explain – in plain English – what that means to your readers for their health care.

  • How, and why, is it possible for LGBT older adults to be a multiply-marginalized minority?

  • Profile two people who are caring for an LGBT older adult – one a blood-line caregiver and the other a family-of-choice caregiver. What’s the same ­ and different – about their situations?



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Eileen Beal, M.A., has been a freelance writer and editorial consultant – primarily covering health care, aging and the overlap between the two – since the late 1990s. Before that, she was assistant editor at Cleveland Jewish News. She has written four health-related books and her articles have appeared in a print and online publications, including AARP's Bulletin, Aging Today, Today's Caregiver, ReportingonHealth.org, PBS's NextAvenue.com, HealthCallings.com and WebMD.com. In 2013, she was a New York Times Fellow in Aging; in 2012, she was a MetLife Fellow.