Two online databases in particular may help older LGBTQ clients find senior living that is welcoming and safe.
SAGE, which stands for “Services and Advocacy for GLBT Elders,” offers tools to help LGBTQ seniors find the best medical care and facilities that have staff trained on better serving them, says Tim R. Johnston, a SAGE care trainer. The nonprofit, which bills itself as the oldest and largest organization helping to improve the lives of LGBTQ adults, offers a list of certified healthcare providers and the Long Term Care Equality Index, which identifies residential long-term care and senior housing.
Johnston, author of “Welcoming LGBT Residents, A Practical Guide for Senior Living Staff” shared these and many other insights during a presentation for healthcare workers serving LGBTQ seniors at a June 7 forum at Providence Fairfax in Fairfax, Va. Providence, AARP Virginia and Insight Memory Care Center sponsored the event.
Many advisors most likely have at least some LGBTQ clients, and some specialize in serving them. There are about 7 million LGBTQ seniors in the U.S., Johnston said. SAGE, which has done a lot of work with the Financial Planning Association, has found through its research that “LGBTQ seniors are more likely to be isolated and financially insecure and need services that are supportive,” Johnston said.
“Re-closeting” happens to some LGBTQ seniors after moving
Johnston suggests that seniors looking for facilities ask the following questions (which become even more important when communicating with places not listed in the databases): Do you work with LGBTQ clients? Did the staff complete training to work with LGBTQ seniors? (Some states, like New York, require healthcare providers to complete training to better care for LGBTQ seniors.) Also, ask to see their internal policies regarding discrimination and how to file grievances.
Like other measures taken to plan for retirement and beyond, Johnston said the best way for LGBTQ seniors to plan for a move to a senior community or facility is to do it in advance so they have time to research, vet and visit places to find the best one for them. He said there have been seniors who move to a place where they do not feel comfortable being who they are so they “re-closet,” once again living their lives without telling people they are gay, bisexual or transgender.
“Re-closeting sometimes happens, usually when someone moves quickly, like when there’s an emergency and they have to go to the hospital and then move quickly into a rehab or skilled nursing facility,” he said.
He advised the healthcare workers that if they suspect that patients do not feel safe being their authentic selves, the workers may want to gently ask them questions about their lives that might help them feel safe opening up about their sexual identity.
Equality Act needed to prevent sexual orientation discrimination
Johnston said that the Older Americans Act helps ensure that seniors get needed services. However, he added, what’s really needed now is for the Equality Act to pass which would create a federal policy that would make it illegal to discriminate against people based on sexual orientation and gender identity. It would also substantially expand the areas to which those discrimination protections apply, he said. In Feb. 2021, the House of Representatives passed the Act, but it has not been made into law.
Johnston said that LGBTQ seniors are at a financial disadvantage because while laws now provide them more legal protection, the laws are so new that LGBTQ people now in their later years have not have those protections most of their lives, and missed out on benefits of those laws.
LGBTQ seniors should plan in advance for power of attorney
Another important area for advance planning is determining who should be given “power of attorney.” It’s important that LGBTQ seniors choose a trusted relative who accepts them and will make the decisions they want “to access medical care or gender-affirming care” if that’s what’s desired, Johnston said.
It’s also important for seniors to voice their concerns either on their own or with the support of advocacy organizations, Johnston said.
“Organizations serving seniors respond to customers,” he said. “Seniors should make their opinions heard to healthcare providers, financial planners or any businesses they deal with.” There are businesses that have figured out that serving seniors well is a good business decision, he added.
But concerns and complaints should come from the seniors themselves.
“To put a finer point on it,” Johnston said, “I can say something all day and it’s viewed as, ‘Well, you’re an advocate. Of course you’re going to say that.’ But if consumers say it, that will be more important than my opinion.”
Healthcare workers should use patients’ preferred terms
Johnston’s book, a training manual published in 2019 for professionals working with LGBTQ seniors, is based on the most recent research and includes stories and testimonials from LGBTQ older adults and their providers.
When asked why the title of his latest book has no “Q” (which stands for “queer” or “questioning”) after “LGBT,” Johnston said that when he was writing his book a few years ago, he felt that a lot of people in the LGBT community did not like the word “queer.” “I think that if I was republishing the book today, I would change the title and add the Q,” he said.
However, during the webinar, he advised participants to not use the word “queer” with their patients and clients “unless you hear people use it in an affirming way.” He said it’s important for healthcare workers to use the terms preferred by the patients as part of “a person-centered model.”
“A person-centered model makes sure that as advocates we are only ever acting at the resident’s request, and helping them achieve their goals,” Johnston explained later in an interview. “It is a way of making sure we always focus on what the resident wants, and do not end up doing what we as advocates think is best, which may not be what the resident wants for themselves.
“I always check in with the residents first to learn what their concerns are and how they want to proceed,” said Johnston. “Empowerment means first giving the older person the skills to advocate for themselves, and only doing something for them if they tell you clearly and directly that they want you to act on their behalf.”
“Gay friendly” does not necessarily mean “trans friendly”
He said healthcare or any other staff should be mindful of the current backlash against those who are transgender, gender nonbinary, and gender nonconforming. (Transgender means you identify differently from the sex assigned to you at birth.)
During the presentation, a listener stated that some in the gay community are not accepting of people who are transgender. Johnston agreed that’s true.
When asked in the interview following the presentation why that is, Johnston said,
“I do not know the cause. There could be many reasons. But ‘gay friendly’ (in senior living settings) does not automatically mean a friendly environment for transgender or gender diverse folks. I think it is always a good idea to dig a little deeper and ask specifically about policies and training about gender identity and inclusion for transgender people.”
Johnston, based in State College, PA, is also the author of “Affirmation, Care Ethics, and LGBT Identity,” published in 2016.
For more information about how financial planners can provide welcoming environments and become advocates for the LGBTQ community, read articles by Laura J. Latourette, CFP, and Bridger Cummings in the Journal of Financial Planning.
For more information about the unique challenges facing members of the LGBTQ community as they age and additional resources for them, visit this SAGE document.