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LGBTQ Elders Fear Being Shoved in Closet in Nursing Care Hunt

June 28, 2022, 9:25 AM

While caring for his aging mother, Donald M. Bell, a 72-year-old gay man, began thinking about where he would spend his twilight years.

“While mom and I were [in her long-term community], we were simply mother and son and I took care of her,” he said. “And even though we enjoyed the community and she passed away there, I quickly learned that it was just not an environment where being out about who I was was a feasible thing to do because you just didn’t know how people would react and we didn’t need the extra burden dealing with life issues anyway. So you could say it scarred me a little bit when I thought about my own situation because, listen, if you’re in what you perceive to be your final living situation, and it’s not a pleasant situation, then it gives you nothing to look forward to.”

As the generation of LGBTQ+ people forged by the AIDS epidemic and drastic cultural shifts of the 1980s and ‘90s enters its retirement years, demands that nursing homes take additional steps to ensure security and compassionate care increase. Over 60% of older LGBTQ+ adults surveyed expressed concerns about treatment in long-term care settings, such as independent or assisted living care facilities. Among their concerns are fears they could be refused or receive limited care, neglect, abuse, harassment, or be pressured to hide their identity.

A couple years before Bell’s mother died, he found Town Hall apartments, Chicago’s first LGBTQ-friendly affordable senior housing development, which he says changed his life.

“Living here has given me a center of safety and community and support and understanding that I wouldn’t have had if I continued to live in my old home environment,” Bell said. “What happens here is that we can go about our lives without having to edit or filter what we do or what we say, and that’s a tremendous bonus to any social situation that you live in.”

The Human Rights Campaign Foundation and SAGE, which advocates for LGBTQ+ elders, urged nursing homes and long-term care communities to develop and include non-discrimination protections specific to older LGBTQ+ residents through the 2021 Long-Term Care Equality Index (LEI). Less than 30% of long-term care communities have policies in place to prevent discrimination against residents based on their orientation or identity, according to Tari Hanneman, director of the Human Rights Campaign’s health and aging program.

Expanding Protections

President Joe Biden boosted those efforts with a recent executive order, calling on the Department of Health and Human Services to develop guidance on preventing discrimination in long-term care facilities. There are regulations that nursing homes funded by Medicare must comply with, but Biden’s order is the first to explicitly include older LGBTQ+ people.

“It’s not to say that there aren’t significant rights in the regulations and that there aren’t protections because there are, but based on the president’s announcement, there will be guides that specifically speaks to those populations and that’s just a really positive step,” said Eric Carlson, directing attorney at Justice In Aging.

For example, Marie King, a 79-year-old transgender woman, in October was allegedly denied a room by Sunrise Assisted Living in Maine because of her identity. She and the facility reached a settlement June 13 at the Maine Human Rights Commission. Adult Family Care Homes of Maine, which runs Sunrise Assisted Living and eight other communities, agreed to follow a transgender non-discrimination policy as a result.

Combating bias will take more than an executive order, said Carey Candrian, an associate professor of Internal Medicine at the University of Colorado School of Medicine and LGBTQ elderly care expert.

“There has to be some connection between these larger overarching policies and protections and then the actual training of staff and of leadership, so the protections go all the way down. It’s nice for staff to have a non-discrimination policy, but if you still have so many residents who are fearful of being bullied or harassed or abused at this critical time in their life and unless these communities do the work to become more inclusive, the protections are really not going to do much.”

Benefits of Training

Long-term communities are already seeing the benefits of creating more inclusive environments, embracing the tenets of person-centered care with the help of SAGECare’s training and certification.

“We wanted to be more informed and we wanted to be better able to speak to and serve the population who’s not only here now but are coming,” said Andy Eick, the executive director of Brookdale’s Battery Park City independent living community. The community is one of nearly 640 SAGECare credentialed organizations, according to the group’s site.

“It’s been a wonderful add to us and our certificate is in the lobby,” Eick said. “People do appreciate the fact that we have the certificate visible. Four families have moved here since our certification and still live here, and I am in no doubt that they would tell you that they have a wonderful quality of life here at the community.”

As part of the settlement with King in Maine, all employees and administrators at Adult Family Care Homes of Maine will attend SAGECare training and post a transgender nondiscrimination statement on the company’s website.

The goal of efforts like the Long-Term Care Equality Index is to combat stigma and help residential care providers better serve their clients.

“The LGBTQ older adults, they’re the ones that fought for our rights in the beginning. So, for them to have to feel like they might have to go back in the closet is really, really sad and that’s why we’re doing this work,” Hanneman said.

Training, education, and policy have to work in tandem, so that other LGBTQ seniors can experience what Bell says he has.

“I really benefit from being in the place that I am, and it’s given me the opportunity for community outreach effort, culturally confirming learning experiences for institutions and agencies and housing developments and all so that there there’s an expansion of safe places where LGBTQ+ elders can be. That’s not something we can build our way out of,” he said.

“I really truly want that for others like me, because we deserve to feel safe.”

To contact the reporter on this story: Ayanna Alexander in Washington at aalexander@bloomberglaw.com

To contact the editors responsible for this story: Andrew Childers at achilders@bloomberglaw.com; Karl Hardy at khardy@bloomberglaw.com