A Source of Pride: What APS Should Know About LGBT Older Adults

by Kendra Kuehn, National Adult Protective Services Association

In recognition of World Elder Abuse Awareness Day (WEAAD) and Pride Month we are highlighting the unique history and needs of older adults who identify as LGBT (lesbian, gay, bisexual, and/or transgender). Building this understanding can help APS programs and workers fully serve their community. To start, elder justice expert Mary Twomey recommends considering key historical events to recognize what your client may have experienced and the impact they have on their life experience.

• If you were 21 in 1953 when President Eisenhower made homosexuality a reason to be fired from your job, you are 88 today when the Supreme Court ruled to protect LGBT workers nationwide.
• If you were 21 in 1969 when the police raided the Stonewall Inn, you are 72 today.
• If you were 21 in 1978 when Harvey Milk was assassinated, you are 62 today.

The Basics

Just as understanding the historical events is important, underlying statistics can help APS recognize the unique needs of clients identifying as LGBT. It is estimated that 2.4 million people over age 65 identify as LGBT which will only grow with the increasing older adult population. Research estimates that one in three LGBT people identify as having a disability. These statistics are likely an undercount due to continuing stigma. According to AARP’s national survey, “Maintaining Dignity: Understanding and Responding to the Challenges Facing Older LGBT Americans,” LGBT older adults are more likely than their non-LGBT peers to be single and live alone. Gay men are also less connected to a support network than lesbian women. Transgender individuals are the least likely to say they had strong supports. Researchers at The Williams Institute found that LGBT identifying older adults have higher rates of mental health problems, disability, and disease. They suggest that these impacts are likely due to a lifetime of discrimination and related stress including discrimination in healthcare. According to the National Center for Transgender Equality, transgender older adults face even higher disparities including 62% of transgender older adults reporting a disability compared to 47% of all LGBT survey respondents. A client may be facing challenges from current, systemic, and historical ageism, ableism, racism, as well as stigma against people who are LGBT.

Abuse of LGBT Older Adults

While national data on LGBT older adults is an issue that needs greater attention, smaller studies indicate high rates of victimization. According to the National Center on Elder Abuse (NCEA), one study of lesbian, gay, or bisexual adults over age 60 found that 65% had been victimized due to their sexual orientation. Reports included verbal abuse, threats of violence, physical assault, sexual assault, and discrimination. twenty-nine percent had been physically attacked. A second study cited by NCEA found that 42% of transgender people of all ages have experienced some form of physical violence or abuse and 80% have experienced verbal abuse or harassment. Although there is little research specific to transgender older adults, it is reasonable to assume older adults are victimized at similar if not greater rates.

While LGBT adults face the same types of abuse as non-LGBT adults this population may face unique consequences of or variations on maltreatment. Even among LGBT adults generational differences may impact reactions and views. According to the National Resource Center on LGBT Aging, FORGE: Transgender Action Network, and NCEA some concerns unique to the LGBT population are:

• Threats to “out” the adult. Adults who identify as LGBT may not be open with everyone they know for a variety of reasons including fear of rejection and discrimination. Grandparents may fear that their access to their grandchildren will be cut off. An abuser may threaten to “out” or tell others the adult’s sexual orientation and/or gender identity without their consent if they do not comply with the abuser.
• Claiming that authorities won’t believe the adult. The abuser may tell the adult that they won’t be believed, will have to come out to report, and/or will face prejudice. This is especially challenging for older adults who have faced a lifetime of discrimination.
• Controlling finances and/or assets. Limited legal protections and supports for LGBT families can make it easy for an abusive LGBT partner to control finances and assets. The abused partner may depend on the abuser financially and the legal discrimination may prevent them from leaving or seeking help without becoming destitute.
• Fear of “being alone.” Ageism combined with greater social isolation among LGBT older adults can lead to staying with an abuser.
• “Internalized” homophobia, biphobia, or transphobia. LBGT adults, particularly older adults, have continually heard that being LGBT is not normal, a sin, or not appropriate. If they have internalized and believe these views, they are more likely to put up with abuse because it fits with the belief. Older adults who have previously been abused, particularly as children, are also likely to see the abuse as normal and expected.
• Self-reliance and fear of authorities. Given historical and current discrimination, LGBT older adults have likely developed a heightened self-reliance and fear of authorities as a survival tactic. This difficulty seeking help may lead to self-neglect for those who are no longer able to physically and/or mentally care for themselves.
• Body privacy. Lambda Legal notes that transgender older adults face particular challenges with care such as denial of transitional hormones or surgery, discrimination if their body does not match their gender, abuse by facility roommates, or abusive treatment by healthcare providers.

What APS Should Know

According to Aaron Tax, Director of Advocacy for SAGE: Advocacy & Services for LGBT Elders, APS should know that “too often LGBT older people feel invisible and feel they cannot be open about themselves. In addition, they fear accessing mainstream services and supports. As a result, LGBT older people often feel uncomfortable or don’t feel welcome reaching out to authorities.”

APS should be a place that all adults feel comfortable reaching out to for help. The National Resource Center on LGBT Aging provides several guides including one on creating an inclusive agency and one on collecting data on sexual orientation and gender identity.

Consider the following recommendations…

• Respect the LGBT adult. The APS value of self-determination also means respecting and using the adult’s preferred pronouns, name, and decisions on being “out.”
• Recognize lived experience. The thought exercise at the beginning of this article can help you recognize a few of the major events and societal views the adult, particularly older adults, have lived through. They might fear telling their full story or be reluctant to accept services. Make sure you know of LGBT friendly services in your area and common legal issues specifically impacting LGBT older adults.
• Realize that everyone’s story is different. Everyone is at a different stage of coming out. Some LGBT adults come out later in life and recognize the impact this may have had on family or other supports. It is also important that APS staff understand that an older adult may have had to “go back in the closet” possibly from discrimination in a long-term care facility or by a caregiver.
• Use inclusive language and images. Make sure your intake and other forms allow for gender identity beyond Male and Female. Check that your public facing materials include LGBT resources. Your intake, assessments, forms, and other resources should be inclusive.
• Partner with LGBT friendly organizations and leaders in your state or community. The National Resource Center on LGBT Aging provides a resource map as a starting point. Ensure that you know what services they provide and that LGBT organizations know who APS is and how to report.
• Educate yourself and your colleagues. The National Resource Center on LGBT Aging and FORGE Transgender Aging Network are good places to start.

Share with us! Tell us what resources you use, what you want to know, or share your thoughts on a peer to peer call.

"All people, regardless of sexual orientation or identity, deserve a safe and supportive environment in which to achieve their full potential." – Harvey Milk

Note: I have chosen to use LGBT for this article as recommended in the APA Style Guide. Check out OutRight Action International’s “Acronyms Explained” to understand the variety of terms and acronyms you may see.