Long-Term Care Considerations for LGBT Adults (Part 1)

This article is designed to assist lesbian, gay, bisexual, and transgender (LGBT) individuals in understanding their unique needs and special considerations when planning for future care needs. The information should be seen as a supplement to the general information on long-term care. It takes into consideration additional laws, programs, and services that may impact LGBT individuals and couples and their planning process:

• Laws and regulations differ from state to state, and these should affect your decisions.
• Resources from Lambda Legal, an organization whose mission is to protect the civil rights of LGBT individuals, may be helpful. Find details on laws and policies in each state that protect LGBT individuals on their website at Link opens in a new windowhttps://www.lambdalegal.org.
• A page from Services and Advocacy for LGBT Elders (SAGE) on LGBT aging facts provides great information: Link opens in a new windowhttps://www.sageusa.org/your-rights-resources.
• Read the Aging with Pride: National Health, Aging, and Sexuality/Gender Study by the National LGBTQ Health and Longevity Center at Link opens in a new windowhttps://www.lgbtmap.org.

LGBT: Health Disparities Impacting Long-Term Care

Many LGBT individuals experience health disparities throughout their lives. While health issues in anyone's younger years may lead to the need for long-term care later in life, limited research shows that health disparities can have a major impact on some LGBT individuals, and this should be taken into account in planning for future long-term care needs. Below are categories of disparities and the current understanding of how they impact LGBT individuals.

Barriers to Health Care Access

LGBT adults are

• Less likely to have health insurance coverage
• More likely to delay or not seek medical care
• Facing barriers to access as older adults due to isolation and a lack of culturally competent providers (One study found that 13 percent of older LGBT adults were denied or provided inferior health care.¹)
• More likely to delay or not get needed prescription medications
• More likely to receive health care services in emergency rooms
• Less likely to receive screenings, diagnoses, and treatment for important medical problems (About 22 percent of LGBT older adults do not reveal sexual orientation to physicians.¹ In some states, health care providers can decline to treat or provide certain necessary treatments to individuals based on their sexual orientation or gender identity.²)
• Particularly distressed in nursing homes (One study indicates elderly LGBT adults face distress from potentially hostile staff and fellow residents, denial of visits from partners and family of choice, and refusal to allow same-sex partners to room together.³)

Negative Impact on Physical and Mental Health and Wellbeing

Societal biases are taking a toll on LGBT adults. They are

• Less likely to report having good health than their heterosexual counterparts
• More likely to have cancer
• More likely to suffer psychological distress
• More likely to require medication for emotional health issues

Other disparities affecting groups within the LGBT community include these:

• Lesbian and bisexual women are less likely to receive mammograms and are more likely to be overweight or obese.
• About 41 percent of LGBT adults age 50+ have a disability.⁴
• Transgender adults are much more likely to have suicide ideation.⁴

More Likely to Engage in Risky Behavior

• LGBT adults are more likely to have problems with alcoholism.
• Older lesbians are significantly more likely to engage in heavy drinking.
• LGBT adults are more likely to smoke cigarettes.
• Gay men are at higher risk of HIV and other STDs, especially among communities of color.

Research also indicates that if you live alone, you're more likely to need paid care and paid long-term assistance than if you're married or single and living with a partner. Planning is particularly important for such individuals.

LGBT Caregivers

Among LGBT elders, many singles and couples are estranged from their families of birth, normally the largest source of support when long-term care is needed. Many in the LGBT community are reliant on "families of choice" for their support. As defined by the National Resource Center on LGBT Aging, these are diverse family structures that

• Are usually created by LGBT people, immigrants, and racial or ethnic minorities
• Include, but are not limited to, life partners, close friends, and other loved ones not biologically related or legally recognized
• Are the source of social and caregiving support
• Provided a tremendous amount of support to gay men during the early years of the AIDS epidemic
• Tend to be from the same age cohort (For the aging LGBT population, this may mean that many in their families of choice are also in need of support and services and therefore may not be available to provide the level of support needed.)

A major question often faced by those needing long-term care is "Do you have family members who will provide care?" Whether you have a family of choice, family of origin, or both to assist you in the event you need long-term supports and services, plan ahead with your "family" now, and begin to talk with your loved ones to develop a plan of care.

References

1. Foglia, M.B., & Fredriksen-Goldsen, K.I. (2014, September). Health disparities among LGBT older adults and the role of nonconscious bias. Hastings Center Report, 44(s4), S40–S44. doi: 10.1002/hast.369
2. Hovey, J.E. (2009). Nursing wounds: Why LGBT elders need protection from discrimination and abuse based on sexual orientation and gender identity. The Elder Law Journal, 17, 95–123.
3. Movement Advancement Project Services (MAP) & SAGE. (2010). Improving the lives of LGBT older adults. Retrieved December 15, 2020 from https://www.lgbtmap.org
4. Services and Advocacy for LGBT Elders (SAGE). (2018). The facts on LGBT aging. Retrieved December 15, 2020 from https://www.sageusa.org