An LGBT-Inclusive Older Americans Act

The Older Americans Act (OAA) serves as the country’s leading vehicle for delivering services to older people nationwide, providing more than $2 billion annually in nutrition and social services. Since its enactment in 1965, the OAA has aimed to ensure that older people have the supports they need to age in good health and with broad community support. It places an emphasis on more vulnerable elders who face multiple barriers that can aggravate economic insecurity, social isolation, and various health challenges related to aging.

Yet strangely, despite ample evidence of their heightened vulnerability and their need for unique aging supports, lesbian, gay, bisexual and transgender (LGBT) older people are invisible in this landmark law. As the OAA comes up for reauthorization, and as millions of LGBT people enter retirement age, Congress should ensure that the OAA supports all elders, including those who require unique supports. LGBT older adults should be written into the framework of the Older Americans Act.

One obstacle facing all aging Americans is the risk of social isolation. The literature on social isolation—summarized in detail in Chronic Illness: Impact and Interventions (Jones and Bartlett Publishers, 2009)—generally reasons that as adults near retirement age, they may become isolated over time from their broader communities (places-of-worship, work settings, etc.), as well as from friends and family. This phenomenon means smaller and lower quality support networks, debilitating feelings of loneliness and depression (among other consequences), and at its worst, an estranged life where one’s physical and mental health deteriorates.

For LGBT older people, the risk of social isolation is even more pronounced. Improving the Lives of LGBT Older Adults, a report released in 2010 by SAGE and the Movement Advancement Project, cites various local-level studies that have shown how LGBT elders have smaller support networks, and are more likely to be single, without children, and estranged from their biological families, which typically serve as supports for older adults. A smaller support network can increase a person’s risk for exploitation, abuse and neglect. Further, researchers have found severe health concerns among LGBT older people, which can aggravate social isolation. A 2011 federally-funded health study of more than 2,500 LGBT elders—The Aging and Health Report: Disparities and Resilience among LGBT Older Adults, led by Dr. Karen Fredriksen-Goldsen—found significant disparities in areas including physical and mental distress, disability, victimization, and lack of access to supportive aging and health services. Moreover, the stigma and discrimination that many LGBT older people have experienced across the lifespan continues into their later years; many reside in settings where LGBT discrimination and bias are both routine and legal. Fearful of mistreatment from health care professionals and aging providers, many LGBT elders delay seeking care until their health deteriorates and crisis hits. These compounding effects of social isolation, poor health and well-being, stigma and discrimination create an oppressive, potentially degenerative loop that few LGBT elders can escape.

LGBT-inclusive aging services help offset these problems by providing spaces for LGBT elders to find community and support—but they are sparse and underfunded. A 2010 nationwide survey of 320 area and state units on aging found that less than 8 percent offered services targeted to LGBT older adults and only 12 percent reported outreach efforts to this population. Beyond that, it’s unclear how effectively LGBT elders are being served, since aging providers rarely track the extent to which their services reach LGBT older people. Similarly, the empirical research on LGBT elders remains meager and should be deepened—an overarching conclusion reached by the Institute of Medicine’s 2011 report, The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding.

The OAA has made great strides in supporting other minority elders. For example, the OAA’s definition of “greatest social need” accounts for elders who face additional barriers, including cultural, social or geographic isolation related to racial and ethnic status. And over the years, the Administration on Aging (AoA)—an agency established by the OAA—has helped translate this mandate by funding programs that benefit a range of minority elders, including specific communities of color. AoA has even recognized the unique needs of LGBT elders by funding, for the first time, the National Resource Center on LGBT Aging, which was seeded with a three-year grant in February 2010 by the U.S. Department of Health and Human Services. Yet the fact remains that while racial and ethnic status are codified in the OAA, sexual orientation and gender identity are not.

Congress can begin rectifying this problem through OAA reauthorization, which has modernized the OAA throughout the decades so that it remains responsive to ever-changing demographics, such as the growing presence of communities of color. First, the OAA should specify LGBT older adults as a vulnerable population with greatest economic and social need. Congress should also permanently establish funding for the National Resource Center on LGBT Aging to ensure cultural competence training for aging providers for generations to come. Finally, Congress should propose solutions in the OAA for improving data collection on LGBT elders among state and area agencies on aging, as well as fund research and grants for organizations working to improve LGBT health, long-term care needs, and access to culturally responsive services.

In April 2011, the Leadership Council of Aging Organizations approved these (and other) recommendations in its official consensus document for OAA reauthorization. In doing so, our country’s leading aging organizations affirmed that LGBT older people are deserving of explicit federal attention.

The Aging Network has spoken—and Congress should respond accordingly.

This op-ed originally appeared in the July issue of Aging Today, the newspaper of the American Society on Aging. Reprinted with permission from the American Society on Aging.

Robert Espinoza is the Senior Director for Public Policy and Communications at Services and Advocacy for GLBT Elders (SAGE). The opinions expressed in this article are those of the author and do not necessarily reflect those of the Diverse Elders Coalition.